Patient: Disease: Type 2 diabetes One hospital Dr. An suggested metformin exercise plus diet control, take two months to review can be reversed; another hospital Dr. Jie said Bystolic need to take lifelong medication until the blood sugar control is not chat to him. Both of them are professors whose advice should I listen to is it possible to reverse my condition? Previous treatment and results: No treatment. Hope to provide help: endocrinology department’s help me to analyze listen to that professor. Doctor: First take metformin 0.25 3 times/day, if there are no obvious side effects, increase to 0.5 3 times/day after 3-5 days, monitor blood sugar. If there is obvious gastrointestinal discomfort, such as abdominal pain, diarrhea, and a significant increase in the number of bowel movements affecting life, change to Bystolic 1-2 tablets, chewed with 3 meals and the first bite. If the blood glucose control is not satisfactory after 3 months, you can add one of Anritzer or Januvia afterwards. If you are significantly obese or have hyperlipidemia at the same time, I would agree with the two professors above and combine the two drugs at the same time, preferring the first option. Discuss your situation together: I. Medical history taking: You are required to add your height, weight, and whether your family (including parents, and the elderly on both sides) has a history of diabetes, hypertension, hyperlipidemia, etc. Whether you are taking other medications, including health care drugs, as some may also have glucocorticoids, such as certain ginseng, deer antler, etc. The date of the test results. To verify: glycated hemoglobin has two? Glucose tolerance blood glucose is 7.8 mmol/L., the big biochemical blood glucose is 6.4 mmol/L, the difference between the two is relatively large, is the time difference? There is eating after dinner, poor sleep will affect fasting blood sugar. Of course if we find elevated blood glucose, change the previous unhealthy lifestyle on blood glucose control will also help. Second, the diagnosis: type 2 diabetes. (The official version of the Chinese guidelines for the prevention and treatment of type 2 diabetes (2013 version) can be downloaded online for study if you are interested.) If your general condition is very good, even without very obvious symptoms, you have a fasting 7.8 of glucose tolerance test, and 16.88 mmol/L at 2 h. If you exclude other more serious diseases such as severe infections and pancreatitis that cause stressful conditions, your diagnosis of diabetes diagnosis should be relatively clear. Contacting your insulin release test and C-peptide secretion test supports a type 2 diabetes mellitus. Is it correct that you provided two glycosylated hemoglobins (6.7 and 15.3)? Even if we refer to the 6.7% result, it supports the diagnosis of diabetes mellitus. Your insulin release test and C-peptide secretion test suggest a delayed insulin wave, not a delayed called function. A delayed insulin wave indicates insulin resistance, suggesting a relatively early stage of impaired islet function. Third, treatment: Before we talk about treatment, let’s see what the goal of our treatment is, that is, what we want to achieve by means of treatment (the official version of the Chinese guidelines for the prevention and treatment of type 2 diabetes (2013 version), if interested, you can download and study online): as you can see, we require not only blood glucose attainment, but a variety of indicators. This is the reason why I asked what to focus on your weight, lipids and other indicators. This includes paying attention to the appropriate indicators when you review them later, at a time that your primary care physician will tell you. Let’s look at the treatment again: the pathway diagram is as follows: this paragraph of questions, diagrams is about type 2 diabetes medication recommendations, metformin is more suitable for you, such as gastrointestinal reactions are obvious (abdominal pain, diarrhea) can be replaced by Bystolic. Anritzer and Januvia are the same class of drugs with similar mechanisms of action. Regarding whether to combine with one of the aforementioned Metformin or Bystolic, it is not yet recommended in China, refer to the 2015+ADA+Diabetes Diagnostic and Treatment Standards+Chinese Edition. Therefore I suggest you: first take metformin 0.25 3 times/day, if there are no significant side effects, increase to 0.5 3 times/day after 3-5 days and monitor blood glucose. If there is obvious gastrointestinal discomfort, such as abdominal pain, diarrhea, and a significant increase in the number of bowel movements affecting your life, you can change to Bystolic 1-2 tablets, chewed at 3 meals and the first bite. If the blood glucose control is not satisfactory after 3 months, you can add one of Anritzer or Genovieve afterwards. Meanwhile, I suggest you: besides blood sugar, other related indexes should also be paid attention to.