When managing a patient with a fasting plasma glucose level of 210 mg/dL, which medication is considered most appropriate?

In managing a patient with a fasting plasma glucose level of 210 mg/dL, metformin is the most appropriate medication to initiate treatment, especially for individuals with type 2 diabetes. Metformin is considered first-line therapy due to its efficacy in lowering blood glucose levels, its capability to promote weight loss, and its low risk of causing hypoglycemia compared to other agents.

Metformin works primarily by decreasing hepatic glucose production and enhancing insulin sensitivity in muscle and fat tissues. This multifaceted approach makes it effective for reducing both fasting and postprandial blood glucose levels. It is also associated with cardiovascular benefits and has a favorable safety profile, making it an ideal first choice for individuals, particularly those who are overweight or obese.

In contrast, insulin is typically reserved for cases where blood glucose levels are significantly elevated, or when the need for prompt control is crucial, such as in acute settings or when patients cannot take oral medications. Sitagliptin, a DPP-4 inhibitor, and glipizide, a sulfonylurea, are other options in diabetes management but are generally not the first-line treatments indicated for patients starting on therapy. Sitagliptin may be added later if glycemic control remains inadequate, while glipiz