In August 2025, the BMJ published the Living Clinical Practice Guideline on the Effects of Pharmacological Agents for Type 2 Diabetes on Cardiorenal Outcomes and Weight Management. Compared with the 2021 version, three changes matter most for general practitioners: the guideline has become living and will be iteratively updated; finerenone and tirzepatide have been added; and risk stratification has been simplified from five to three strata with obesity incorporated into decision making. Importantly, the inclusion of finerenone indicates that treatment decisions in type 2 diabetes should focus on patient-important cardiovascular, kidney, and weight outcomes rather than glucose lowering alone. The accompanying visual evidence summaries and the Multiple and Treatment Comparison Health Intervention Tool (MATCH-IT) can help general practitioners intuitively present the absolute benefits, absolute risks, and treatment burden of different drugs to patients. Focusing on the primary care setting in China, this article interprets the clinical value of the living guideline, the rationale for incorporating finerenone into diabetes management guidelines, and the understanding and application of the new risk stratification in general practice outpatient settings.

BMJ于2025年8月发布了《2型糖尿病治疗药物对心肾结局及体质量管理作用：动态更新的临床实践指南》。与2021年版本相比，此次更新的部分内容值得基层全科医生关注：指南改为动态临床实践指南，推荐将随新证据持续迭代；新增非奈利酮和替尔泊肽，其中非奈利酮的纳入提示2型糖尿病药物治疗不应仅限于降糖，而应以心肾结局、体质量长期预后等患者重要终点为导向；风险分层由5层简化为3层，并将肥胖纳入决策维度。指南配套的可视化证据总结和多方案比较决策支持工具（MATCH-IT），可帮助全科医生将不同药物的绝对获益与风险和治疗负担直观地呈现于患者。本文结合我国基层医疗场景，重点解读动态指南的临床价值、非奈利酮被纳入糖尿病指南的理论依据，以及新版风险分层在全科门诊中的理解与应用。