Initial Management of Glycemia in Type 2 Diabetes Mellitus

An asymptomatic 45-year-old Hispanic man has a fasting plasma glucose level of 142 mg per deciliter (7.9 mmol per liter) on initial evaluation and 139 mg per deciliter (7.7 mmol per liter) on reevaluation. Other than a steady gain in weight since college and borderline hypertension, his medical history is unremarkable. He is 175 cm (5 ft 9 in.) tall and weighs 95 kg (209 lb; body-mass index, 31.2), and his blood pressure is 138/88 mm Hg. Physical examination is notable only for abdominal obesity and absent ankle reflexes. How should this patient be treated?