Certified Diabetes Care and Education Specialist (CDCES) Practice Exam

What is the most appropriate first-line drug therapy for a newly diagnosed 45-year-old female with type 2 diabetes and an A1C of 8.8%?

1. Exenatide

2. Saxagliptin

3. Acarbose

4. Metformin

The correct answer is: Metformin

Metformin is recognized as the first-line drug therapy for individuals newly diagnosed with type 2 diabetes, especially in this case with an A1C level of 8.8%. This recommendation is grounded in its robust track record of efficacy, safety, tolerability, and potential benefits beyond glycemic control, including weight neutrality or modest weight loss and cardiovascular protection. In patients with type 2 diabetes, metformin helps to lower blood glucose levels primarily by decreasing hepatic glucose production, increasing insulin sensitivity in peripheral tissues, and enhancing glucose uptake. Moreover, it has a low risk of causing hypoglycemia when used alone, making it a suitable first choice for managing diabetes in the general population. Other medications listed, such as exenatide, saxagliptin, and acarbose, while useful in specific contexts, are generally reserved for either second-line therapy or situations where additional glucose-lowering effects are needed, in conjunction with lifestyle changes or metformin. Each of these alternatives has different mechanisms of action or targets, and some may have a higher potential for side effects or specific patient contraindications that make them less ideal as initial therapies.