Estrategia terapéutica en el paciente diabético (II). Tratamiento farmacológico del paciente con diabetes mellitus tipo 2. Criterios de selección y evidencia actual de los fármacos antidiabéticos no insulínicos

The management of type 2 diabetes mellitus is complex and requires a multifaceted approach that combines nonpharmacological interventions with pharmacological treatments. Non-insulin antidiabetics (NIA) have evolved considerably, progressing from traditional agents such as biguanides and sulfonylureas to newer ones such as SGLT-2 inhibitors and GLP-1 agonists and from a glucocentric approach to management based on comorbidities. Metformin continues to be the first-line treatment due to its efficacy and safety profile. However, the variety of NIAs allows for personalizing treatment according to each patient's specific needs, considering factors such as the presence of comorbidities, cardiovascular risk, and patient preference. This document reviews the different pharmacological groups of NIAs and their mechanisms of action, efficacy, and side effects. It also addresses the selection criteria for these drugs, emphasizing the importance of an informed decision based on the most recent evidence and individual patient characteristics, in addition to updated evidence on these pharmacological groups.