Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline
A BMJ Rapid Recommendations living guideline gives risk-stratified advice on SGLT2 inhibitors, GLP-1 receptor agonists, finerenone and tirzepatide for adults with type 2 diabetes, matching treatment intensity to each patient's cardiovascular and kidney risk.
Background
A rapidly evolving evidence base and multiple competing agents have made static guidelines hard to keep current for adults with type 2 diabetes at varied cardiovascular and kidney risk. This living guideline dynamically incorporates the latest trial data to inform prioritisation among four drug classes.
Key findings
Recommendations were stratified by risk. For lower-risk patients the panel issued a weak recommendation against SGLT2 inhibitors or GLP-1 receptor agonists. For moderate risk, a weak recommendation in favour of SGLT2 inhibitors or GLP-1 receptor agonists and a weak recommendation against finerenone. For higher risk (established cardiovascular disease and/or CKD or heart failure), a strong recommendation in favour of SGLT2 inhibitors or GLP-1 receptor agonists and a weak recommendation in favour of finerenone in CKD. Across strata, a weak recommendation in favour of tirzepatide in adults with obesity.
Clinical implications
The framework lets clinicians match therapy to individual cardiovascular and kidney risk rather than treating all patients alike, and is designed to update as new trial data emerge. It aligns nephrology and diabetes practice around SGLT2 inhibitors and GLP-1 receptor agonists as cornerstones for higher-risk patients.
Category
Guidelines
Source
The BMJ
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