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 Nunes, Silva-Nunes, José, Pedrosa, Hermelinda Cordeiro, Moreira, Rodrigo Oliveira, Da Silva Duarte, Rui Manuel Calado, Da Costa Carvalho, Davide Mauricio, Trujilho, Fábio Rogério, Dos Santos Raposo, João Filipe Cancela, Parente, Erika Bezerra, Valente, Fernando, De Moura, Fábio Ferreira, Hohl, Alexandre, Melo, Miguel, Araujo, Francisco Garcia Pestana, De Araújo Principe, Rosa Maria Monteiro Castro, Kupfer, Rosane, Costa E Forti, Adriana, Valerio, Cynthia Melissa, Ferreira, Hélder José, Duarte, João Manuel Sequeira, Saraiva, José Francisco Kerr, Rodacki, Melanie, Castelo, Maria Helane Costa Gurgel, Monteiro, Mariana Pereira, Branco, Patrícia Quadros, De Matos, Pedro Manuel Patricio, De Melo Pereira De Magalhães, Pedro Carneiro, Betti, Roberto Tadeu Barcellos, Réa, Rosângela Roginski, Trujilho, Thaisa Dourado Guedes, Pinto, Lana Catani Ferreira, Leitão, Cristiane Bauermann
Tipo de documento: Outros
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10362/98892
Resumo: Background: In 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 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 were 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 mellitusASCVDAtherosclerotic diseaseCardiovascular riskChronic kidney diseaseDiabetes treatmentGuidelinesHeart failureIschemic heart diseaseType 2 diabetesInternal MedicineEndocrinology, Diabetes and MetabolismSDG 3 - Good Health and Well-beingBackground: In 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 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 were 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.NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)RUNBertoluci, Marcello CasacciaSalles, João Eduardo NunesSilva-Nunes, JoséPedrosa, Hermelinda CordeiroMoreira, Rodrigo OliveiraDa Silva Duarte, Rui Manuel CaladoDa Costa Carvalho, Davide MauricioTrujilho, Fábio RogérioDos Santos Raposo, João Filipe CancelaParente, Erika BezerraValente, FernandoDe Moura, Fábio FerreiraHohl, AlexandreMelo, MiguelAraujo, Francisco Garcia PestanaDe Araújo Principe, Rosa Maria Monteiro CastroKupfer, RosaneCosta E Forti, AdrianaValerio, Cynthia MelissaFerreira, Hélder JoséDuarte, João Manuel SequeiraSaraiva, José Francisco KerrRodacki, MelanieCastelo, Maria Helane Costa GurgelMonteiro, Mariana PereiraBranco, Patrícia QuadrosDe Matos, Pedro Manuel PatricioDe Melo Pereira De Magalhães, Pedro CarneiroBetti, Roberto Tadeu BarcellosRéa, Rosângela RoginskiTrujilho, Thaisa Dourado GuedesPinto, Lana Catani FerreiraLeitão, Cristiane Bauermann2020-06-05T00:52:55Z2020-05-242020-05-24T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/otherapplication/pdfhttp://hdl.handle.net/10362/98892engPURE: 18445036https://doi.org/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:RCAAP2024-05-22T17:45:52Zoai:run.unl.pt:10362/98892Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-05-22T17:45:52Repositório 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
ASCVD
Atherosclerotic disease
Cardiovascular risk
Chronic kidney disease
Diabetes treatment
Guidelines
Heart failure
Ischemic heart disease
Type 2 diabetes
Internal Medicine
Endocrinology, Diabetes and Metabolism
SDG 3 - Good Health and Well-being
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 Nunes
Silva-Nunes, José
Pedrosa, Hermelinda Cordeiro
Moreira, Rodrigo Oliveira
Da Silva Duarte, Rui Manuel Calado
Da Costa Carvalho, Davide Mauricio
Trujilho, Fábio Rogério
Dos Santos Raposo, João Filipe Cancela
Parente, Erika Bezerra
Valente, Fernando
De Moura, Fábio Ferreira
Hohl, Alexandre
Melo, Miguel
Araujo, Francisco Garcia Pestana
De Araújo Principe, Rosa Maria Monteiro Castro
Kupfer, Rosane
Costa E Forti, Adriana
Valerio, Cynthia Melissa
Ferreira, Hélder José
Duarte, João Manuel Sequeira
Saraiva, José Francisco Kerr
Rodacki, Melanie
Castelo, Maria Helane Costa Gurgel
Monteiro, Mariana Pereira
Branco, Patrícia Quadros
De Matos, Pedro Manuel Patricio
De Melo Pereira De Magalhães, Pedro Carneiro
Betti, Roberto Tadeu Barcellos
Réa, Rosângela Roginski
Trujilho, Thaisa Dourado Guedes
Pinto, Lana Catani Ferreira
Leitão, Cristiane Bauermann
author_role author
author2 Salles, João Eduardo Nunes
Silva-Nunes, José
Pedrosa, Hermelinda Cordeiro
Moreira, Rodrigo Oliveira
Da Silva Duarte, Rui Manuel Calado
Da Costa Carvalho, Davide Mauricio
Trujilho, Fábio Rogério
Dos Santos Raposo, João Filipe Cancela
Parente, Erika Bezerra
Valente, Fernando
De Moura, Fábio Ferreira
Hohl, Alexandre
Melo, Miguel
Araujo, Francisco Garcia Pestana
De Araújo Principe, Rosa Maria Monteiro Castro
Kupfer, Rosane
Costa E Forti, Adriana
Valerio, Cynthia Melissa
Ferreira, Hélder José
Duarte, João Manuel Sequeira
Saraiva, José Francisco Kerr
Rodacki, Melanie
Castelo, Maria Helane Costa Gurgel
Monteiro, Mariana Pereira
Branco, Patrícia Quadros
De Matos, Pedro Manuel Patricio
De Melo Pereira De Magalhães, Pedro Carneiro
Betti, Roberto Tadeu Barcellos
Réa, Rosângela Roginski
Trujilho, Thaisa Dourado Guedes
Pinto, Lana Catani Ferreira
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 NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
RUN
dc.contributor.author.fl_str_mv Bertoluci, Marcello Casaccia
Salles, João Eduardo Nunes
Silva-Nunes, José
Pedrosa, Hermelinda Cordeiro
Moreira, Rodrigo Oliveira
Da Silva Duarte, Rui Manuel Calado
Da Costa Carvalho, Davide Mauricio
Trujilho, Fábio Rogério
Dos Santos Raposo, João Filipe Cancela
Parente, Erika Bezerra
Valente, Fernando
De Moura, Fábio Ferreira
Hohl, Alexandre
Melo, Miguel
Araujo, Francisco Garcia Pestana
De Araújo Principe, Rosa Maria Monteiro Castro
Kupfer, Rosane
Costa E Forti, Adriana
Valerio, Cynthia Melissa
Ferreira, Hélder José
Duarte, João Manuel Sequeira
Saraiva, José Francisco Kerr
Rodacki, Melanie
Castelo, Maria Helane Costa Gurgel
Monteiro, Mariana Pereira
Branco, Patrícia Quadros
De Matos, Pedro Manuel Patricio
De Melo Pereira De Magalhães, Pedro Carneiro
Betti, Roberto Tadeu Barcellos
Réa, Rosângela Roginski
Trujilho, Thaisa Dourado Guedes
Pinto, Lana Catani Ferreira
Leitão, Cristiane Bauermann
dc.subject.por.fl_str_mv ASCVD
Atherosclerotic disease
Cardiovascular risk
Chronic kidney disease
Diabetes treatment
Guidelines
Heart failure
Ischemic heart disease
Type 2 diabetes
Internal Medicine
Endocrinology, Diabetes and Metabolism
SDG 3 - Good Health and Well-being
topic ASCVD
Atherosclerotic disease
Cardiovascular risk
Chronic kidney disease
Diabetes treatment
Guidelines
Heart failure
Ischemic heart disease
Type 2 diabetes
Internal Medicine
Endocrinology, Diabetes and Metabolism
SDG 3 - Good Health and Well-being
description Background: In 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 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 were 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 2020-06-05T00:52:55Z
2020-05-24
2020-05-24T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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format other
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/98892
url http://hdl.handle.net/10362/98892
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv PURE: 18445036
https://doi.org/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
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instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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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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