A 50-year-old woman is 5 ft 7 in tall and weighs 185 lb. There is a family history of diabetes mellitus. Fasting blood glucose (FBG) is 160 mg/dL and 155 mg/dL on two occasions. HgA1c is 7.9%. You educate the patient on medical nutrition therapy. She returns for reevaluation in 8 weeks. She states she has followed diet and exercise recommendations, but her FBG remains between 140 and 150 and HgA1C is 7.7%. She is asymptomatic, and physical examination shows no abnormalities. Which of the following is the treatment of choice?
A 50-year-old woman is 5 ft 7 in tall and weighs 185 lb. There is a family history of diabetes mellitus. Fasting blood glucose (FBG) is 160 mg/dL and 155 mg/dL on two occasions. HgA1c is 7.9%. You educate the patient on medical nutrition therapy. She returns for reevaluation in 8 weeks. She states she has followed diet and exercise recommendations, but her FBG remains between 140 and 150 and HgA1C is 7.7%. She is asymptomatic, and physical examination shows no abnormalities. Which of the following is the treatment of choice?
💡 Explanation
## **Core Concept**
The patient presents with elevated fasting blood glucose (FBG) and HbA1c levels, indicating poor glycemic control. She has a family history of diabetes mellitus and is currently asymptomatic. The core concept here revolves around the management of type 2 diabetes mellitus, focusing on lifestyle modifications and pharmacological interventions.
## **Why the Correct Answer is Right**
The patient has been diagnosed with type 2 diabetes mellitus based on her elevated FBG and HbA1c levels. After 8 weeks of medical nutrition therapy (MNT) and exercise, her glycemic control remains suboptimal. According to current guidelines, such as those from the American Diabetes Association (ADA), the initial pharmacological treatment for type 2 diabetes often involves **metformin**, especially in the absence of contraindications. Metformin works by decreasing hepatic glucose production and increasing insulin sensitivity. It is considered a first-line agent due to its efficacy, safety profile, and potential benefits on cardiovascular outcomes.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, other antidiabetic drugs like sulfonylureas, thiazolidinediones, DPP-4 inhibitors, or GLP-1 receptor agonists might be considered. However, without specific details on why they are incorrect, we focus on the rationale for metformin as the first line.
- **Option B:** This option is also not provided, but generally, insulin therapy or other classes of medications might be considered if metformin is contraindicated or not tolerated.
- **Option C:** Similarly, without specifics, the emphasis remains on why metformin stands out as a preferred initial pharmacotherapy.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that **metformin** is recommended as the first-line pharmacological agent for the treatment of type 2 diabetes mellitus, provided there are no contraindications (e.g., renal impairment, liver disease). It has a long-standing history of use, is relatively inexpensive, and has a favorable effect on body weight.
## **Correct Answer:** .
✓ Correct Answer: D. Metformin
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