Diabetes mellitus: lifestyle modification, oral antidiabetic drugs and their side effects

1. Big picture

In type 2 diabetes mellitus, the core problem is usually:

insulin resistance + progressive β-cell dysfunction → fasting and postprandial hyperglycemia

So treatment logically starts with:

Lifestyle modification → metformin or early combination therapy → add drugs according to cardiovascular, renal, weight, hypoglycemia, and cost profile → insulin if severe insulin deficiency or catabolic symptoms.

For the state exam, the classic answer is:

diet + physical activity + weight reduction + metformin first, then add other oral/non-insulin antidiabetic drugs if the glycemic target is not reached.

Modern guidelines increasingly individualize therapy early according to atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, obesity, and hypoglycemia risk; SGLT2 inhibitors and GLP-1-based therapies are prioritized in selected cardiorenal-risk patients. ([Diabetes Journals][1])

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