Which oral antidiabetic agent is considered the cornerstone of monotherapy for newly diagnosed diabetes?

Metformin is recognized as the cornerstone of monotherapy for newly diagnosed type 2 diabetes due to its unique mechanism of action and favorable safety profile. It primarily works by decreasing hepatic glucose production, enhancing insulin sensitivity in peripheral tissues, and improving glucose uptake. This helps reduce blood sugar levels effectively.

In addition to its glucose-lowering effects, metformin is associated with weight neutrality or even modest weight loss, which is advantageous for many patients, especially those who may be overweight or obese. Furthermore, it has a low risk of causing hypoglycemia compared to other oral antidiabetic agents because it does not stimulate insulin secretion directly.

Metformin also has potential cardiovascular benefits, making it a suitable choice for individuals who may have concomitant cardiovascular risks. The drug's long-standing presence in clinical practice has led to extensive data supporting its effectiveness and safety, reinforcing its status as the first-line treatment recommended by guidelines for the management of newly diagnosed type 2 diabetes. Consequently, its use is well established and widely endorsed, particularly in scenarios where lifestyle modifications alone are insufficient to achieve glycemic control.