{
  "abstract": "Abstract Clinical question What are the benefits and harms of medications for adults with type 2 diabetes at varied risks of cardiovascular and kidney related complications?Context Emerging clinical trials of novel medications have demonstrated benefits on cardiovascular, kidney, and weight related outcomes in people with type 2 diabetes. Dynamically updated practice guidelines adhering to standards of trustworthiness are necessary in response to a rapidly evolving evidence base and the availability of multiple medication alternatives. This living practice guideline incorporates the latest available medications and evidence and provides recommendations stratified by risks of cardiovascular and kidney complications to inform diabetes management.Recommendations The panel issued risk-stratified recommendations regarding four prioritised medications for adults with type 2 diabetes (SGLT-2 inhibitors, GLP-1 receptor agonists, finerenone and tirzepatide):• Lower risk (three or fewer cardiovascular risk factors without established cardiovascular disease (CVD) or chronic kidney disease (CKD)): weak recommendation against SGLT-2 inhibitors or GLP-1 receptor agonists.• Moderate risk (more than three cardiovascular risk factors without established CVD or CKD; or established CVD and/or CKD at lower risk of complications): weak recommendation in favour of SGLT-2 inhibitors or GLP-1 receptor agonists; and a weak recommendation against finerenone in adults with CKD.• Higher risk (established CVD and/or CKD at higher risk of complications, or established heart failure): strong recommendation in favour of SGLT-2 inhibitors or GLP-1 receptor agonists; and a weak recommendation in favour of finerenone in adults with CKD.• Across risk strata: weak recommendation in favour of tirzepatide in adults with obesity.About this guideline and how it was created An international panel including two patient partners, clinicians, and methodologists produced these recommendations. The panel followed standards for trustworthy guidelines and used the GRADE approach, explicitly considering the balance of benefits, harms and burdens of treatment from an individual patient perspective. Recommendations were informed by a linked living systematic review and network meta-analysis evaluating relative benefits and harms updated to 31 July 2024; and by linked systematic reviews addressing risk prediction models and values and preferences of adults with type 2 diabetes. Candidate therapeutics are prioritised based on availability of sufficient randomised trial data, relevance to a global audience and likelihood of changing practice.This is the first version of the living guideline. The guideline is part of the BMJ Rapid Recommendations series. MAGICapp displays the most recent version of the guideline and full content including evidence summaries and decision aids; major updates will be published in The BMJ. We encourage re-use, adaptation and translation of these living guidelines, and recognise that the lack of availability or high costs of some medications may be prohibitive and will impact on how these recommendations are implemented across different health care systems.",
  "authors": [
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada",
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway"
      ],
      "name": "Arnav Agarwal"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "Department of Internal Medicine, Division of Nephrology and Hypertension, University of Kansas, KS, USA"
      ],
      "name": "Reem Mustafa"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis, CA, USA"
      ],
      "name": "Veena Manja"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway",
        "Division of General Internal Medicine, Department of Medicine, Hôpitaux Universitaire de Genève and University of Geneva, Geneva, Switzerland"
      ],
      "name": "Thomas Agoritsas"
    },
    {
      "affiliations": [
        "The BMJ, BMA House, Tavistock Square, London, UK"
      ],
      "name": "Helen Macdonald"
    },
    {
      "affiliations": [
        "Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China",
        "Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China"
      ],
      "name": "Sheyu Li"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway",
        "Ted Rogers Center for Heart Research, Toronto, Ontario, Canada"
      ],
      "name": "Farid Foroutan"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada"
      ],
      "name": "Daniel Rayner"
    },
    {
      "affiliations": [
        "Endocrinology Division, Department of Internal Medicine, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico",
        "Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon Facultad de Medicina, Monterrey, Nuevo León, Mexico",
        "Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, USA"
      ],
      "name": "René Rodriguez-Gutierrez"
    },
    {
      "affiliations": [
        "Department of Endocrinology, Clinic of Medicine, St Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway",
        "HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway"
      ],
      "name": "Bjørn Olav Åsvold"
    },
    {
      "affiliations": [
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway",
        "Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway"
      ],
      "name": "Anja Fog Heen"
    },
    {
      "affiliations": [
        "Palestine Diabetes Institute, Nablus, Palestine"
      ],
      "name": "Jenan Gabi"
    },
    {
      "affiliations": [
        "Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China"
      ],
      "name": "Lixin Guo"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China"
      ],
      "name": "Qiukui Hao"
    },
    {
      "affiliations": [
        "Future Evidence Foundation, Melbourne, Australia"
      ],
      "name": "Britta Tendel Jeppesen"
    },
    {
      "affiliations": [
        "George Institute for Global Health, New Delhi, India",
        "School of Public Health, Imperial College London, South Kensington Campus, London, UK",
        "Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India"
      ],
      "name": "Vivekanand Jha"
    },
    {
      "affiliations": [
        "Department of Nephrology, Ghent University Hospital, Ghent, Belgium"
      ],
      "name": "Evi Nagler"
    },
    {
      "affiliations": [
        "patient partner, USA"
      ],
      "name": "Adrienne Odom"
    },
    {
      "affiliations": [
        "Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland",
        "Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"
      ],
      "name": "Nicolas Rodondi"
    },
    {
      "affiliations": [
        "Department of Endocrinology, Kasturba Medical College (KMC)- Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India"
      ],
      "name": "Sahana Shetty"
    },
    {
      "affiliations": [
        "Solidaris, Brussels, Belgium"
      ],
      "name": "Mieke Vermandere"
    },
    {
      "affiliations": [
        "patient partner, USA"
      ],
      "name": "Robin Wright"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada",
        "Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada",
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway"
      ],
      "name": "Gordon Guyatt"
    },
    {
      "affiliations": [
        "MAGIC Evidence Ecosystem Foundation, Oslo, Norway",
        "Institute of Health and Society, University of Oslo Faculty of Medicine, Oslo, Norway"
      ],
      "name": "Per Olav Vandvik"
    }
  ],
  "title": "Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline",
  "uid": "153b0060-09c8-52aa-ae4e-9db32485ff5e"
}