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

2020-05-24Recensão Acesso aberto
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dc.contributor.authorBertoluci, Marcello Casaccia
dc.contributor.authorSalles, João Eduardo Nunes
dc.contributor.authorSilva-Nunes, José
dc.contributor.authorPedrosa, Hermelinda Cordeiro
dc.contributor.authorMoreira, Rodrigo Oliveira
dc.contributor.authorDa Silva Duarte, Rui Manuel Calado
dc.contributor.authorDa Costa Carvalho, Davide Mauricio
dc.contributor.authorTrujilho, Fábio Rogério
dc.contributor.authorDos Santos Raposo, João Filipe Cancela
dc.contributor.authorParente, Erika Bezerra
dc.contributor.authorValente, Fernando
dc.contributor.authorDe Moura, Fábio Ferreira
dc.contributor.authorHohl, Alexandre
dc.contributor.authorMelo, Miguel
dc.contributor.authorAraujo, Francisco Garcia Pestana
dc.contributor.authorDe Araújo Principe, Rosa Maria Monteiro Castro
dc.contributor.authorKupfer, Rosane
dc.contributor.authorCosta E Forti, Adriana
dc.contributor.authorValerio, Cynthia Melissa
dc.contributor.authorFerreira, Hélder José
dc.contributor.authorDuarte, João Manuel Sequeira
dc.contributor.authorSaraiva, José Francisco Kerr
dc.contributor.authorRodacki, Melanie
dc.contributor.authorCastelo, Maria Helane Costa Gurgel
dc.contributor.authorMonteiro, Mariana Pereira
dc.contributor.authorBranco, Patrícia Quadros
dc.contributor.authorDe Matos, Pedro Manuel Patricio
dc.contributor.authorDe Melo Pereira De Magalhães, Pedro Carneiro
dc.contributor.authorBetti, Roberto Tadeu Barcellos
dc.contributor.authorRéa, Rosângela Roginski
dc.contributor.authorTrujilho, Thaisa Dourado Guedes
dc.contributor.authorPinto, Lana Catani Ferreira
dc.contributor.authorLeitão, Cristiane Bauermann
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.pblSpringer Verlag
dc.date.accessioned2020-06-05T00:52:55Z
dc.date.available2020-06-05T00:52:55Z
dc.date.issued2020-05-24
dc.description.abstractBackground: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1670135
dc.identifier.doi10.1186/s13098-020-00551-1
dc.identifier.otherPURE: 18445036
dc.identifier.otherPURE UUID: e7b98fc0-46f4-4d06-abdd-79f3a104cf7d
dc.identifier.otherScopus: 85085482173
dc.identifier.otherPubMed: 32489427
dc.identifier.otherWOS: 000536918200001
dc.identifier.urihttp://hdl.handle.net/10362/98892
dc.identifier.urlhttps://www.scopus.com/pages/publications/85085482173
dc.language.isoeng
dc.peerreviewedyes
dc.subjectASCVD
dc.subjectAtherosclerotic disease
dc.subjectCardiovascular risk
dc.subjectChronic kidney disease
dc.subjectDiabetes treatment
dc.subjectGuidelines
dc.subjectHeart failure
dc.subjectIschemic heart disease
dc.subjectType 2 diabetes
dc.subjectInternal Medicine
dc.subjectEndocrinology, Diabetes and Metabolism
dc.subjectSDG 3 - Good Health and Well-being
dc.titlePortuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitusen
dc.typereview
degois.publication.issue1
degois.publication.titleDiabetology and Metabolic Syndrome
degois.publication.volume12
dspace.entity.typePublication
rcaap.rightsopenAccess

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