2023 UPDATE: Luso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetes

• Autor(a) principal: Bertoluci, Marcello Casaccia
• Data de Publicação: 2023
• Outros Autores: Júnior, Wellington S. Silva, Valente, Fernando, Araujo, Levimar Rocha, Lyra, Ruy, Castro, João Jácome de, Raposo, João, Miranda, Paulo Augusto Carvalho, Boguszewski, Cesar Luiz, Hohl, Alexandre, Duarte, Rui, Salles, Joao Eduardo Nunes, Silva-Nunes, José, Dores, Jorge, Melo, Miguel, Sá, João Roberto de, Neves, João Sérgio, Moreira, Rodrigo Oliveira, Malachias, Marcus Vinicius Bolivar, Lamounier, Rodrigo Nunes, Malerbi, Domingos Augusto, Calliari, Luís Eduardo, Cardoso, Luis Miguel, Carvalho, Maria Raquel, Ferreira, Hélder José, Nortadas, Rita, Trujilho, Fábio Rogério, Leitão, Cristiane Bauermann, Simões, José Augusto Rodrigues, Reis, Mónica Isabel Natal dos, Melo, Pedro, Marcelino, Mafalda, Carvalho, Davide
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.6/13388
• topic: ASCVD; Atherosclerotic disease; Cardiovascular risk; Chronic kidney disease; DKD; Diabetes treatment; Guidelines; Heart failure; Ischemic heart disease; Type 2 diabetes; SGLT2 inhibitors; GLP-1 RA

Background The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond gly‑ cemic control. In this context, Brazil and Portugal defned a joint panel of four leading diabetes societies to update the guideline published in 2020. Methods The panelists searched MEDLINE (via PubMed) for the best evidence from clinical studies on treating T2D and its cardiorenal complications. The panel searched for evidence on antidiabetic therapy in people with T2D with‑ out cardiorenal disease and in patients with T2D and atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or diabetic kidney disease (DKD). The degree of recommendation and the level of evidence were determined using predefned criteria. Results and conclusions All people with T2D need to have their cardiovascular (CV) risk status stratifed and HbA1c, BMI, and eGFR assessed before defning therapy. An HbA1c target of less than 7% is adequate for most adults, and a more fexible target (up to 8%) should be considered in frail older people. Non-pharmacological approaches are recommended during all phases of treatment. In treatment naïve T2D individuals without cardiorenal complications, metformin is the agent of choice when HbA1c is 7.5% or below. When HbA1c is above 7.5% to 9%, starting with dual therapy is recommended, and triple therapy may be considered. When HbA1c is above 9%, starting with dual therapyt is recommended, and triple therapy should be considered. Antidiabetic drugs with proven CV beneft (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efcacy in weight reduction should be considered when obesity is present. If HbA1c remains above tar‑ get, intensifcation is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D.