A 48-year-old female presents with profound polyuria, polydipsia, weight loss, and recurrent candidal vulvovaginitis. Fasting plasma glucose is 8.6 mmol/L (155 mg/dL) and HbA1c is 9.2%. According to the American Diabetes Association and UAE National Guidelines, what is the initial first-line pharmacological monotherapy, assuming normal renal function (eGFR > 60 mL/min)?

Answer and explanation

Correct answer: B. Metformin

  1. Step 1: Metformin (a biguanide) remains the established foundation first-line pharmacological monotherapy for type 2 diabetes mellitus due to high glucose-lowering efficacy, weight neutrality, low hypoglycemia risk, cardiovascular safety, and low cost.
  2. Step 2: Consequently, the correct clinical answer is Metformin.
Answer
Metformin.
Why not the others: 'Glimepiride' is a sulfonylurea associated with significant hypoglycemia and weight gain, reserved as add-on therapy; 'Empagliflozin' is an SGLT2 inhibitor recommended as add-on or in patients with established ASCVD/HF/CKD, but metformin remains initial core therapy; 'Pioglitazone' is a thiazolidinedione associated with fluid retention, heart failure exacerbation, and bone fractures.

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