An obese NIDDM patient present with FBS=180 mg% and PPBS=260 mg% Management include-a) Glibenclamideb) Diet therapy+exercisec) Diet therapy+exercise + Metformin d) Chlorpropamide

**Core Concept**
Management of type 2 diabetes mellitus (T2DM) involves lifestyle modifications and pharmacotherapy. The primary goal is to achieve glycemic control, prevent complications, and minimize side effects. In obese patients with T2DM, initiating lifestyle changes and pharmacotherapy with metformin is a recommended approach.

**Why the Correct Answer is Right**
Metformin is a first-line oral antidiabetic medication for the treatment of T2DM. It works by decreasing hepatic glucose production, increasing insulin sensitivity, and enhancing glucose uptake in muscles. In obese patients, metformin is particularly beneficial as it helps with weight loss and improves insulin resistance. Additionally, metformin has a lower risk of hypoglycemia compared to sulfonylureas.

**Why Each Wrong Option is Incorrect**
**Option A:** Glibenclamide is a sulfonylurea that stimulates insulin release from the pancreas. While effective in lowering blood glucose, it may cause weight gain and has a higher risk of hypoglycemia, making it a less ideal choice for obese patients.

**Option B:** Diet therapy and exercise are essential components of T2DM management, but using them alone may not be sufficient to achieve optimal glycemic control, especially in obese patients. Adding metformin to lifestyle modifications enhances the therapeutic effect.

**Option D:** Chlorpropamide is another sulfonylurea with a higher risk of hypoglycemia and weight gain, making it a less suitable option for obese patients with T2DM.

**Clinical Pearl / High-Yield Fact**
Metformin is the most commonly prescribed oral antidiabetic medication for T2DM due to its efficacy, safety profile, and potential for weight loss. It is essential to initiate lifestyle modifications and pharmacotherapy with metformin in obese patients with T2DM to achieve optimal glycemic control and minimize the risk of complications.

**Correct Answer:** C. Diet therapy+exercise + Metformin.