Strongly consider starting a second-line agent with metformin at diagnosis if the patient's HbA1c > 8%, as most of these will not reach an HbA1c target <7% with metformin alone.

People newly diagnosed with type 2 diabetes and HbA1c >8%

Start a second-line glucose-lowering agent together with metformin at diagnosis

Metformin alone

Achievement of HbA1c target <7%