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

context

Emerging clinical trials of novel medications have demonstrated benefits on cardiovascular, kidney, and weight related outcomes in people with type 2 diabetes.

新型药物的新兴临床试验已在2型糖尿病患者中显示出对心血管、肾脏和体重相关结果的益处。

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.

为了应对快速发展的证据基础和多种药物选择的可用性，有必要制定动态更新的、符合可信标准的实践指南。

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.

这个活指南结合了最新的可用药物和证据，并根据心血管和肾脏并发症的风险提供分层建议，以指导糖尿病管理。

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 (established CVD and/or CKD at higher risk of complications, or established heart failure): strong recommendation in favour of SGLT-2 inhibitors or GLP-1 receptor agonists; and a weak recommendation in favour of finerenone in adults with CKD.• Across risk strata: weak recommendation in favour of tirzepatide in adults with obesity.

专家小组针对四种优先考虑的药物发布了针对成年2型糖尿病患者的分层风险建议（SGLT-2抑制剂、GLP-1受体激动剂、finerenone和tirzepatide）：• 低风险（三个或更少的心血管风险因素，没有确立的心血管疾病（CVD）或慢性肾脏病（CKD））：对SGLT-2抑制剂或GLP-1受体激动剂的弱推荐反对。• 中等风险（超过三个心血管风险因素，没有确立的CVD或CKD；或已确立的CVD和/或CKD，但并发症风险较低）：对SGLT-2抑制剂或GLP-1受体激动剂的弱推荐支持；以及对CKD成人中finerenone的弱推荐反对。• 高风险（已确立的CVD和/或CKD，但并发症风险较高，或已确立的心力衰竭）：对SGLT-2抑制剂或GLP-1受体激动剂的强烈推荐支持；以及对CKD成人中finerenone的弱推荐支持。• 在所有风险分层中：对肥胖成人中tirzepatide的弱推荐支持。