For de “no”

Abstract

For the management of type 1 diabetes (T1DM), the use of non-insulin medications (NIMs) has been proposed to improve glycemic control and other metabolic parameters. However, there are sound arguments for maintaining insulin-dependent therapies.

• Limited Efficacy of NIMs: Studies show that NIMs provide minor improvements in glucose control with an average HbA1c reduction of only 0.2–0.5%
• Increased Risk of Hypoglycemia and Side Effects: The use of NIMs as add-on to insulin therapies has been shown to increase the risk of suffering hypoglycemia and side effects, which may further complicate the management of T1DM.
• Insufficient Evidence for Long-Term Benefits: Current studies on the addition of NIMs are of short duration and with few participants, resulting in insufficient and clinically insignificant evidence to support its widespread use.
• Complications Associated with New Therapies: Medications such as SGLT2 inhibitors, while promising, are associated with significant risks such as euglycemic diabetic ketoacidosis, raising serious safety concerns.
• Individualized Strategies and Close Monitoring: When considering the use of adjunctive therapies, careful assessments of patient-specific characteristics and close monitoring should be carried out in order to adjust insulin doses and minimize risks.

In conclusión, insulin therapy remains the cornerstone in the management of type 1 diabetes. NIMs have not demonstrated sufficient efficacy nor an adequate safety profile to justify their generalized use as adjunctive therapy for these patients. Continued intensive and personalized insulin management is recommended to achieve glycemic targets and minimize complications.