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

Abstract

Background: 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 HbA 1c 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 HbA 1c is 6.5-7.5%. When HbA 1c is 7.5-9.0%, dual therapy with metformin plus an SGLT2i and/or GLP-1 RA (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 HbA 1c 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

Doença Renal Do Diabetes: A Importância Do Diagnóstico E Tratamento Precoces

“…O controle glicêmico é fundamental, bem como o controle da pressão arterial e dislipidemia, a prática de exercício físico, alimentação saudável e cessar o tabagismo nos pacientes com esse hábito 9 . Em todas as fases do tratamento a modificação do estilo de vida deve ser recomendada 12 .…”

Exploring Early Combination Strategy in Latin American Patients With Newly Diagnosed Type 2 Diabetes:&nbsp;A Sub-analysis of the VERIFY&nbsp;Study&nbsp;

“…Based on the clinical bene ts of early combination therapy demonstrated by the VERIFY global study, the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) have updated their consensus statement suggesting that healthcare providers should engage in shared decision making around initial combination therapy in new-onset cases of T2DM [25]. Similarly, the latest update of the Brazilian guidelines recommends early combination therapy in treatment-naïve patients with HbA1c 6.5-7.5% to delay treatment failure and improve glycemic control based on the clinical bene ts [26].…”

Exploring early combination strategy in Latin American patients with newly diagnosed type 2 diabetes: a sub-analysis of the VERIFY study

“…Based on the clinical benefits of early combination therapy demonstrated by the VERIFY global study, the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) have updated their consensus statement suggesting that healthcare providers should engage in shared decision making around initial combination therapy in new-onset cases of T2DM [ 28 ]. Similarly, the latest update of the Brazilian guidelines recommends early combination therapy in treatment-naïve patients with HbA1c 6.5–7.5% to delay treatment failure and improve glycemic control based on the clinical benefits [ 29 ].…”