Mehlman High Yield Risk Factors Practice Test

The key idea is that severe hyperglycemia in type 2 diabetes is most effectively addressed first with a glucose-lowering medication, because improving glycemic control reduces long-term complications and overall morbidity. Starting metformin is the best choice here because it directly lowers hepatic glucose production and improves insulin sensitivity, which lowers HbA1c and reduces microvascular complications (retinopathy, nephropathy, neuropathy) and even mortality in overweight patients. The patient’s blood pressure is normal and there’s no proteinuria, so ACE inhibitors for kidney protection aren’t currently a priority. Although statins and aspirin have cardiovascular benefits, the immediate and strongest impact on reducing morbidity in this scenario comes from correcting the marked hyperglycemia with metformin.