Type 2 Diabetes Mellitus — UKMLA MCQ

Instant feedback + full explanation. One question, done properly.

EasyEndocrinology & DiabetesType 2 Diabetes MellitusUKMLA

A 52-year-old patient with type 2 diabetes mellitus has an HbA1c of 8.5% (69 mmol/mol) despite lifestyle changes. According to NICE, which is the recommended first-line pharmacological agent?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Metformin

Metformin is the correct answer. In an adult with type 2 diabetes whose HbA1c remains above target despite lifestyle measures, NICE recommends metformin as the first-line pharmacological treatment component, provided it is not contraindicated or not tolerated. Current NICE NG28 specifies modified-release metformin as part of initial glucose-lowering therapy, with additional agents selected according to comorbidities and risk. Sulfonylureas, pioglitazone, GLP-1 receptor agonists and insulin are not the routine first-line single-agent choice in this uncomplicated scenario.

Reference: NICE Guideline NG28: Type 2 diabetes in adults: management, last updated 2026. https://www.nice.org.uk/guidance/ng28/chapter/initial-medicines