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▎The content team editor of WuXi AppTec recently, The BMJ published international clinical practice guidelines, recommending SGLT-2 inhibitors or GLP-1 receptor agonists for adult type 2 diabetes, focusing on different For patients with heart and kidney risk, the benefits and harms of these two types of drugs combined with routine diagnosis and treatment (life>
The guidelines are jointly formulated by clinical and methodological experts from more than ten countries around the world.
The corresponding authors of the article are Dr.
Reem A Mustafa, a nephrologist at the University of Kansas, and Associate Professor Hao Qiukui, West China Hospital Geriatrics Center, Sichuan University.
Associate Professor Li Sheyu, Department of Endocrinology and Metabolism, West China Hospital is the first author of the guide, and West China Hospital of Sichuan University is the guide.
Lead unit.
Screenshot source: The BMJ Type 2 diabetes patients have an increased risk of cardiovascular disease, kidney disease and other complications.
With the accumulation of high-quality experimental evidence, the management of type 2 diabetes is shifting from being dominated by blood glucose treatment goals to focusing on both cardiovascular and renal benefits.
SGLT-2 (sodium-glucose cotransporter 2) inhibitors and GLP-1 (glucagon-like peptide 1) receptor agonists are two relatively new types of hypoglycemic drugs, which are usually used for blood glucose levels after metformin treatment.
Elevated population, but as trials prove their heart and kidney benefits, these drugs have the potential to be used for treatment earlier.
SGLT-2 inhibitors are a class of oral hypoglycemic drugs, including empagliflozin, canagliflozin, dapagliflozin and etogliflozin.
They increase the excretion of glucose and sodium in the urine by inhibiting SGLT-2 in the kidneys, thereby reducing blood sugar levels.
Such drugs may also slightly lower blood pressure and weight.
GLP-1 receptor agonists are a class of non-insulin injection hypoglycemic drugs, including exenatide, liraglutide, lixisenatide, abiglutide, dulaglutide, smeglutide and loxide Senatide.
They mimic the intestinal hormone incretin and bind to its receptors, thereby slowing down food digestion, controlling appetite, and regulating the secretion of insulin and glucagon.
The guidelines stratify the risk of heart and kidney complications in patients with type 2 diabetes.
The relevant criteria are as follows: Cardiovascular risk factors include: age> 60 years old, male, Asian, African or Hispanic, cardiovascular disease or kidney disease Family history, poor control of glycosylated hemoglobin (>6.
5%), smoking, poor control of hypertension (>140/90 mm Hg), dyslipidemia (total cholesterol ≥5.
2 mmol/L or HDL-C<1 mmol/L) ) Cardiovascular disease (CVD) is defined as: suffering from coronary artery disease, or having suffered from myocardial infarction, stroke and chronic kidney disease (CKD) is defined as: eGFR<60 mL/min/1.
73m2, or proteinuria (albumin excretion ≥ 30mg/24hr or urinary albumin-creatinine ratio ≥30mg/g) Based on the latest evidence-based medical evidence, for patients with different risk stratifications, the guidelines are based on existing prescriptions and the risks and benefits of using or not using these two types of drugs The evaluations were carried out separately, and the following recommendations were finally formed.
With ≤3 cardiovascular risk factors, but no CVD or CKD: It is not recommended to initiate SGLT-2 inhibitors or GLP-1 receptor agonist therapy (weak recommendation).
＞3 cardiovascular risk factors, but no CVD or CKD: It is recommended to start using SGLT-2 inhibitors (weak recommendation), and it is not recommended to start GLP-1 receptor agonist therapy (weak recommendation).
Diagnosed CVD or CKD: It is weakly recommended to start using SGLT-2 inhibitors and GLP-1 receptor agonists.
Diagnosed CVD and CKD: It is strongly recommended to start using SGLT-2 inhibitors, and it is weakly recommended to start using GLP-1 receptor agonists.
For patients who wish to further reduce the risk of CVD and CKD outcomes: It is weakly recommended to start using SGLT-2 inhibitors instead of GLP-1 receptor agonists.
Source of title picture: 123RF reference materials [1] Li S, Vandvik PO, Lytvyn L, Guyatt GH, Palmer SC, Rodriguez-Gutierrez R, et al.
, (2021).
SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline.
BMJ, doi:10.
1136/bmj.
n1091[2] The international clinical practice guide for diabetes led by West China Hospital is released.
Retrieved June 1, 2021, from http://scu.
edu.
cn /info/1207/18861.
htm Note: This article aims to introduce the progress of medical and health research, not a recommendation for treatment.
If you need guidance on the treatment plan, please go to a regular hospital for treatment.
The guidelines are jointly formulated by clinical and methodological experts from more than ten countries around the world.
The corresponding authors of the article are Dr.
Reem A Mustafa, a nephrologist at the University of Kansas, and Associate Professor Hao Qiukui, West China Hospital Geriatrics Center, Sichuan University.
Associate Professor Li Sheyu, Department of Endocrinology and Metabolism, West China Hospital is the first author of the guide, and West China Hospital of Sichuan University is the guide.
Lead unit.
Screenshot source: The BMJ Type 2 diabetes patients have an increased risk of cardiovascular disease, kidney disease and other complications.
With the accumulation of high-quality experimental evidence, the management of type 2 diabetes is shifting from being dominated by blood glucose treatment goals to focusing on both cardiovascular and renal benefits.
SGLT-2 (sodium-glucose cotransporter 2) inhibitors and GLP-1 (glucagon-like peptide 1) receptor agonists are two relatively new types of hypoglycemic drugs, which are usually used for blood glucose levels after metformin treatment.
Elevated population, but as trials prove their heart and kidney benefits, these drugs have the potential to be used for treatment earlier.
SGLT-2 inhibitors are a class of oral hypoglycemic drugs, including empagliflozin, canagliflozin, dapagliflozin and etogliflozin.
They increase the excretion of glucose and sodium in the urine by inhibiting SGLT-2 in the kidneys, thereby reducing blood sugar levels.
Such drugs may also slightly lower blood pressure and weight.
GLP-1 receptor agonists are a class of non-insulin injection hypoglycemic drugs, including exenatide, liraglutide, lixisenatide, abiglutide, dulaglutide, smeglutide and loxide Senatide.
They mimic the intestinal hormone incretin and bind to its receptors, thereby slowing down food digestion, controlling appetite, and regulating the secretion of insulin and glucagon.
The guidelines stratify the risk of heart and kidney complications in patients with type 2 diabetes.
The relevant criteria are as follows: Cardiovascular risk factors include: age> 60 years old, male, Asian, African or Hispanic, cardiovascular disease or kidney disease Family history, poor control of glycosylated hemoglobin (>6.
5%), smoking, poor control of hypertension (>140/90 mm Hg), dyslipidemia (total cholesterol ≥5.
2 mmol/L or HDL-C<1 mmol/L) ) Cardiovascular disease (CVD) is defined as: suffering from coronary artery disease, or having suffered from myocardial infarction, stroke and chronic kidney disease (CKD) is defined as: eGFR<60 mL/min/1.
73m2, or proteinuria (albumin excretion ≥ 30mg/24hr or urinary albumin-creatinine ratio ≥30mg/g) Based on the latest evidence-based medical evidence, for patients with different risk stratifications, the guidelines are based on existing prescriptions and the risks and benefits of using or not using these two types of drugs The evaluations were carried out separately, and the following recommendations were finally formed.
With ≤3 cardiovascular risk factors, but no CVD or CKD: It is not recommended to initiate SGLT-2 inhibitors or GLP-1 receptor agonist therapy (weak recommendation).
＞3 cardiovascular risk factors, but no CVD or CKD: It is recommended to start using SGLT-2 inhibitors (weak recommendation), and it is not recommended to start GLP-1 receptor agonist therapy (weak recommendation).
Diagnosed CVD or CKD: It is weakly recommended to start using SGLT-2 inhibitors and GLP-1 receptor agonists.
Diagnosed CVD and CKD: It is strongly recommended to start using SGLT-2 inhibitors, and it is weakly recommended to start using GLP-1 receptor agonists.
For patients who wish to further reduce the risk of CVD and CKD outcomes: It is weakly recommended to start using SGLT-2 inhibitors instead of GLP-1 receptor agonists.
Source of title picture: 123RF reference materials [1] Li S, Vandvik PO, Lytvyn L, Guyatt GH, Palmer SC, Rodriguez-Gutierrez R, et al.
, (2021).
SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes: a clinical practice guideline.
BMJ, doi:10.
1136/bmj.
n1091[2] The international clinical practice guide for diabetes led by West China Hospital is released.
Retrieved June 1, 2021, from http://scu.
edu.
cn /info/1207/18861.
htm Note: This article aims to introduce the progress of medical and health research, not a recommendation for treatment.
If you need guidance on the treatment plan, please go to a regular hospital for treatment.
