MEDizzy - A 54-year-old woman is diagnosed with type 2 diabetes

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A 54-year-old woman is diagnosed with type 2 diabetes mellitus after a routine follow-up for impaired fasting glucose showed that her hemoglobin A1C is now 7.6%. She has attempted to lose weight and exercise with no improvement in her hemoglobin A1C, and drug therapy is now recommended. She has mild systemic hypertension that is well controlled and no other medical conditions. Which of the following is the most appropriate frst-line therapy?

ExplanationFirst-line oral therapy for patients with T2DM is metformin. It is contraindicated in patients with a glomerular fltration rate <60 mL/min, any form of acidosis, congestive heart failure, liver disease, or severe hypoxemia, but is well tolerated in most individuals. Insulin secretagogues, biguanides, α-glucosidase inhibitors, thiazolidinediones, GLP- 1 agonists, dipeptidyl peptidase-4 (DPP-IV) inhibitors, and insulin have all been approved as monotherapy for T2DM. Because of extensive clinical experience, favorable side efect profle, and relatively low cost, metformin is the recommended frst-line agent. It has additional benefts of promotion of mild weight loss, lower insulin levels, and mild improvements in lipid profle. Sulfonylureas such as glyburide, GLP-1 agonists such as exenatide, and insulin DPP-IV inhibitors such as sitagliptin may be appropriate as combination therapy but are not considered frst-line therapy for most patients.