On physical exam, his height is 68" and weight 214 lb (body mass index [BMI] 31). His blood pressure (BP) is 154/90. The remainder of his exam is notable only for abdominal obesity and a decreased right pedal pulse. He stopped smoking 10 years ago and has 1 glass of wine with dinner several nights per week. He takes an occasional over-the-counter antacid for heartburn and a non-sedating antihistamine for springtime allergies.

John’s family history is positive for Type 2 diabetes in both parents. Father had a heart attack at age 61 with subsequent coronary artery bypass graft surgery. Mother has osteoporosis; his children are both alive and well.

On further discussion, John believes that his weight gain is related to the change in his living situation. In the past, his wife cooked most of their meals and tried to "make them nutritious." His daughters frequently invite him for dinner, but he typically declines so as "not to be a burden." They are worried about his health and whether "he is taking care of himself."

Labs: After an 8-hour fast, fasting blood sugar (FBS) = 142 mg/dL on initial evaluation and 139 mg/dL on reevaluation, indicating Type 2 diabetes. High-density lipoproteins (HDL): 36; Low-density lipoproteins (LDL): 147; TG: 130 mg/dL.

Which of the following is the most important goal of therapy for John?

1. Lifestyle modification
2. Control of blood pressure
3. Lipid management
4. Glucose control
5. All of the above