According to the AACE/ACE glycemic control algorithm, what is a recommended initial therapy for a patient with an A1C level of 8.7%?

The recommended initial therapy for a patient with an A1C level of 8.7% according to the AACE/ACE glycemic control algorithm emphasizes the importance of a multifactorial approach to manage diabetes effectively. Dual therapy with metformin and a GLP-1 receptor agonist is particularly appropriate in this scenario because it addresses the need for improved glycemic control while also considering the patient's potential weight management goals and cardiovascular health.

Metformin is typically the first-line medication due to its established efficacy, safety profile, and additional benefits such as weight neutrality and potential weight loss. A GLP-1 receptor agonist complements this by further enhancing glycemic control through mechanisms such as increasing insulin secretion in response to meals, reducing glucagon release, delaying gastric emptying, and promoting satiety. This combination is particularly beneficial for patients who present with significant hyperglycemia, as indicated by the A1C level above the recommended target.

Using dual therapy at this level of A1C helps to achieve glucose targets more effectively than monotherapy and can lead to better long-term management of diabetes. This strategy is consistent with guidelines that recommend initiating more aggressive treatment for higher A1C levels—especially when lifestyle modifications alone are unlikely to provide sufficient glycemic control