Q: I was just diagnosed with type 2 diabetes based on a high fasting blood sugar. Do I need to start medication right away? If so, which medication is best?
A: Diet and exercise are the ideal treatments for type 2 diabetes. However, even when lifestyle changes are successful at first, most of us don't stay with them. The lost weight has a way of finding its way back home, to our middles.
American Diabetes Association's guidelines acknowledged this reality. Lifestyle changes to lose weight and get more active are step one in its guidelines. But the association also said that people just diagnosed with type 2 diabetes should start taking metformin right away.
The American College of Physicians (ACP) just published its own guidelines for treatment of people with newly diagnosed type 2 diabetes. The ACP says doctors should give people a chance to lower blood sugar with lifestyle changes first. For some people, losing as few as 10 pounds, combined with 30 minutes of exercise daily, can bring blood sugar levels back into the normal, healthy range.
If blood sugar doesn't get into the normal range after a few months, then the ACP agrees that metformin is the best drug treatment.
Metformin lowers blood sugar, in part, by decreasing the liver's production of sugar (glucose). Metformin also makes insulin more effective in moving sugar out of the bloodstream and into cells. When this process doesn't work well, it's called insulin resistance. Cells don't let sugar in, so sugar has nowhere to go. Levels in the blood start to climb. Insulin resistance is one of the main features of type 2 diabetes.
So you have a choice: Try lifestyle changes only for a few months, or start metformin right away, combined with diet and exercise.
When making the choice, be realistic. Will you really stick with a strict diet and exercise program over the long haul?
If you doubt it, then start the metformin now.
If you think you can do it, there's nothing wrong -- and a lot right -- with first trying a weight-loss program and exercise. You can start metformin later if needed.
(Howard LeWine, M.D., is a practicing internist at Brigham and Women's Hospital, Boston, Mass., and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)
(For additional consumer health information, please visit http://www.health.harvard.edu.)