Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes – A2

ANSWER — Correct.

Lifestyle change to achieve weight loss, including medical nutrition therapy and exercise, is a cost-effective component of the treatment of type 2 diabetes at the time of diagnosis and subsequently. Health care professionals (including clinicians, nurses, and registered dietitians) should promote this approach. However, in most instances, lifestyle interventions alone do not achieve or maintain weight loss and metabolic targets.

Metformin should usually be prescribed concurrently with lifestyle intervention in the treatment of the patient with newly diagnosed type 2 diabetes [1]. (See "Initial management of hyperglycemia in adults with type 2 diabetes mellitus".)

Metformin is the agent of choice because it reduces glycated hemoglobin (A1C) values by approximately 1.5 percent, facilitates the achievement of mild weight loss, has a low incidence of gastrointestinal side effects when given with meals, and is inexpensive when generic formulations are prescribed. This agent should be given with meals, started at low doses (eg, 500 mg by mouth once or twice daily), and then increased as tolerated to a full dose of 2000 to 2500 mg a day in divided doses with meals. Metformin acts by decreasing hepatic glucose output. (See "Metformin in the treatment of adults with type 2 diabetes mellitus".)

In this patient, the A1C value decreased to 7.1 percent at three months, to 7.0 percent at six months, and to 6.9 percent at one year after the initiation of lifestyle change and metformin.

Return to the beginning to explore the other pharmacologic choices offered in this case. (See "Interactive diabetes case 17: A 47-year-old patient with newly discovered type 2 diabetes".)