Based on the current ADA guidelines, the right agent for monotherapy for the patient since she is hesitant to start on insulin is Metformin. Metformin is the generic name and is sold under the trade name Glucophage. Metformin is recommended as per the ADA guidelines as the first-line medication for managing 2 diabetes (Steinberg & Carlson, 2019). The patient will be started on Metformin 500mg, which is to be taken twice a day orally. The medication will be taken 30 minutes before the meals. Noting that the diabetic patient is obese, pre-hypertensive, and lab tests show total cholesterol is 260 mg/dL, with triglycerides at 290 mg/dL, HDL at 49 mg/dL, and LDL at 170 mg/dL, Metformin taken 30 minutes before meals is expected to manage both TC and cholesterol levels as has it has been noted to improve postprandial triglycerides and LDL-Cholesterol levels by 8%, and lower plasma glucose by 7.5% compared to if taken during meals (Methnani et al., 2023).
Metformin is contraindicated for renal impairment, leading to high serum creatine levels due to abnormal creatine clearance, congestive heart failure, especially in elderly patients, and acute or chronic metabolic acidosis (Adriana Stoica et al., 2020). Metformin is also contraindicated for reactions and conditions that increase the risk of heart failure, heart attack, and respiratory failure.
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