New Guidelines Refine Treatment Strategies for Type 2 Diabetes, cardiovascular & Kidney Health
Recent clinical practice guidelines, published in the BMJ and highlighted by EurekAlert!, offer a nuanced approach to managing Type 2 Diabetes (T2D) and its frequently enough-linked complications – cardiovascular disease and kidney problems. Developed by an international panel of patient partners, clinicians, and methodologists, these recommendations represent a meaningful step forward in personalized diabetes care.
This isn’t just another set of guidelines.The panel rigorously followed the GRADE methodology - a globally recognized standard for trustworthy recommendations – ensuring a clear and evidence-based process. They conducted a living systematic review and network meta-analysis, incorporating data from an impressive 869 randomized controlled trials encompassing nearly half a million individuals with T2D.This massive dataset included 63 medications and tracked 26 key outcomes,as of July 31,2024.
A Risk-Stratified Approach: Who Benefits Most?
The core of these guidelines lies in a risk-stratified approach. Instead of a one-size-fits-all strategy, treatment decisions should be tailored to an individual’s risk level for cardiovascular and kidney complications. Here’s a breakdown of the key recommendations:
Lower Risk: For adults with a lower risk profile, the panel suggests against the routine use of SGLT-2 inhibitors or GLP-1 receptor agonists. Extensive data (110 trials with nearly 90,000 participants for SGLT-2 inhibitors and 109 trials with over 102,000 for GLP-1s) didn’t demonstrate sufficient benefit in this group to outweigh potential drawbacks.
Moderate Risk: For those at moderate risk, consideration should be given to both GLP-1s and SGLT-2 inhibitors.The evidence supporting their use in this population is robust, mirroring the trial data used for the lower-risk group.
Higher Risk: Adults facing a higher risk of cardiovascular and kidney complications should benefit from SGLT-2 inhibitors or GLP-1s. A considerable body of evidence - 219 trials involving nearly 199,000 participants - showed significant benefits for overall survival, cardiovascular health, and kidney function, clearly outweighing risks.
Chronic Kidney Disease (CKD) – Moderate Risk: Interestingly, the panel suggests against using finerenone in this group. Limited benefits, potential harms, cost considerations, and limited clinical experiance drove this weak proposal, based on data from 2 trials with over 13,000 participants.
CKD – Highest Risk: However, for individuals with CKD and the highest risk of cardiovascular and kidney complications, finerenone may be considered. Two trials indicated potential survival and kidney benefits that could outweigh the risks.
Obesity & T2D: Tirzepatide shows promise for adults with obesity and T2D. Though, healthcare providers should carefully weigh the stronger evidence base supporting the cardiovascular and kidney benefits of established GLP-1 receptor agonists when making treatment choices.
Shared Decision-Making is Key
These guidelines aren’t meant to be prescriptive. The panel emphasizes the critical importance of shared decision-making. Healthcare providers must accurately assess an individual’s risk profile using appropriate risk stratification tools and then engage in a collaborative discussion with the patient, considering their values and preferences.Why These Guidelines Matter
These updated recommendations represent a significant evolution in T2D management. By focusing on individualized risk assessment and prioritizing treatments with proven benefits, they offer the potential to improve outcomes, reduce complications, and enhance the quality of life for millions living with this chronic condition.
References:
- Cardiovascular, kidney-related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline. BMJ 2025;390:e082071. doi.org/10.1136/bmj-2024-082071
- Experts recommend SGLT-2 and GLP-1 diabetes drugs only for adults at moderate to higher risk of heart and kidney problems. EurekAlert! News release. August 14, 2025. Accessed August 29, 2025.https://www.e
