The patient’s fasting blood glucose level is slightly elevated. Therefore, lifestyle modifications are attempted first, such as diet and activity modifications with a 5% weight loss goal. If this is unsuccessful, a biguanide will likely be considered. Oral hypoglycemics such as biguanides (metformin) are the initial pharmacological choice rather than insulin unless HbA1c is highly elevated. Increased water intake and decreased sodium intake is a lifestyle modification for hypertension, not diabetes.