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2023 Update

2023-07-19Recensão Acesso aberto
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dc.contributor.authorBertoluci, Marcello Casaccia
dc.contributor.authorSilva Júnior, Wellington S
dc.contributor.authorValente, Fernando
dc.contributor.authorAraujo, Levimar Rocha
dc.contributor.authorLyra, Ruy
dc.contributor.authorde Castro, João Jácome
dc.contributor.authorRaposo, João Filipe
dc.contributor.authorMiranda, Paulo Augusto Carvalho
dc.contributor.authorBoguszewski, Cesar Luiz
dc.contributor.authorHohl, Alexandre
dc.contributor.authorDuarte, Rui
dc.contributor.authorSalles, João Eduardo Nunes
dc.contributor.authorSilva-Nunes, José
dc.contributor.authorDores, Jorge
dc.contributor.authorMelo, Miguel
dc.contributor.authorde Sá, João Roberto
dc.contributor.authorNeves, João Sérgio
dc.contributor.authorMoreira, Rodrigo Oliveira
dc.contributor.authorMalachias, Marcus Vinícius Bolívar
dc.contributor.authorLamounier, Rodrigo Nunes
dc.contributor.authorMalerbi, Domingos Augusto
dc.contributor.authorCalliari, Luis Eduardo
dc.contributor.authorCardoso, Luis Miguel
dc.contributor.authorCarvalho, Maria Raquel
dc.contributor.authorFerreira, Hélder José
dc.contributor.authorNortadas, Rita
dc.contributor.authorTrujilho, Fábio Rogério
dc.contributor.authorLeitão, Cristiane Bauermann
dc.contributor.authorSimões, José Augusto Rodrigues
dc.contributor.authorDos Reis, Mónica Isabel Natal
dc.contributor.authorMelo, Pedro
dc.contributor.authorMarcelino, Mafalda
dc.contributor.authorCarvalho, Davide
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer Verlag
dc.date.accessioned2023-11-16T22:09:39Z
dc.date.available2023-11-16T22:09:39Z
dc.date.issued2023-07-19
dc.description© 2023. The Author(s).
dc.description.abstractBACKGROUND: The management of antidiabetic therapy in people with type 2 diabetes (T2D) has evolved beyond glycemic control. In this context, Brazil and Portugal defined 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 without 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 predefined criteria. RESULTS AND CONCLUSIONS: All people with T2D need to have their cardiovascular (CV) risk status stratified and HbA1c, BMI, and eGFR assessed before defining therapy. An HbA1c target of less than 7% is adequate for most adults, and a more flexible 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 benefit (AD1) are recommended to reduce CV events if the patient is at high or very high CV risk, and antidiabetic agents with proven efficacy in weight reduction should be considered when obesity is present. If HbA1c remains above target, intensification is recommended with triple, quadruple therapy, or even insulin-based therapy. In people with T2D and established ASCVD, AD1 agents (SGLT2 inhibitors or GLP-1 RA with proven CV benefit) are initially recommended to reduce CV outcomes, and metformin or a second AD1 may be necessary to improve glycemic control if HbA1c is above the target. In T2D with HF, SGLT2 inhibitors are recommended to reduce HF hospitalizations and mortality and to improve HbA1c. In patients with DKD, SGLT2 inhibitors in combination with metformin are recommended when eGFR is above 30 mL/min/1.73 m2. SGLT2 inhibitors can be continued until end-stage kidney disease.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent3321558
dc.identifier.doi10.1186/s13098-023-01121-x
dc.identifier.issn1758-5996
dc.identifier.otherPURE: 74248454
dc.identifier.otherPURE UUID: b7200b98-07e3-44a3-8666-8e80702287c4
dc.identifier.otherPubMed: 37468901
dc.identifier.otherPubMedCentral: PMC10354939
dc.identifier.otherScopus: 85165352759
dc.identifier.urihttp://hdl.handle.net/10362/160046
dc.language.isoeng
dc.peerreviewedyes
dc.subjectASCVD
dc.subjectAtherosclerotic disease
dc.subjectCardiovascular risk
dc.subjectChronic kidney disease
dc.subjectDKD
dc.subjectDiabetes treatment
dc.subjectGLP-1 RA
dc.subjectGuidelines
dc.subjectHeart failure
dc.subjectIschemic heart disease
dc.subjectSGLT2 inhibitors
dc.subjectpe 2 diabetes
dc.subjectSDG 3 - Good Health and Well-being
dc.title2023 Updateen
dc.title.subtitleLuso-Brazilian evidence-based guideline for the management of antidiabetic therapy in type 2 diabetesen
dc.typereview
degois.publication.issue1
degois.publication.titleDiabetology and Metabolic Syndrome
degois.publication.volume15
dspace.entity.typePublication
rcaap.rightsopenAccess

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