A 52-year-old man with newly diagnosed type 2 diabetes, BMI 33 kg/m², HbA1c 58 mmol/mol, normal renal function, and a preference for a medication that supports weight loss. Select the most appropriate antidiabetic medication.

• A. Glipizide
• B. Pioglitazone
• C. Metformin
• D. Acarbose

Answer: (C)

Metformin is the best fit here because it improves glycemic control while supporting weight loss in an overweight patient with type 2 diabetes. It lowers hepatic glucose production and improves insulin sensitivity, giving a meaningful HbA1c reduction without causing hypoglycemia when used alone. It’s weight-friendly (often neutral or modestly weight-reducing), inexpensive, and safe in people with normal renal function. In contrast, the other options tend to promote weight gain or have less favorable safety considerations for someone who is obese: a sulfonylurea increases insulin release and can cause hypoglycemia and weight gain; a thiazolidinedione also causes weight gain and has edema and other risks; acarbose has limited efficacy and mainly gastrointestinal side effects. So metformin best aligns with the goals of reducing glucose while aiding weight loss.