Patient profile: Male, 54 years old, BMI 32 kg/m2.

Presentation: The patient had newly diagnosed Type 2 diabetes with HbA1c at 7.8%. He also had hypertension, with blood pressure averaging 142/88 mmHg, and dyslipidaemia, with triglycerides at 2.1 mmol/L. There was also a family history of premature coronary disease.

Assessment: The assessment included metabolic blood tests, fasting insulin, HOMA-IR, lipid profile, liver function, urine albumin-creatinine ratio and screening for sleep apnoea and depression. Diet, activity, sleep and alcohol intake were also reviewed.

Clinical picture: This was early Type 2 diabetes driven by insulin resistance and broader metabolic syndrome. The patient was considered suitable for intensive lifestyle intervention with possible early pharmacological support.

Support plan: The patient was supported to consider metformin 500 mg twice daily with his primary care or endocrine team. Nutrition focused on a low-glycaemic, plant-forward Mediterranean ketogenic-style approach, reducing carbohydrates to around 100 to 130 g per day, increasing fibre to at least 30 g daily, and creating a calorie deficit to support 7 to 10% weight loss over 6 months. Exercise included 150 to 300 minutes per week of moderate aerobic work and 2 to 3 resistance sessions weekly. HIIT was added if appropriate. Supplements included berberine 500 mg three times daily, alpha-lipoic acid 300 to 600 mg daily, vitamin D if low, and chromium picolinate 200 to 400 mcg daily where indicated. Diabetes self-management education, motivational interviewing and CGM support were also considered.

Outcome at 6 months: HbA1c reduced from 7.8% to 6.3%. Fasting insulin and HOMA-IR improved significantly. Weight reduced by 9%, bringing BMI down to 29.2. Triglycerides reduced from 2.1 mmol/L to 1.4 mmol/L, and blood pressure improved from 142/88 mmHg to 128/78 mmHg. The patient also reported better energy and strong adherence to the plan.

Key point: Early, intensive lifestyle support can produce major metabolic improvement and may reduce the need for more intensive treatment later.