An international panel of experts has released updated treatment guidelines in The BMJ.
They recommended that two newer types of medications—SGLT-2 inhibitors and GLP-1 receptor agonists—should be prescribed to most adults with type 2 diabetes who are at high or moderate risk of heart and kidney complications.
The panel, part of The BMJ’s “Rapid Recommendations” initiative, suggests that these drugs can significantly reduce the risks of serious health problems such as heart attack, stroke, and kidney failure.
For people with higher risk, the benefits are considered strong enough that nearly all should be taking one or both of these medications.
For adults at moderate risk, the panel also supports using these drugs in most cases. However, for those at lower risk, routine use is not recommended. Instead, they suggest doctors have open discussions with patients about the pros and cons, taking into account the patient’s preferences and values.
In people with type 2 diabetes who also have chronic kidney disease and are at high risk of complications, the panel recommends the use of another drug called finerenone, which has shown more benefits than risks. But they advise against its use in people at moderate risk, where the balance of benefit is less clear.
For those with both diabetes and obesity, the panel highlights the importance of weight loss along with reducing heart and kidney risks. They recommend considering tirzepatide, a medication that has shown strong effects on weight loss, regardless of the person’s level of cardiovascular or kidney risk.
Still, they caution that tirzepatide should not automatically replace GLP-1 receptor agonists, especially in high-risk patients. GLP-1 drugs have stronger evidence supporting their benefits for heart and kidney health, while tirzepatide is better at reducing weight.
The choice between the two should be made based on the patient’s overall health risks and their treatment priorities.
This new guideline is based on a “living” systematic review of nearly 500,000 adults with type 2 diabetes from 869 randomized controlled trials. It is designed to be continuously updated as new research becomes available.
The panel used the GRADE system to assess the quality of evidence and ensure recommendations are based on trustworthy, up-to-date science.
The guideline includes an interactive tool called MATCH-IT to help patients and healthcare providers make informed decisions together. However, the experts recognize that high costs or limited access to these medications may be a barrier, especially in some countries.
“This massive global review shows the value of collaboration on continuously updated evidence to support healthcare decisions,” said Professor Per Olav Vandvik, a senior author of the report.
He encourages global partnerships, such as the Alliance for Living Evidence (ALIVE) and the Evidence Synthesis Infrastructure Collaborative (ESIC), to adapt and share these guidelines widely.
Regular updates to these recommendations will follow as new data emerges, helping health systems around the world provide better care for people with diabetes.
If you care about diabetes, please read studies about Scientists find a promising treatment for type 2 diabetes and findings of Certain type 2 diabetes treatment may bring heart risks.
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The study is published in BMJ.
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