Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus

Detalhes bibliográficos
Autor(a) principal: Bertoluci, Marcello Casaccia
Data de Publicação: 2020
Outros Autores: 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
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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spelling 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 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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