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 accordin