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Type 2 diabetes initial management — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareType 2 diabetes initial managementUSMLE Step 3

A 49-year-old man is seen after an employer health screen showed fasting glucose of 168 mg/dL. Repeat A1c is 7.8%. He has no catabolic symptoms. BMI is 34 kg/m2, creatinine is normal, and urine albumin-creatinine ratio is normal. He prefers to avoid injections. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Start metformin and structured lifestyle intervention

New uncomplicated type 2 diabetes is generally treated with lifestyle measures and metformin if tolerated, with individualized escalation.

Reference: American Diabetes Association Standards of Care in Diabetes—2026: https://professional.diabetes.org/standards-of-care