Metformin, when used as monotherapy in type 2 diabetes, is unlikely to cause hypoglycemia.

• A. True; it does not cause hypoglycemia when used alone.
• B. True; it causes hypoglycemia in most patients.
• C. False; it increases hepatic glucose production.
• D. False; it directly increases insulin secretion.

Answer: (A)

The key idea is that metformin lowers blood glucose without increasing insulin secretion, so as a single therapy it is unlikely to cause hypoglycemia. Metformin acts mainly by reducing hepatic gluconeogenesis and by improving insulin sensitivity in muscle, with a small effect on intestinal glucose absorption. Because it doesn’t raise insulin levels or enhance insulin action beyond what’s needed, blood glucose stays balanced and hypoglycemia is uncommon when used alone.

The other statements conflict with how metformin works: it does not increase hepatic glucose production, and it does not directly boost insulin secretion. Hypoglycemia can occur if metformin is combined with other glucose-lowering drugs (like sulfonylureas or insulin) or in certain situations such as severe renal impairment, but on its own it’s unlikely to cause hypoglycemia.