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In this context, a joint panel of four endocrinology societies from Brazil and Portugal was established to develop an evidence-based guideline for treatment of hyperglycemia in T2DM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>MEDLINE (via PubMed) was searched for randomized clinical trials, meta-analyses, and observational studies related to diabetes treatment. When there was insufficient high-quality evidence, expert opinion was sought. Updated positions on treatment of T2DM patients with heart failure (HF), atherosclerotic CV disease (ASCVD), chronic kidney disease (CKD), and patients with no vascular complications were developed. The degree of recommendation and the level of evidence were determined using predefined criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and conclusions<\/jats:title><jats:p>In non-pregnant adults, the recommended HbA<jats:sub>1c<\/jats:sub>target is below 7%. Higher levels are recommended in frail older adults and patients at higher risk of hypoglycemia. Lifestyle modification is recommended at all phases of treatment. Metformin is the first choice when HbA<jats:sub>1c<\/jats:sub>is 6.5\u20137.5%. When HbA<jats:sub>1c<\/jats:sub>is 7.5\u20139.0%, dual therapy with metformin plus an SGLT2i and\/or GLP-<jats:sub>1<\/jats:sub>RA (first-line antidiabetic agents, AD1) is recommended due to cardiovascular and renal benefits. If an AD1 is unaffordable, other antidiabetic drugs (AD) may be used. Triple or quadruple therapy should be considered when HbA<jats:sub>1c<\/jats:sub>remains above target. In patients with clinical or subclinical atherosclerosis, the combination of one AD1 plus metformin is the recommended first-line therapy to reduce cardiovascular events and improve blood glucose control. In stable heart failure with low ejection fraction (&lt;\u200940%) and glomerular filtration rate (eGFR)\u2009&gt;\u200930\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>, metformin plus an SGLT-2i is recommended to reduce cardiovascular mortality and heart failure hospitalizations and improve blood glucose control. In patients with diabetes-associated chronic kidney disease (CKD) (eGFR 30\u201360\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>or eGFR 30\u201390\u00a0mL\/min\/1.73\u00a0m<jats:sup>2<\/jats:sup>with albuminuria\u2009&gt;\u200930\u00a0mg\/g), the combination of metformin and an SGLT2i is recommended to attenuate loss of renal function, reduce albuminuria and improve blood glucose control. In patients with severe renal failure, insulin-based therapy is recommended to improve blood glucose control. Alternatively, GLP-<jats:sub>1<\/jats:sub>RA, DPP4i, gliclazide MR and pioglitazone may be considered to reduce albuminuria. In conclusion, the current evidence supports individualizing anti-hyperglycemic treatment for T2DM.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13098-020-00551-1","type":"journal-article","created":{"date-parts":[[2020,5,24]],"date-time":"2020-05-24T11:02:52Z","timestamp":1590318172000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8307-3162","authenticated-orcid":false,"given":"Marcello Casaccia","family":"Bertoluci","sequence":"first","affiliation":[]},{"given":"Jo\u00e3o Eduardo Nunes","family":"Salles","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9","family":"Silva-Nunes","sequence":"additional","affiliation":[]},{"given":"Hermelinda Cordeiro","family":"Pedrosa","sequence":"additional","affiliation":[]},{"given":"Rodrigo Oliveira","family":"Moreira","sequence":"additional","affiliation":[]},{"given":"Rui Manuel Calado","family":"da Silva Duarte","sequence":"additional","affiliation":[]},{"given":"Davide Mauricio","family":"da Costa Carvalho","sequence":"additional","affiliation":[]},{"given":"F\u00e1bio Rog\u00e9rio","family":"Trujilho","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o Filipe Cancela","family":"dos Santos Raposo","sequence":"additional","affiliation":[]},{"given":"Erika Bezerra","family":"Parente","sequence":"additional","affiliation":[]},{"given":"Fernando","family":"Valente","sequence":"additional","affiliation":[]},{"given":"F\u00e1bio Ferreira","family":"de Moura","sequence":"additional","affiliation":[]},{"given":"Alexandre","family":"Hohl","sequence":"additional","affiliation":[]},{"given":"Miguel","family":"Melo","sequence":"additional","affiliation":[]},{"given":"Francisco Garcia Pestana","family":"Araujo","sequence":"additional","affiliation":[]},{"given":"Rosa Maria Monteiro Castro","family":"de Ara\u00fajo Principe","sequence":"additional","affiliation":[]},{"given":"Rosane","family":"Kupfer","sequence":"additional","affiliation":[]},{"given":"Adriana","family":"Costa e Forti","sequence":"additional","affiliation":[]},{"given":"Cynthia Melissa","family":"Valerio","sequence":"additional","affiliation":[]},{"given":"H\u00e9lder Jos\u00e9","family":"Ferreira","sequence":"additional","affiliation":[]},{"given":"Jo\u00e3o Manuel Sequeira","family":"Duarte","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9 Francisco Kerr","family":"Saraiva","sequence":"additional","affiliation":[]},{"given":"Melanie","family":"Rodacki","sequence":"additional","affiliation":[]},{"given":"Maria Helane Costa Gurgel","family":"Castelo","sequence":"additional","affiliation":[]},{"given":"Mariana Pereira","family":"Monteiro","sequence":"additional","affiliation":[]},{"given":"Patr\u00edcia Quadros","family":"Branco","sequence":"additional","affiliation":[]},{"given":"Pedro Manuel Patricio","family":"de Matos","sequence":"additional","affiliation":[]},{"given":"Pedro Carneiro","family":"de Melo Pereira de Magalh\u00e3es","sequence":"additional","affiliation":[]},{"given":"Roberto Tadeu Barcellos","family":"Betti","sequence":"additional","affiliation":[]},{"given":"Ros\u00e2ngela Roginski","family":"R\u00e9a","sequence":"additional","affiliation":[]},{"given":"Thaisa Dourado Guedes","family":"Trujilho","sequence":"additional","affiliation":[]},{"given":"Lana Catani Ferreira","family":"Pinto","sequence":"additional","affiliation":[]},{"given":"Cristiane Bauermann","family":"Leit\u00e3o","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2020,5,24]]},"reference":[{"key":"551_CR1","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13098-017-0251-z","volume":"9","author":"MC Bertoluci","year":"2017","unstructured":"Bertoluci MC, Moreira RO, Faludi A, Izar MC, Schaan BD, Valerio CM, et al. 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sits on the advisory board of Sanofi.Fernando Valente: NovoNordisk, AstraZeneca.F\u00e1bio Ferreira de Moura: has received speaker\u2019s fees and\/or support for participation in scientific conferences from Novo Nordisk, AstraZeneca, and Boehringer Ingelheim.Alexandre Hohl: has served as a scientific consultant for AstraZeneca, Novo Nordisk, and Sanofi.Miguel Melo: has consulting relationships with Bial and has participated in advisory panels and presented lectures for: Abbott, AstraZeneca, Bial, Boehringer Ingelheim, Johnson & Johnson, Lilly, NovoNordisk, Sanofi.Francisco Garcia Pestana Araujo: has received speaker\u2019s fees from and\/or served as an investigator in trials sponsored by Astra, Lilly, Medinfar, MSD, Tecninfar.Rosa Maria Monteiro Castro de Ara\u00fajo Principe: has served as a clinical investigator in trials sponsored by Novo Nordisk, Bayer, and Sanofi.Adriana Costa e Forti: has received clinical research grants and\/or support for participation in scientific conferences from AstraZeneca, Boehringer, Lilly, MSD, Novo Nordisk, Sanofi, Takeda.Cynthia Melissa Valerio: has received clinical research grants, speaker\u2019s fees, and\/or support for participation in scientific conferences from Novo Nordisk, Takeda, and Novartis.Jo\u00e3o Manuel Sequeira Duarte: has received grants and fees as consultant, speaker and investigator in clinical trials from Sanofi, Lilly, AstraZeneca, Novo Nordisk, Boehringer Ingelheim, Mundipharma, MSD, Tecnimed, and Bial.Melanie Rodacki: has received event sponsorship and speaker\u2019s fees from Novo Nordisk, Abbott, and Sanofi.Pedro Manuel Patricio de Matos: has sat on advisory boards for MSD and AstraZeneca, and has received honoraria and research support from MSD, AstraZeneca, Boehringer-Lilly, Novo Nordisk, Abbott, and Bayer AG.Pedro Carneiro de Melo Pereira de Magalh\u00e3es: has served as principal investigator in clinical trials sponsored by Bayer Pharma AG and Novo Nordisk; sits on advisory or expert boards for AstraZeneca; and has received support for participation in scientific conferences from Bial, Medinfar, Novo Nordisk, Sanofi.Ros\u00e2ngela Roginski R\u00e9a: has received clinical research grants, speaker\u2019s fees, and\/or support for participation in scientific conferences from AstraZeneca, Boehringer-Ingelheim, Eli Lilly, Janssen, Merck, MSD, Novo Nordisk, Sanofi, and Takeda.Roberto Tadeu Barcellos Betti, Patr\u00edcia Quadros Branco, Rosane Kupfer, Thaisa Dourado Guedes Trujilho, Maria Helane Costa Gurgel Castelo, Cristiane Bauermann Leit\u00e3o, H\u00e9lder Jos\u00e9 Ferreira, Jos\u00e9 Francisco Kerr Saraiva, Mariana Pereira Monteiro, Lana Catani Ferreira Pinto declare no conflicts of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"45"}}