What class of medications is generally the first line of treatment for type 2 diabetes?

Biguanides, particularly metformin, are recognized as the first line of treatment for type 2 diabetes due to their effectiveness and long-established safety profile. Metformin works primarily by decreasing hepatic glucose production and improving insulin sensitivity in peripheral tissues, which helps to lower blood glucose levels. It has been shown to not only manage blood sugar levels but also to have additional benefits such as weight neutrality or even modest weight loss, making it suitable for many patients who may be overweight.

When initiating therapy for type 2 diabetes, this class of medication is generally preferred because it does not cause weight gain and has a lower risk of hypoglycemia compared to other oral medications. Additionally, metformin has demonstrated cardiovascular benefits in patients with diabetes, which is particularly important considering the increased risk of heart disease in this population.

Other classes of medications, while effective, are usually considered after metformin due to factors such as cost, side effect profiles, and the overall treatment goals for managing type 2 diabetes.