A 55-year-old man with known type 2 diabetes presents with a fasting plasma glucose of 220 mg/dL and HbA1c of 10.2%. He has no symptoms of hyperglycaemia and no cardiovascular disease. According to ADA 2024 guidelines, what is the preferred initial therapy combination?
- A Metformin plus a GLP-1 receptor agonist with proven CV benefit ✓
- B Metformin monotherapy for 3 months then reassess
- C Sulfonylurea plus metformin
- D Basal insulin plus metformin
Correct answer: A. Metformin plus a GLP-1 receptor agonist with proven CV benefit
Explanation
ADA 2024 Standards of Care recommend that patients with HbA1c 1.5–2% above target at diagnosis be considered for combination therapy from the outset. With HbA1c of 10.2% (target typically ≤7%), dual therapy is appropriate. GLP-1 receptor agonists (e.g., semaglutide, liraglutide) have proven cardiovascular benefit in SUSTAIN-6 and LEADER trials and are preferred combination agents in patients with or at high risk for ASCVD. Metformin monotherapy alone would be insufficient given the degree of hyperglycaemia.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.