2022 中国专家共识：无临床心血管疾病或慢性肾脏疾病的新诊断2型

作者：中华医学网发布时间：2026-02-02 10:26浏览：次

Expert Consensus on Personalized Initiation of Glucose-Lowering Therapy in Adults with Newly Diagnosed Type 2 Diabetes without Clinical Cardiovascular Disease or Chronic Kidney Disease (2022)

Basic Information

Full Title: Expert consensus on personalized initiation of glucose-lowering therapy in adults with newly diagnosed type 2 diabetes without clinical cardiovascular disease or chronic kidney disease
Lead Author: Professor Tong Nanwei (West China Hospital, Sichuan University)
Publication Details: Published in Journal of Evidence-Based Medicine in 2022, DOI: 10.1111/jebm.12474
Target Population: Adult patients with newly diagnosed T2D without clinical CVD or CKD (may have related risk factors)
Core Purpose: To provide precision/personalized glucose-lowering strategies based on large-scale clinical trial evidence, balancing glycemic control and target organ protection (CVD, CKD, liver) for this specific cohort

Core Rationale

In patients with newly diagnosed T2D free of clinical CVD/CKD, atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF) are the main life-threatening comorbidities, making cardiovascular safety and protection a top priority in initial medication selection. For other subgroups, preventing CKD or hepatic fibrosis becomes the primary goal. Additional considerations include pharmacological properties, weight impact, hypoglycemia risk, comorbidities, combination regimens, cost, accessibility, and patient preference.

Personalized Stratification & Medication Recommendations

1. Stratification by Risk Profiles & Preferred Agents

Risk Subgroup	Recommended Medications	Priority Recommendations
Without ASCVD/HF/CKD risk factors (overweight/obese)	Metformin, AGI, SGLT2i, GLP-1 RA	SGLT2i preferred if affordable; GLP-1 RA (e.g., dulaglutide) preferred if injectable therapy is acceptable and cost-effective
Without ASCVD/HF/CKD risk factors (non-obese, no weight concerns)	Insulin secretagogues, pioglitazone, DPP-4i	Prioritize agents with neutral weight effects and low hypoglycemia risk
With multiple ASCVD risk factors (dyslipidemia, hypertension, smoking, premature ASCVD family history, etc.)	Metformin, AGI, GLP-1 RA, SGLT2i	Dulaglutide preferred when injectable therapy is feasible and cost-appropriate
With HF risk factors (hypertension, valvular heart disease, cardiomyopathy, sleep apnea, etc.)	SGLT2i	SGLT2i as first-line for HF risk mitigation
With CKD risk factors (hypertension, history of acute kidney injury, autoimmune renal disease, etc.)	SGLT2i, GLP-1 RA (liraglutide, dulaglutide, semaglutide)	SGLT2i first-line; GLP-1 RA as alternative if injectable therapy is tolerated

2. Glycemic Target-Based Treatment Initiation

When target HbA1c + 0.5% < current HbA1c ≤ target HbA1c + 1.5%: Implement lifestyle intervention + monotherapy.
If monotherapy fails to achieve target HbA1c after 3 months, initiate combination therapy with complementary mechanisms of action.
Select high-efficacy agents when the gap between current HbA1c and target value ≥ 1%.

Key Medication Selection Principles

Cardiorenal Protection Orientation: Prioritize SGLT2i and GLP-1 RA with confirmed cardiorenal benefits for patients with elevated ASCVD/HF/CKD risk, aligning with target organ protection goals.
Hypoglycemia Risk Control: Prefer agents with low intrinsic hypoglycemia risk (metformin, SGLT2i, DPP-4i, GLP-1 RA) as initial monotherapy; minimize combination with sulfonylureas/glinides unless necessary.
Weight Management Matching: For overweight/obese patients, prioritize weight-neutral or weight-lowering agents (SGLT2i, GLP-1 RA, metformin); avoid weight-promoting agents (e.g., some insulin secretagogues) in patients with weight-related concerns.
Practicality & Accessibility: Integrate cost, dosing convenience, and patient preference into shared decision-making to enhance long-term treatment adherence.

Core Consensus Highlights

This consensus fills the evidence gap for newly diagnosed T2D patients without clinical CVD/CKD, a population underrepresented in major cardiorenal outcome trials.
It establishes a risk-stratified, patient-centered framework that moves beyond one-size-fits-all protocols, linking medication selection to modifiable target organ risk factors.
It integrates glycemic efficacy, safety profiles, organ protection, and real-world clinical factors (cost, tolerance, administration route) to optimize personalized initial therapy.