Evidence mapPaperPMID 40813129Full record

GuidelineBMJ (Clinical research ed.)2025

Cardiovascular, kidney related, and weight loss effects of therapeutics for type 2 diabetes: a living clinical practice guideline.

Arnav Agarwal, Reem Mustafa, Veena Manja, Thomas Agoritsas, Helen Macdonald, Sheyu Li, Farid Foroutan, Daniel Rayner, René Rodriguez-Gutierrez, Bjørn Olav Åsvold and 14 more

Abstract readPractice Guideline
In one paragraph

Guideline in BMJ (Clinical research ed.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Cardiorenal outcomes of weight loss interventions in people with CKD and type 2 diabetes.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026
    Article
  4. Review
  5. Article
  6. Review
  7. Review
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

24 authors.

Arnav AgarwalDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Reem MustafaDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Veena ManjaDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Thomas AgoritsasDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada per@magicevidence.org thomas@magicevidence.org.
Helen MacdonaldThe BMJ, BMA House, Tavistock Square, London, UK.
Sheyu LiDepartment of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
Farid ForoutanDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Daniel RaynerDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
René Rodriguez-GutierrezEndocrinology Division, Department of Internal Medicine, Hospital Universitario Dr José Eleuterio González, Monterrey, Nuevo León, Mexico.
Bjørn Olav ÅsvoldDepartment of Endocrinology, Clinic of Medicine, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Anja Fog HeenMAGIC Evidence Ecosystem Foundation, Oslo, Norway.
Jenan GabiPalestine Diabetes Institute, Nablus, Palestine.
Lixin GuoDepartment of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Qiukui HaoDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Britta Tendel JeppesenFuture Evidence Foundation, Melbourne, Australia.
Vivekanand JhaGeorge Institute for Global Health, New Delhi, India.
Evi NaglerDepartment of Nephrology, Ghent University Hospital, Ghent, Belgium.
Adrienne Odompatient partner, USA.
Nicolas RodondiInstitute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Sahana ShettyDepartment of Endocrinology, Kasturba Medical College (KMC)- Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India.
Mieke VermandereSolidaris, Brussels, Belgium.
Robin Wrightpatient partner, USA.
Gordon GuyattDepartment of Health Research Methods, Evidence and Impact, Hamilton, Ontario, Canada.
Per Olav VandvikMAGIC Evidence Ecosystem Foundation, Oslo, Norway per@magicevidence.org thomas@magicevidence.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

clinical questionWhat 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

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 2Hypoglycemic AgentsRenal Insufficiency, ChronicWeight LossGlucagon-Like Peptide-1 Receptor AgonistsHumansSodium-Glucose Transporter 2 InhibitorsGlucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsSodium-Glucose Transporter 2 Inhibitors

Identifiers

PMID40813129
PMCPMC12355350

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.