Metformin

Metformin is a useful first-line treatment for diabetes and would be particularly appropriate in this overweight patient as it was the only treatment in UKPDS that was weight neutral over long-term therapy and was at least as effective as sulphonylureas in reducing long-term microvascular and macrovascular complications of diabetes. In fact high-dose metformin treatment has been shown to aid weight loss in obese patients. It is contraindicated in significant hepatic, renal or cardiac failure and the dose should be increased slowly to minimise the risk of GI disturbance which are a common side effect and reason for inability to tolerate this treatment. UKPDS showed that treatment of hypertension is at least as important as glycaemic control in prevention of micro- and macrovascular complications of type II diabetes. Having been confirmed on two occasions by his GP it should be aggressively treated. Most hypertensive diabetics will require more than one anti-hypertensive agent to control their blood pressure.