There’s really no best drug for type 2 diabetes

Dear Dr. Roach: What is the best medication for type 2 diabetes?

— PH

Dear PH: If I ask the students or residents I teach to answer that question, I warn them it’s a trick. The best medicine is nothing.

In most cases, type 2 diabetes can be prevented and treated with a lifestyle that includes regular, moderate exercise and a diet that is primarily plant-based and avoids excess sugar. Unfortunately, many people don’t follow that advice (and our society makes it harder to do so).

It’s true that some people can develop type 2 diabetes despite living a very healthy lifestyle. Type 2 diabetes is actually not just one diagnosis, but several metabolic issues that lead to this final endpoint. The best drug depends on the underlying problem, which is not always found.