A 54-year-old man is evaluated at a follow-up visit after being diagnosed with type 2 diabetes mellitus 3 months ago. His initial hemoglobin A1c level was 8.5%. He opted for lifestyle modifications initially and has lost 4.5 kg (10 lb) after making significant changes to his diet and increasing his activity level. His average blood glucose level currently is 180 mg/dL (10 mmol/L). Medical history is otherwise unremarkable.

On physical examination:
- Blood pressure: 130/74 mm Hg
- Pulse: 70/min
- BMI: 27

The examination is otherwise unremarkable. His repeat hemoglobin A1c level today is 7.9%, but he would like it to be lower. Results of other laboratory studies are within normal ranges.

Which of the following is the most appropriate management?
A. Continue current management
B. Initiate empagliflozin
C. Initiate liraglutide
D. Initiate metformin

The most appropriate management for the 54-year-old man with type 2 diabetes mellitus is initiating metformin. Metformin is a first-line medication for the management of type 2 diabetes. It works by reducing the production of glucose by the liver and improving the body's response to insulin. Studies have shown that metformin can help lower A1c levels and improve glycemic control. The patient's A1c level of 7.9% indicates that his diabetes is not well controlled, and initiating metformin can help to further reduce his A1c.

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