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Should I start taking medicine right after a diagnosis of diabetes?

Dr. Jack Merendino, MD
Endocrinology Diabetes & Metabolism
This is a tricky question, and the answer is going to vary from one person to another depending on the situation. The first thing you should know is that several major professional organizations who set guidelines for diabetes treatment, including the American Diabetes Association and the European Association for the Study of Diabetes, say that people should be started on a particular diabetes medication, metformin, right from the time of diagnosis, unless they have a reason that they should not take this medication, such as kidney problems or an allergy to the drug. In actual practice, this is done quite often. But sometimes a doctor will encourage a patient to make lifestyle changes first, and then start the drug if lifestyle changes alone are not effective.
I think there are several common-sense guidelines you can follow in answering this question. If you already eat healthfully, exercise and have a normal body weight, or if you are already doing everything you can to live a healthy lifestyle, there is not much point in waiting to start medication. If you have repeatedly been counseled to make those changes but have not, it is probably appropriate to start medication unless there is reason to believe this time will be different. If you have very high blood sugars, let us say with an A1c of more than eight or fingerstick glucoses that are often more than 200, lifestyle changes alone are probably not going to make enough difference, and medicine should be started.
On the other hand, if the glucose elevations are only modest, perhaps with an A1c in the high sixes or low sevens, and there is good reason to think the person will make significant lifestyle changes, I often will give him or her the chance to turn things around without medication. Here is an important thing to remember, though: Starting any medication does not make you dependent on it. Even if you start medicine and are successful in making needed lifestyle changes, there is a good possibility you can reduce or stop the medication, so you do not lose any ground by going on the medication right away.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.