Guía de práctica clínica para el tratamiento y seguimiento de la diabetes mellitus tipo 2 en la población colombiana mayor de 18 años: Asociación Colombiana de Endocrinología, Diabetes y Metabolismo, 2025

Background: The Colombian Association of Endocrinology, Diabetes and Metabolism (ACE) developed this clinical practice guideline with the aim of providing updated recommendations for the management and follow-up of individuals living with type 2 diabetes mellitus (T2DM) in Colombia. This update responds to the need to revise the recommendations established in the national guideline published in 2016, in light of recent and robust global scientific evidence that has substantially modified the therapeutic approach.Objective: The guideline emphasizes the preventive approach to cardiovascular and renal outcomes, as well as the integration of lifestyle interventions and the incorporation of technology as an essential component of a holistic approach to T2DM care.Methods: The guideline was developed using the GRADE methodology, in accordance with the AGREE II and Institute of Medicine standards. The process included the formulation of nine PICO questions, systematic literature searches, critical appraisal of evidence, and formulation of recommendations by an interdisciplinary panel with patient participation. Transparency was ensured through conflict-of-interest management and external international review.Main recommendations: Combination therapy with metformin and either a sodiumglucose cotransporter-2 inhibitor (SGLT2i) or a dipeptidyl peptidase-4 inhibitor (DPP-4i) is recommended for patients with significantly elevated HbA1c levels, while combinations with sulfonylureas are discouraged.In patients who do not reach glycemic targets with metformin monotherapy, adding an SGLT2i or a glucagon-like peptide-1 receptor agonist (AR GLP-1) is suggested, the latter being particularly indicated in individuals with overweight, obesity, or markedly elevated HbA1c.For patients with inadequate glycemic control despite oral antidiabetic therapy, the preferred next step is the addition of a AR GLP-1, especially in those with a body mass index (BMI) >27 kg/m². Basal insulin should be considered when glycemic control is not achieved with a AR GLP-1.In cases of T2DM associated with overweight or obesity, the use of AR GLP-1s or dual GLP-1/GIP receptor agonists is recommended. In individuals with class II or higher obesity, metabolic or bariatric surgery may be considered, provided it is accompanied by patient education, individualized risk–benefit assessment, and performed in specialized reference centers.Cardiorenal protective therapies (SGLT2i, AR GLP-1, finerenone) should be prioritized and initiated regardless of glycemic control or concomitant therapy, in individuals with atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, according to individual clinical profiles.The use of real-time continuous glucose monitoring (CGM) systems is recommended in patients receiving multiple daily insulin doses and experiencing hypoglycemia or inadequate glycemic control.Finally, the guideline underscores the importance of continuous diabetes education and a multidisciplinary approach as cornerstones of comprehensive care for all individuals with T2DM.Conclusions: This guideline provides a practical and rigorous framework for the comprehensive management of T2DM in Colombia, with recommendations tailored to the national context and high potential to improve quality of life and reduce disease burden.