Metformin: Arguments for Maintaining its Position as First-Line Pharmacological Treatment in Type 2 Diabetes Mellitus

A 62-year-old female was referred to her primary care physician for newly diagnosed Type 2 diabetes mellitus (T2DM). She was overweight (BMI: 29.1 kg/m2) and had well-controlled hypertension and dyslipidaemia. She stopped smoking 5 months previously, after she had suffered a myocardial infarction. Her history was otherwise unremarkable. Glycated haemoglobin was 8.4% (68 mmol/mol); her estimated glomerular filtration rate was normal and there was no albuminuria. She was moderately physically active and tried to adhere to a healthy diet. She was not motivated to enter a weight-loss programme at this point. Her physician considered pharmacological treatment of her diabetes, especially as intensification of lifestyle changes in this patient would be difficult. How should this patient be advised?