■美国医师学会(ACP)制定了该临床指南,以更新有关2型糖尿病新药物治疗的建议。本临床指南基于有效的最佳证据,比较利益和危害,考虑患者的价值观和偏好,和成本。
■本临床指南基于对2型糖尿病新型药物治疗的有效性和危害的系统评价。包括胰高血糖素样肽-1(GLP-1)激动剂,GLP-1激动剂和葡萄糖依赖性促胰岛素多肽激动剂,钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂,二肽基肽酶-4(DPP-4)抑制剂,和长效胰岛素,用作单一疗法或与其他药物联合使用。临床指南委员会优先考虑以下结果,使用等级(建议评估等级,开发和评估)方法:全因死亡率,主要不良心血管事件,心肌梗塞,中风,充血性心力衰竭住院治疗,慢性肾病进展,严重不良事件,和严重的低血糖。减肥,以总体体重减轻至少10%的参与者的百分比来衡量,是一个优先的结果,但数据不足以进行网络meta分析,且未按GRADE进行评级.
■本临床指南的受众是医生和其他临床医生。该人群是患有2型糖尿病的非妊娠成年人。
■ACP建议在2型糖尿病和血糖控制不足的成人中,在二甲双胍和生活方式改变中添加钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂或胰高血糖素样肽-1(GLP-1)激动剂(强烈推荐;高确定性证据)。
•使用SGLT-2抑制剂可降低全因死亡风险,主要不良心血管事件,慢性肾病进展,以及充血性心力衰竭导致的住院治疗.
•使用GLP-1激动剂降低全因死亡风险,主要不良心血管事件,和中风。
■ACP建议不要在2型糖尿病和血糖控制不足的成人中添加二甲双胍和生活方式改变二肽基肽酶-4(DPP-4)抑制剂,以降低发病率和全因死亡率(强烈推荐;高确定性证据)。
UNASSIGNED: The American College of Physicians (ACP) developed this clinical
guideline to update recommendations on newer pharmacologic treatments of type 2 diabetes. This clinical
guideline is based on the best available evidence for effectiveness, comparative benefits and harms, consideration of patients\' values and preferences, and costs.
UNASSIGNED: This clinical
guideline is based on a systematic review of the effectiveness and harms of newer pharmacologic treatments of type 2 diabetes, including glucagon-like peptide-1 (GLP-1) agonists, a GLP-1 agonist and glucose-dependent insulinotropic polypeptide agonist, sodium-glucose cotransporter-2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, and long-acting insulins, used either as monotherapy or in combination with other medications. The Clinical
Guidelines Committee prioritized the following outcomes, which were evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach: all-cause mortality, major adverse cardiovascular events, myocardial infarction, stroke, hospitalization for congestive heart failure, progression of chronic kidney disease, serious adverse events, and severe hypoglycemia. Weight loss, as measured by percentage of participants who achieved at least 10% total body weight loss, was a prioritized outcome, but data were insufficient for network meta-analysis and were not rated with GRADE.
UNASSIGNED: The audience for this clinical
guideline is physicians and other clinicians. The population is nonpregnant adults with type 2 diabetes.
UNASSIGNED: ACP recommends adding a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control (strong recommendation; high-certainty evidence). • Use an SGLT-2 inhibitor to reduce the risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure. • Use a GLP-1 agonist to reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke.
UNASSIGNED:
ACP recommends against adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin and lifestyle modifications in adults with type 2 diabetes and inadequate glycemic control to reduce morbidity and all-cause mortality (strong recommendation; high-certainty evidence).