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Diabetes Mellitus Type 2

Discussion

Choice of Initial Therapy

This depends upon the severity of symptoms and associated clinical factors.

If the patient is asymptomatic, a trial of just a meal plan and increased activity is appropriate. With a negative caloric balance, glucose levels come down before any change in weight is seen. In a very obese person, metformin may be useful because it is the only antidiabetic medication that does not cause weight gain.

In a symptomatic patient, relative insulin deficiency predominates and either a sulfonylurea or insulin should be used. Metformin can be added. Initial therapy with metformin or a thiazolidinedione alone can take several weeks to develop a full effect.