Highlights of this approach are: intervention at the time of diagnosis with metformin (monotherapy with metformin as the initial pharmacologic therapy for most patients with type 2 diabetes) in combination with lifestyle changes (MNT and exercise), and continuing timely augmentation of therapy with additional agents (including early initiation of insulin therapy) as a means of achieving and maintaining recommended levels of glycemic control (Fasting plasma glucose or preprandial: 70 - 130mg / dl, 2 hours posprandial: <180mg / dl and A1C <7% for most patients/3 months).