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Portuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes Mellitus

2020Journal article Open access
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dc.contributor.authorBertoluci, M
dc.contributor.authorNunes Salles, JE
dc.contributor.authorSilva-Nunes, J
dc.contributor.authorCordeiro Pedrosa, H
dc.contributor.authorMoreira, R
dc.contributor.authorCalado da Silva Duarte, R
dc.contributor.authorMaurício da Costa Carvalho, D
dc.contributor.authorTrujilho, F
dc.contributor.authorCancela dos Santos Raposo, JF
dc.contributor.authorParente, E
dc.contributor.authorValente, F
dc.contributor.authorFerreira de Moura, F
dc.contributor.authorHohl, A
dc.contributor.authorMelo, M
dc.contributor.authorAraújo, F
dc.contributor.authorde Araújo Principe, RM
dc.contributor.authorKupfer, R
dc.contributor.authorCosta e Forti, A
dc.contributor.authorValerio, C
dc.contributor.authorFerreira, HJ
dc.contributor.authorDuarte, JM
dc.contributor.authorKerr Saraiva, JF
dc.contributor.authorRodacki, M
dc.contributor.authorGurgel Castelo, MH
dc.contributor.authorPereira Monteiro, M
dc.contributor.authorQuadros Branco, P
dc.contributor.authorPatrício de Matos, PM
dc.contributor.authorPereira de Magalhães, P
dc.contributor.authorBetti, R
dc.contributor.authorRéa, R
dc.contributor.authorTrujilho, T
dc.contributor.authorFerreira Pinto, L
dc.contributor.authorBauermann Leitão, C
dc.date.accessioned2021-07-15T15:07:04Z
dc.date.available2021-07-15T15:07:04Z
dc.date.issued2020
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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationDiabetol Metab Syndr. 2020 May 24;12:45.pt_PT
dc.identifier.doi10.1186/s13098-020-00551-1pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3767
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherBMCpt_PT
dc.subjectHCC ENDpt_PT
dc.subjectASCVDpt_PT
dc.subjectAtherosclerotic Diseasept_PT
dc.subjectCardiovascular Riskpt_PT
dc.subjectChronic Kidney Diseasept_PT
dc.subjectDiabetes Treatmentpt_PT
dc.subjectGuidelinespt_PT
dc.subjectIschemic Heart Diseasept_PT
dc.subjectHeart Failurept_PT
dc.subjectType 2 Diabetes.pt_PT
dc.titlePortuguese-Brazilian Evidence-Based Guideline on the Management of Hyperglycemia in Type 2 Diabetes Mellituspt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue1pt_PT
oaire.citation.startPage45pt_PT
oaire.citation.titleDiabetology & Metabolic Syndromept_PT
oaire.citation.volume12pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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