In patients with non-insulin-dependent diabetes mellitus the first step in treatment is to regulate diet, aiming to reduce any overweight patients to their ideal weight, and in all patients to control the intake of carbohydrates and calories.1 When diet fails to prevent hyperglycaemia, an oral hypoglycaemic drug is necessary. Many specialists would probably start with a sulphonylurea, although for the obese patient there may be an advantage in using the biguanide metformin because it suppresses appetite.
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