The chapter on pharmacologic management of Type 2 Diabetes provides guidelines for the initial and subsequent use of antihyperglycemic agents. Key messages include: - If glycemic targets are not met within 2 to 3 months of lifestyle management, antihyperglycemic pharmacotherapy should be initiated. - Timely adjustments and additions of antihyperglycemic agents should be made to achieve target A1C levels within 3 to 6 months. - For patients with severe hyperglycemia (A1C ≥8.5%), antihyperglycemic agents should be initiated concurrently with lifestyle management, and combination therapy may be considered, including insulin. - Metformin is the preferred initial agent due to its effectiveness, mild side effects, long-term safety, and lack of hypoglycemia risk and weight gain. The chapter emphasizes the importance of individualized treatment regimens, considering factors such as degree of hyperglycemia, risk of hypoglycemia, effectiveness in reducing complications, weight impact, and patient preferences. Lifestyle modifications, including nutrition therapy and physical activity, should be continued alongside pharmacotherapy. The chapter also discusses the use of various classes of antihyperglycemic agents, their mechanisms of action, and their relative efficacy and safety profiles. Additionally, it addresses the management of hypoglycemia, the use of insulin, and the importance of tailoring insulin regimens to achieve good metabolic control while minimizing hypoglycemia.The chapter on pharmacologic management of Type 2 Diabetes provides guidelines for the initial and subsequent use of antihyperglycemic agents. Key messages include: - If glycemic targets are not met within 2 to 3 months of lifestyle management, antihyperglycemic pharmacotherapy should be initiated. - Timely adjustments and additions of antihyperglycemic agents should be made to achieve target A1C levels within 3 to 6 months. - For patients with severe hyperglycemia (A1C ≥8.5%), antihyperglycemic agents should be initiated concurrently with lifestyle management, and combination therapy may be considered, including insulin. - Metformin is the preferred initial agent due to its effectiveness, mild side effects, long-term safety, and lack of hypoglycemia risk and weight gain. The chapter emphasizes the importance of individualized treatment regimens, considering factors such as degree of hyperglycemia, risk of hypoglycemia, effectiveness in reducing complications, weight impact, and patient preferences. Lifestyle modifications, including nutrition therapy and physical activity, should be continued alongside pharmacotherapy. The chapter also discusses the use of various classes of antihyperglycemic agents, their mechanisms of action, and their relative efficacy and safety profiles. Additionally, it addresses the management of hypoglycemia, the use of insulin, and the importance of tailoring insulin regimens to achieve good metabolic control while minimizing hypoglycemia.