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Management of an Adult With Type 2 Diabetes With Antidiabetic Medications: A Case Scenario

Slide: 10 of 26

Treatment Decision

In addition to lifestyle interventions, what is the best choice for the first antidiabetic drug in this patient’s treatment?

Discussion of Answers:

A. Incorrect. Explanation: There is low strength of evidence that nateglinide and alpha-glucosidase inhibitors are less efficacious in reducing HbA1c (~0.5-1% absolute difference) compared with other oral diabetes medications.

B. Incorrect. Explanation: There is moderate strength of evidence that metformin lowers HbA1c 0.5% better than dipeptidyl peptidase-4 inhibitors.

C. Incorrect. Explanation: According to the ADA/EASD consensus statement and algorithm for the treatment of Type 2 diabetes, lifestyle modifications and metformin would be recommended for this patient.

D. Correct. Explanation: This patient has no contraindications to the use of metformin, which may also may have a more favorable effect on his weight, an essential component of his treatment goals.  This is also the recommendation of the ADA/EASD consensus statement.