The epidemic of type 2 diabetes mellitus has been met by evolving strategy and clinical tactics, including the generally-accepted recommendation to initiate drug therapy concurrent with therapeutic lifestyle changes. Barring contraindications, metformin should be the first drug treatment prescribed, based on considerations of cost, efficacy, and safety. When metformin monotherapy fails to produce the goal for glycemic control, add-on therapy can include a sulfonylurea, a sodium-glucose transporter type 2 inhibitor, an alpha-glucosidase inhibitor, or a thiazolidinedione. New niche therapies include colesevelam and bromocriptine mesylate. Consideration should be given to the effect of the drug therapy on cardiovascular disease.
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