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Advisor(s)
Abstract(s)
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.
Description
Keywords
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
Citation
Bertoluci MC, Silva-Júnior WS, Valente F, et al. 2023 UPDATE Luso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetes. Diabetology & Metabolic Syndrome. 2023; 15:160. Doi 10.1186/s13098-023-01121-x
Publisher
BMC