Newer Pharmacologic Treatments in Adults With Type 2 Diabetes: A Clinical Guideline From the American College of Physicians

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  Qaseem, Amir ; Obley, Adam J. ; Shamliyan, Tatyana ; Hicks, Lauri A. ; Harrod, Curtis S. ; Crandall, Carolyn J.
• Description:
  Description:
  
  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.
  
  Methods:
  
  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.
  
  Audience and Patient Population:
  
  The audience for this clinical guideline is physicians and other clinicians. The population is nonpregnant adults with type 2 diabetes.
  
  Recommendation 1:
  
  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).
  
  Recommendation 2:
  
  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).
  
  
• Subjects:
  Adult Diabetes Mellitus, Type 2 Dipeptidyl-Peptidase IV Inhibitors Drug Therapy, Combination Glucagon-Like Peptide 1 Humans Hypoglycemic Agents Insulin Sodium-Glucose Transporter 2 Inhibitors
• Source:
  Ann Intern Med. 177(5):658-666
• Pubmed ID:
  38639546
• Pubmed Central ID:
  PMC11614146
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  177
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:c95c180572cbad1af733c1ebb7a935e7f712e5b725ebeebc4425ce8ca986147f1e3c0055b060a53babd2b01c65bcf79f1e18ac7c46f4e1c22fa43f0e00fd18f3
• Download URL:
  https://stacks.cdc.gov/view/cdc/174262/cdc_174262_DS1.pdf
• File Type:
  [PDF - 981.32 KB ]