2024+ACP临床指南:成人2型糖尿病的新药物治疗.pdf
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1、Newer Pharmacologic Treatments in Adults With Type 2 Diabetes:A Clinical Guideline From the American College of PhysiciansAmir Qaseem,MD,PhD,MHA;Adam J.Obley,MD;Tatyana Shamliyan,MD,MS;Lauri A.Hicks,DO;Curtis S.Harrod,PhD,MPH;and Carolyn J.Crandall,MD,MS;for the Clinical Guidelines Committee of the
2、American College of Physicians*Description:The American College of Physicians(ACP)developed this clinical guideline to update recommen-dations on newer pharmacologic treatments of type 2diabetes.This clinical guideline is based on the bestavailable evidence for effectiveness,comparative ben-efits an
3、d harms,consideration of patients values andpreferences,and costs.Methods:This clinical guideline is based on a system-atic review of the effectiveness and harms of newerpharmacologic treatments of type 2 diabetes,includingglucagon-like peptide-1(GLP-1)agonists,a GLP-1 ago-nist and glucose-dependent
4、 insulinotropic polypeptideagonist,sodiumglucose cotransporter-2(SGLT-2)inhibitors,dipeptidyl peptidase-4(DPP-4)inhibitors,and long-acting insulins,used either as monotherapyor in combination with other medications.The ClinicalGuidelines Committee prioritized the following out-comes,which were evalu
5、ated using the GRADE(Grading of Recommendations Assessment,Develop-ment and Evaluation)approach:all-cause mortality,major adverse cardiovascular events,myocardial in-farction,stroke,hospitalization for congestive heartfailure,progression of chronic kidney disease,seriousadverse events,and severe hyp
6、oglycemia.Weightloss,as measured by percentage of participants whoachieved at least 10%total body weight loss,was aprioritized outcome,but data were insufficient for net-work meta-analysis and were not rated with GRADE.Audience and Patient Population:The audience forthis clinical guideline is physic
7、ians and other clini-cians.The population is nonpregnant adults with type2 diabetes.Recommendation 1:ACP recommends adding asodiumglucose cotransporter-2(SGLT-2)inhibi-tor or glucagon-like peptide-1(GLP-1)agonist to met-formin and lifestyle modifications in adults with type 2diabetes and inadequate
8、glycemic control(strongrecommendation;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 hospitali-zation due to congestive heart failure.?Use a GLP-1 agonist to reduce the risk fo
9、r all-causemortality,major adverse cardiovascular events,andstroke.Recommendation 2:ACP recommends against add-ing a dipeptidyl peptidase-4(DPP-4)inhibitor to met-formin and lifestyle modifications in adults with type 2diabetes and inadequate glycemic control to reducemorbidity and all-cause mortali
10、ty(strong recommen-dation;high-certainty evidence).Ann Intern Med.doi:10.7326/M23-2788Annals.orgFor author,article,and disclosure information,see end of text.This article was published at Annals.org on 19 April 2024.The age-adjusted prevalence of type 2 diabetes inadults is 14.8%in the United States
11、(1)and 10.5%globally(2).The age-adjusted incidence of type 2 dia-betes in U.S.adults is 5.8 per 1000 persons;however,an estimated 23%of the U.S.adults with type 2 diabe-tes are undiagnosed(3).Type 2 diabetes is associated with higher risk formortality and morbidity,greater health care use,andgreater
12、 costs when adultswithdiabetes are comparedwith those without diabetes(4).The economic burdenof type 2 diabetes in the United States is substantial,with an annual estimated cost of$327 billion,includ-ing$237 billion in direct medical costs and$90 billionin reduced productivity(5).*This article,autho
13、red by Amir Qaseem,MD,PhD,MHA;Adam J.Obley,MD;Tatyana Shamliyan,MD,MS;Lauri A.Hicks,DO;Curtis S.Harrod,PhD,MPH;andCarolyn J.Crandall,MD,MS,was developed for the Clinical Guidelines Committee of the American College of Physicians.Individuals who served on theClinical Guidelines Committee from initiat
14、ion of the project until its approval were Carolyn J.Crandall,MD,MS(Chair);Lauri A.Hicks,DO(Vice Chair);Timothy J.Wilt,MD,MPH(Immediate Past Chair);Ethan M.Balk,MD,MPH;Thomas G.Cooney,MD;J.Thomas Cross Jr.,MD,MPH;Nick Fitterman,MD;Jennifer S.Lin,MD,MCR;Michael Maroto,JD,MBA;Matthew C.Miller,MD;Adam
15、J.Obley,MD;Douglas K.Owens,MD,MS;Paul Shekelle,MD,PhD,MPH;Jeffrey A.Tice,MD;and Janice E.Tufte.ACP staff were Kate Carroll,MPH;Itziar Etxeandia-Ikobaltzeta,PhD,PharmD;Curtis S.Harrod,PhD,MPH;Amir Qaseem,MD,PhD,MHA;Tatyana Shamliyan,MD,MS;and Jennifer Yost,PhD,RN.Approved by the ACP Board of Regents
16、on 4 November 2023.Author.Nonauthor contributor.Nonphysician public representative.See also:Related articlesEditorial commentWeb-OnlySupplementVisual Clinical GuidelineAnnals.orgAnnals of Internal Medicine 2024 American College of Physicians 1CLINICALGUIDELINEDownloaded from https:/annals.org by Gua
17、ngdong University of Technology on 04/19/2024.Type 2 diabetes disproportionately affects adultswith obesity and racial and ethnic minorities(6).Forexample,the age-adjusted prevalence of type 2 diabe-tes is higher in Black(19%)and Hispanic(21%)adultsthan in White adults(12%)(7).People with type 2 dia
18、-betes and social risk factors are more likely to die pre-maturely and to have health-related complications,poor access to high-quality health care,and difficultywith adherence to treatments than people with type 2diabetes who do not have adverse social risk factors(815).In the United States,the exc
19、ess risk for prema-ture deaths attributed to type 2 diabetes decreasedbetween 1997 and 2011 among Hispanic and Whiteadults,but not among Black adults(16).Access tohigh-quality health care in people with type 2 diabe-tes differs by race and ethnicity even after adjustmentfor socioeconomic,lifestyle,a
20、nd health factors(17).Itis important to note that race and ethnicity are socialconstructs rather than biological risk factors.Differencesin risk for diabetes and outcomes in people with diabe-tes may be mediated by such factors as social determi-nantsofhealth.Majortreatmentgoalsfor patientswithtype2
21、diabe-tes include adequate glycemic control and primary andsecondary prevention of atherosclerotic cardiovascularand kidney diseases,which account for nearly half of alldeaths among adults with type 2 diabetes(18).Despitemultiple treatment options,16%of adults with type 2diabetes have inadequate gly
22、cemic control,with hemo-globin A1c(HbA1c)levels of 9%or higher(7).Inadequateglycemic control is more prevalent among Black(24%)and Hispanic(29%)adults than among White adults(9%)with type 2 diabetes(7).In 2017,the American College of Physicians(ACP)published a clinical guideline on oral pharmacologi
23、ctreatments of type 2 diabetes focused on glycemiccontrol(19).The ACP Clinical Guidelines Committee(CGC)recommended that clinicians prescribe met-formin,in addition to lifestyle treatments,when phar-macologic therapy is needed to improve glycemiccontrol in adults with type 2 diabetes(19).SCOPE ANDPU
24、RPOSEThis ACP clinical guideline is an update to the 2017version(19)with evidence about the effectiveness andharms of newer pharmacologic treatments to reducetheriskforall-causemortality,cardiovascular morbidity,and progression of chronic kidney disease(CKD)inadults with type 2 diabetes.In addition
25、toincorporatingnetwork meta-analyses(NMAs),this clinical guidelineadds key questions on patient values and preferencesand economic evidence.Newer pharmacologic treatments include glucagon-like peptide-1(GLP-1)agonists(dulaglutide,exenatide,liraglutide,lixisenatide,and semaglutide),a GLP-1 ago-nist a
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- acp 临床 指南 成人 糖尿病 药物 治疗 医治
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