摘要2型糖尿病（T2DM）患者易发生动脉粥样硬化性心血管疾病（ASCVD）和慢性肾脏病（CKD），且心肾疾病为T2DM致残和致死的主要原因。因此，应该对T2DM患者进行心血管风险评估，并筛查和防治心肾疾病。本共识中推荐，对于T2DM合并ASCVD或心血管风险极高危、心力衰竭（HF）或CKD患者，如果没有禁忌证或不耐受，二甲双胍应作为一线降糖药物并一直保留在治疗方案中；同时，不论患者的糖化血红蛋白（HbA 1c）是否达标，T2DM合并ASCVD或心血管风险极高危的患者建议优先联合具有心血管获益证据的胰高糖素样肽-1受体激动剂（GLP-1RA）或钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）；T2DM合并HF患者建议优先联合SGLT2i；T2DM合并CKD患者建议优先联合SGLT2i，若不能使用SGLT2i，建议联合具有肾脏获益证据的GLP-1RA。此外，在T2DM合并ASCVD、HF或CKD的患者中，还需全面管理好其他心血管危险因素，包括生活方式干预、降压、调脂、抗血小板治疗等，同时应特别注意防范低血糖。

abstractsPatients with type 2 diabetes mellitus (T2DM) are at risk of developing atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD), which are important causes of disabling and death in these patients. For the prevention and management of both ASCVD and CKD, cardiovascular risk factors should be systematically evaluated, and ASCVD and CKD should be screened in patients with T2DM. In this consensus, it is recommended that metformin is the first-line hypoglycemic agent for patients with T2DM and established ASCVD or very high cardiovascular risk, heart failure (HF), or CKD, and it should be remaining in the treatment regimen unless contraindicated or intolerable. In patients with T2DM and established ASCVD or very high cardiovascular risk, addition of glucagon-like peptide 1 receptor agonist (GLP-1RA) or sodium-glucose cotransporter 2 inhibitor (SGLT2i) with proven cardiovascular benefit should be considered whatever the level of glycated hemoglobin (HbA 1c). SGLT2i should be preferably added on the therapies of patients with T2DM and HF. In patients with T2DM and CKD, SGLT2i should be preferred for the combination therapy, and GLP-1RA with proven renal benefit would be alternative if SGLT2i is contraindicated. The prevention of hypoglycemia and management of multiple risk factors, including lifestyle modification, antihypertensive, lipid-lowering and antiplatelet therapies, should be kept in mind in treating patients with T2DM and ASCVD, HF or CKD.