Establishing an appropriate nutrition plan requires time and effort and is best accomplished with assistance from a registered dietitian-nutri- tionist or a diabetes education program. 2. Initiation of an exercise program for those with T2DM has been shown to improve glycemic control, with a prior meta-analysis showing a significant reduction in mean HbA1c (7.65% ver- sus 8.31%) in individuals assigned to an exercise program versus control groups.S4.2-22 The com- bination of aerobic and resistance training fur- ther improves glycemic control and facilitates weight loss more than either type of exercise Prospective cohort studies have pro- vided supportive data for the benefits of physical activity in individuals with T2DM, with increased levels of physical activity associated with lower rates of CVD events and CVD death.S4.2-17 How to best promote physical activity in indi- viduals with T2DM remains unclear. For older indi- viduals with other comorbidities, a simple walking program may be ideal, whereas for younger, healthier individuals, a variety of activities should be encouraged. In addition to a structured exer- cise program, a general increase in physical activity throughout the day (eg, taking the stairs, walking or biking to work, avoiding prolonged periods of sitting) should be encouraged. 3. Metformin decreases hepatic glucose produc- tion and increases peripheral insulin sensitivity, Figure 2. Treatment of T2DM for primary prevention of cardiovascular disease. type 2 diabetes mellitus. CLINICAL STATEMENTS AND GUIDELINES leading to a reduction in hyperglycemia in adults with T2DM. 