Bertoluci, 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 Bauermann2020-06-052020-06-052020-05-24PURE: 18445036PURE UUID: e7b98fc0-46f4-4d06-abdd-79f3a104cf7dScopus: 85085482173PubMed: 32489427WOS: 000536918200001http://hdl.handle.net/10362/98892Background: 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.1670135engASCVDAtherosclerotic diseaseCardiovascular riskChronic kidney diseaseDiabetes treatmentGuidelinesHeart failureIschemic heart diseaseType 2 diabetesInternal MedicineEndocrinology, Diabetes and MetabolismSDG 3 - Good Health and Well-beingreview10.1186/s13098-020-00551-1https://www.scopus.com/pages/publications/85085482173