本文由小咖机器人翻译整理

期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-2788

摘要内容如下：

描述

美国内科医师学会（ACP）制定了这一临床指南，以更新对2型糖尿病新药物治疗的建议。该临床指南是基于有效性、比较益处和危害、考虑患者的价值和偏好以及成本的最佳可用证据。

方法

本临床指南基于对新型药物治疗2型糖尿病的有效性和危害的系统回顾，包括胰高血糖素样肽-1（GLP-1）激动剂、GLP-1激动剂和葡萄糖依赖性促胰岛素多肽激动剂、钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂、二肽基肽酶-4（DPP-4）抑制剂和长效胰岛素，可单独使用或与其他药物联合使用。临床指南委员会优先考虑以下结果，并使用GRADE（建议评估、制定和评估分级）方法进行评估：全因死亡率、主要不良心血管事件、心肌梗死、卒中、充血性心力衰竭住院、慢性肾病进展、严重不良事件和严重低血糖。体重减轻，以达到至少10%的总体体重减轻的参与者的百分比来衡量，是一个优先结果，但数据不足以进行网络荟萃分析，也没有按等级进行评级。

受众和患者群体

本临床指南的受众是内科医生和其他临床医生。人群是患有2型糖尿病的非妊娠成人。

建议1

ACP建议在患有2型糖尿病和血糖控制不佳的成人中，在二甲双胍和生活方式调整的基础上添加钠-葡萄糖协同转运蛋白-2（SGLT-2）抑制剂或胰高血糖素样肽-1（GLP-1）激动剂（强烈推荐；高确定性证据）。

•使用SGLT-2抑制剂可降低全因死亡率、主要不良心血管事件、慢性肾病进展和因充血性心力衰竭住院的风险。

•使用GLP-1激动剂降低全因死亡率、主要不良心血管事件和卒中的风险。

建议2

ACP建议，对于患有2型糖尿病且血糖控制不佳的成人，不要在二甲双胍和生活方式调整中添加二肽基肽酶-4（DPP-4）抑制剂，以降低发病率和全因死亡率（强烈推荐；高确定性证据）。

英文原文如下：

Abstracts

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).

• Use an SGLT-2 inhibitor to reduce the risk for all-cause mortality, major adverse cardiovascular events, progression of chronic kidney disease, and hospitalization due to congestive heart failure.

• Use a GLP-1 agonist to reduce the risk for all-cause mortality, major adverse cardiovascular events, and stroke.

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).

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