Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline

作者：Arnav Agarwal, Reem A. Mustafa, Veena Manja, Thomas Agoritsas, Helen MacDonald, Sheyu Li, Farid Foroutan, Daniel Rayner, René Rodríguez‐Gutiérrez, Bjørn Olav Åsvold, Anja Fog Heen, Jenan Gabi, Lixin Guo, Qiukui Hao, Britta Tendel Jeppesen, Vivekanand Jha, Evi Nagler, Adrienne Odom, Nicolas Rodondi, Sahana Shetty, Mieke Vermandere, Robin Wright, Gordon Guyatt, Per Olav Vandvik · 发表于：BMJ · 年份：2025 · DOI：10.1136/bmj-2024-082071 · 被引用次数：25 · 研究领域：Diabetes Treatment and Management、Chronic Kidney Disease and Diabetes、Bariatric Surgery and Outcomes

Abstract Clinical question What are the benefits and harms of medications for adults with type 2 diabetes at varied risks of cardiovascular and kidney related complications? Context Emerging clinical trials of novel medications have demonstrated benefits on cardiovascular, kidney, and weight related outcomes in people with type 2 diabetes. Dynamically updated practice guidelines adhering to standards of trustworthiness are necessary in response to a rapidly evolving evidence base and the availability of multiple medication alternatives. This living practice guideline incorporates the latest available medications and evidence and provides recommendations stratified by risks of cardiovascular and kidney complications to inform diabetes management. Recommendations The panel issued risk-stratified recommendations regarding four prioritised medications for adults with type 2 diabetes (SGLT-2 inhibitors, GLP-1 receptor agonists, finerenone and tirzepatide): • Lower risk (three or fewer cardiovascular risk factors without established cardiovascular disease (CVD) or chronic kidney disease (CKD)): weak recommendation against SGLT-2 inhibitors or GLP-1 receptor agonists. • Moderate risk (more than three cardiovascular risk factors without established CVD or CKD; or established CVD and/or CKD at lower risk of complications): weak recommendation in favour of SGLT-2 inhibitors or GLP-1 receptor agonists; and a weak recommendation against finerenone in adults with CKD. • Higher risk (estab...