(Answer is C) We will continue with the treatment of this patient next week.

All approved oral agents lower HbA1c to some extent. Although there is no one ideal agent, the ADA Consensus Statement on the Approach to Management of Hyperglycemia^[1] recommends the use of metformin in combination with lifestyle changes at the time of diagnosis. Metformin improves glycemic control by inhibiting gluconeogenesis and increasing insulin-stimulated glucose uptake. Gastrointestinal side effects include loose stools and diarrhea. No hypoglycemia or weight gain is typically noted when metformin is used as monotherapy.

1. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009;32(1):193-203.