At the moment, metformin remains the first choice in treatment algorithms for type 2 diabetes

if you don't have a contraindication that I will address.

Now someday that may change as newer medications are tested against metformin monotherapy for

things like cardiovascular outcomes and other measures and we'll see if metformin

still ends up the king of the first choice options in type 2 diabetics over the next years but whether

or not it is the first choice it likely will remain a very important oral medication for a long time in treating type 2 diabetes.

As I start tackling medication therapy in type 2 diabetes, I want to acknowledge some inconvenient

truths. Many people are motivated to change and that is a joy to see. They have a desire to

lose weight, not only so they can post about it, but

they have genuine motivation that they have found. There are also many type 2 diabetic patients

that either won't change or can't change, meaning some of them are in such a quagmire

that they may be so obese and unhealthy with heart disease, restrictive lung disease,

and arthritis, that asking them to change is always a good idea, but in reality doesn't occur

very much.

I've had patients who can barely walk on their arthritic knee, but they are too sick to safely

get a knee replacement.

We see patients that don't even refer to their

knee anymore in terms of right and left, but refer to it as the good knee or the bad knee.

And some of our diabetic patients we meet after they've actually had amputations, sometimes

of one extremity or both extremities, which obviously further restricts their exercise

ability. There are exercises you can do, but they do have restrictions and safety issues that

they need to deal with. And then there are patients that potentially could change, but they tell

...