Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.21/11824 |
Resumo: | Background: In the current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for the treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence was determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5–7.5%. When HbA1c is 7.5–9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30–60 mL/min/1.73 m2 or eGFR 30–90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM. |
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Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitusDiabetesDiabetes treatmentType 2 diabetesCardiovascular riskGuidelinesHeart failureChronic kidney diseaseIschemic heart diseaseASCVDAtherosclerotic diseasePortugalBrasilBackground: In the current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for the treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence was determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5–7.5%. When HbA1c is 7.5–9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30–60 mL/min/1.73 m2 or eGFR 30–90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.BMCRCIPLBertoluci, Marcello CasacciaSalles, João EduardoSilva-Nunes, JoséPedrosa, Hermelinda CordeiroMoreira, Rodrigo OliveiraDuarte, Rui ManuelCarvalho, Davide MauricioTrujilho, Fábio RogérioRaposo, João FilipeParente, Erika BezerraValente, FernandoMoura, Fábio Ferreira deHohl, AlexandreMelo, MiguelAraujo, Francisco GarciaPrincipe, Rosa MariaKupfer, RosaneCosta e Forti, AdrianaValerio, Cynthia MelissaFerreira, Hélder JoséDuarte, João ManuelSaraiva, José FranciscoRodacki, MelanieCastelo, Maria HelaneMonteiro, Mariana PereiraBranco, Patrícia QuadrosMatos, Pedro ManuelMagalhães, Pedro CarneiroBetti, Roberto TadeuRéa, Rosângela RoginskiTrujilho, Thaisa DouradoPinto, Lana CataniLeitão, Cristiane Bauermann2020-06-11T18:50:52Z2020-052020-05-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.21/11824engBertoluci MC, Salles JE, Silva-Nunes J, Pedrosa HC, Moreira RO, Duarte RM, et al. Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus. Diabetol Metab Syndr. 2020;12:45.10.1186/s13098-020-00551-1info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-08-03T10:03:33Zoai:repositorio.ipl.pt:10400.21/11824Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:20:00.076695Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
title |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
spellingShingle |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus Bertoluci, Marcello Casaccia Diabetes Diabetes treatment Type 2 diabetes Cardiovascular risk Guidelines Heart failure Chronic kidney disease Ischemic heart disease ASCVD Atherosclerotic disease Portugal Brasil |
title_short |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
title_full |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
title_fullStr |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
title_full_unstemmed |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
title_sort |
Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus |
author |
Bertoluci, Marcello Casaccia |
author_facet |
Bertoluci, Marcello Casaccia Salles, João Eduardo Silva-Nunes, José Pedrosa, Hermelinda Cordeiro Moreira, Rodrigo Oliveira Duarte, Rui Manuel Carvalho, Davide Mauricio Trujilho, Fábio Rogério Raposo, João Filipe Parente, Erika Bezerra Valente, Fernando Moura, Fábio Ferreira de Hohl, Alexandre Melo, Miguel Araujo, Francisco Garcia Principe, Rosa Maria Kupfer, Rosane Costa e Forti, Adriana Valerio, Cynthia Melissa Ferreira, Hélder José Duarte, João Manuel Saraiva, José Francisco Rodacki, Melanie Castelo, Maria Helane Monteiro, Mariana Pereira Branco, Patrícia Quadros Matos, Pedro Manuel Magalhães, Pedro Carneiro Betti, Roberto Tadeu Réa, Rosângela Roginski Trujilho, Thaisa Dourado Pinto, Lana Catani Leitão, Cristiane Bauermann |
author_role |
author |
author2 |
Salles, João Eduardo Silva-Nunes, José Pedrosa, Hermelinda Cordeiro Moreira, Rodrigo Oliveira Duarte, Rui Manuel Carvalho, Davide Mauricio Trujilho, Fábio Rogério Raposo, João Filipe Parente, Erika Bezerra Valente, Fernando Moura, Fábio Ferreira de Hohl, Alexandre Melo, Miguel Araujo, Francisco Garcia Principe, Rosa Maria Kupfer, Rosane Costa e Forti, Adriana Valerio, Cynthia Melissa Ferreira, Hélder José Duarte, João Manuel Saraiva, José Francisco Rodacki, Melanie Castelo, Maria Helane Monteiro, Mariana Pereira Branco, Patrícia Quadros Matos, Pedro Manuel Magalhães, Pedro Carneiro Betti, Roberto Tadeu Réa, Rosângela Roginski Trujilho, Thaisa Dourado Pinto, Lana Catani Leitão, Cristiane Bauermann |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
RCIPL |
dc.contributor.author.fl_str_mv |
Bertoluci, Marcello Casaccia Salles, João Eduardo Silva-Nunes, José Pedrosa, Hermelinda Cordeiro Moreira, Rodrigo Oliveira Duarte, Rui Manuel Carvalho, Davide Mauricio Trujilho, Fábio Rogério Raposo, João Filipe Parente, Erika Bezerra Valente, Fernando Moura, Fábio Ferreira de Hohl, Alexandre Melo, Miguel Araujo, Francisco Garcia Principe, Rosa Maria Kupfer, Rosane Costa e Forti, Adriana Valerio, Cynthia Melissa Ferreira, Hélder José Duarte, João Manuel Saraiva, José Francisco Rodacki, Melanie Castelo, Maria Helane Monteiro, Mariana Pereira Branco, Patrícia Quadros Matos, Pedro Manuel Magalhães, Pedro Carneiro Betti, Roberto Tadeu Réa, Rosângela Roginski Trujilho, Thaisa Dourado Pinto, Lana Catani Leitão, Cristiane Bauermann |
dc.subject.por.fl_str_mv |
Diabetes Diabetes treatment Type 2 diabetes Cardiovascular risk Guidelines Heart failure Chronic kidney disease Ischemic heart disease ASCVD Atherosclerotic disease Portugal Brasil |
topic |
Diabetes Diabetes treatment Type 2 diabetes Cardiovascular risk Guidelines Heart failure Chronic kidney disease Ischemic heart disease ASCVD Atherosclerotic disease Portugal Brasil |
description |
Background: In the current management of type 2 diabetes (T2DM), cardiovascular and renal prevention have become important targets to be achieved. In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for the treatment of hyperglycemia in T2DM. Methods: MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence was determined using predefined criteria. Results and conclusions: In non-pregnant adults, the recommended HbA1c target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA1c is 6.5–7.5%. When HbA1c is 7.5–9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA1c remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (< 40%) and glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30–60 mL/min/1.73 m2 or eGFR 30–90 mL/min/1.73 m2 with albuminuria > 30 mg/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-1RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-06-11T18:50:52Z 2020-05 2020-05-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.21/11824 |
url |
http://hdl.handle.net/10400.21/11824 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Bertoluci MC, Salles JE, Silva-Nunes J, Pedrosa HC, Moreira RO, Duarte RM, et al. Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus. Diabetol Metab Syndr. 2020;12:45. 10.1186/s13098-020-00551-1 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
BMC |
publisher.none.fl_str_mv |
BMC |
dc.source.none.fl_str_mv |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799133468517466112 |