Abstract
In contrast to current approaches to Type 2 diabetes (T2DM), the management of Type 1 diabetes (T1DM) continues to be glucocentric. This is understandable considering the substantial lifetime risk of potentially devastating microvascular complications associated with the disease. Consequently, advances in the management of T1DM have largely focused on enhanced insulin preparations, technologies for insulin delivery and blood glucose monitoring. However, despite the use of these therapeutic approaches, only 21% of adults (and fewer children) reach glycemic targets associated with a lower risk of microvascular complications and life expectancy in patients with T1DM is 12 years shorter than that of the general population. Cardiovascular and kidney disease, together with hypoglycemia, are the major causes of mortality in patients with T1DM.
Significant morbidity and mortality are associated with T1DM, but also with its treatment. The adverse effects of insulin, causing hypoglycemia (which is often a key barrier to achieving glycemic targets) and body weight gain are well known to clinicians. Insufficient attention has been paid to the burden of diabetes self-management and the negative impact of the disease and its treatment on patients’ quality of life.
Should practitioners consider a broader perspective on T1DM management with the objective of reducing microvascular and macrovascular risk, while simultaneously reducing the burden of T1DM and the adverse effects of therapy? Could using non-insulin antihyperglycemic agents (NIAHAs) as adjuncts to insulin assist practitioners in achieving this objective? The potential utility of NIAHAs in the management of T1DM is discussed in this paper.