Seven simple steps.
Metformin should be started for pre-diabetics with fasting glucose greater than 95..
Liraglutide (Victoza) injection should be second drug for obese diabetic type 2. The new oral semaglutide will be good for those who don't want to take injections if it works and is tolerable)
Canagliflozin (Invokana) should then be added for further glucose control for type 2 Diabetes.
Hopefully during this period the patient has been on LCHF (low carbohydrate high) or some form of Atkins diet or South Beach Diet.
Check that carbohydrates are low enough to cause nutritional ketosis with urine strips or blood sticks.
To lose more weight and then maintain weight loss a patient will eventually need to be on either Qysemia, Contrave or Belviq for the rest of their lives.
Good news is people only need to walk 20 to 30 minutes a day or achieve 5,000 to 10,000 steps a day. Exercise is for health not weight loss.
Drink decaf coffee in morning so that afternoon hunger can be treated with a strong cup of regular coffee.
Insulin and Bariatric surgery should be reserved for those who fail the above and have morbid obesity
Update on my weight maintenance 7-14-19 link