Khuyến cáo về kê đơn thuốc giảm cân ở bệnh nhân tiểu đường

• Scottish Intercollegiate Guidelines Network (SIGN) national clinical guideline on management of obesity can be found at SIGN 2010 Feb PDF, summary can be found in BMJ 2010 Feb 24;340:c154
• National Institute for Care Excellence (NICE) guidance on
  • update on obesity: identification, assessment, and management of overweight and obesity in children, young people, and adults can be found at NICE 2014 Nov 27:CG189PDF, summary can be found in BMJ 2014 Nov 27;349:g6608
  • obesity: prevention, identification, assessment, and management of overweight and obesity in adults and children can be found at NICE 2006 Dec 13:CG43, last updated 2015 Mar 15PDF
  • naltrexone–bupropion for managing overweight and obesity can be found at NICE 2017 Dec 12:TA94PDF

• review can be found in Endocrinol Metab (Seoul) 2014 Dec 29;29(4):410full-text
• review can be found in Curr Diabetes Rev 2007 May;3(2):95
• review of weight loss drugs for preventing progression from prediabetes to diabetes can be found in Endocr Pract 2015 Jun;21(6):634
• review of long-term drug therapy for obesity can be found in Arch Intern Med 2001 Aug 13/27;161(15):1814, commentary can be found in Arch Intern Med 2002 May 13;162(9):1070
• review of drug therapy can be found in J Clin Endocrinol Metab 2004 Jun;89(6):2616
• review of new options including medications for the treatment of obesity and type 2 diabetes can be found in J Diabetes Complications 2013 Sep-Oct;27(5):508full-text

The references listed below are used in this DynaMed topic primarily to support background information and for guidance where evidence summaries are not felt to be necessary. Most references are incorporated within the text along with the evidence summaries.

1. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100(2):342-62
2. Garvey WT, Mechanick JI, Brett EM, et al; American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocr Pract 2016 Jul;22 Suppl 3:1, executive summary can be found at Endocr Pract 2016 Jul;22(7):842

• American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) grading system
  • grades of recommendation
    • Grade A – best evidence level 1, or best evidence level 2 but adjusted upward for positive subjective factors
    • Grade B – best evidence level 2, or best evidence level 1 adjusted downward for negative subjective factors, or best evidence level 3 adjusted upward for positive subjective factors
    • Grade C – best evidence level 3, or best evidence level 2 adjusted downward for negative subjective factors, or best evidence level 4 adjusted upward for positive subjective factors
    • Grade D – best evidence level 4, or best evidence level 3 adjusted downward for negative subjective factors, or < two-thirds consensus (regardless of evidence level)
  • levels of evidence
    • Level 1 – randomized trials or meta-analysis of randomized trials
    • Level 2 – nonrandomized controlled trial, prospective cohort study, retrospective case-control study, or meta-analysis of these types of studies
    • Level 3 – cross-sectional study, surveillance study, consecutive case series, or single case reports
    • Level 4 – no evidence (theory, opinion, consensus, review, or preclinical study)
  • Reference – AACE/ACE comprehensive clinical practice guidelines for medical care of patients with obesity (Endocr Pract 2016 Jul;22 Suppl 3:1), executive summary can be found at Endocr Pract 2016 Jul;22(7):842

• Endocrine Society uses Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system
  • strength of recommendation
    • Strong recommendation – guideline panel members have high confidence that desirable effects of recommendation outweigh undesirable effects (or vice versa)
    • Weak recommendation – guideline panel members conclude with less confidence that desirable effects of recommendation probably outweigh undesirable effects, or benefits and harms are finely balanced, or appreciable uncertainty
  • quality of evidence
    • High-quality evidence – consistent evidence from well-performed randomized controlled trials, or exceptionally strong evidence from unbiased observational studies
    • Moderate-quality evidence – randomized controlled trials with important limitations (inconsistent results, methodological flaws, indirect or imprecise evidence), or unusually strong evidence from unbiased observational studies
    • Low-quality evidence – ≥ 1 critical outcome from observational studies, randomized controlled trials with serious flaws, or indirect evidence
    • Very low-quality evidence – ≥ 1 of the critical outcomes from unsystematic clinical observations or very indirect evidence
  • Reference – Endocrine Society clinical practice guideline on pharmacological management of obesity (J Clin Endocrinol Metab 2015 Feb;100(2):342)