Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus
Carlo Di Mario, Stefano Genovese, Gaetano Antonio Lanza, Edoardo Mannucci, Giancarlo Marenzi, Edoardo Sciatti, Dario Pitocco, the Expert Panel Group, Angelo Avogaro, Federico Bertuzzi, Enzo Bonora, Claudio Borghi, Raffaella Buzzetti, Stefano Carugo, Davide Capodanno, Agostino Consoli, Antonio Conti, Rossella Danesi, Paolo Di Bartolo, Gaetano Maria De Ferrari, Stefano Favale, Carlo Giorda, Francesco Giorgino, Angela Girelli, Paolo Golino, Francesco Grigioni, Ciro Indolfi, Concetta Irace, Elisabetta Lovati, Ada Maffettone, Maria Masulli, Fabrizio Oliva, Luigi Oltrona Visconti, Emanuela Orsi, Uberto Pagotto, Leonardo Paloscia, Gianfranco Parati, Pasquale Perrone, Gianfranco Piccirillo, Paolo Pozzilli, Giuseppe Pugliese, Francesco Purrello, Flavio Ribichini, Andrea Rubboli, Michele Senni, Roberto Trevisan, Claudio Tubili, Massimo Uguccioni
Abstract
BACKGROUND: Continuous glucose monitoring (CGM) shows in more detail the glycaemic pattern of diabetic subjects and provides several new parameters ("glucometrics") to assess patients' glycaemia and consensually guide treatment. A better control of glucose levels might result in improvement of clinical outcome and reduce disease complications. This study aimed to gather an expert consensus on the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk or with heart disease. METHODS: A list of 22 statements concerning type of patients who can benefit from CGM, prognostic impact of CGM in diabetic patients with heart disease, CGM use during acute cardiovascular events and educational issues of CGM were developed. Using a two-round Delphi methodology, the survey was distributed online to 42 Italian experts (21 diabetologists and 21 cardiologists) who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. RESULTS: Forty experts (95%) answered the survey. Every statement achieved a positive consensus. In particular, the panel expressed the feeling that CGM can be prognostically relevant for every diabetic patient (70%) and that is clinically useful also in the management of those with type 2 diabetes not treated with insulin (87.5%). The assessment of time in range (TIR), glycaemic variability (GV) and hypoglycaemic/hyperglycaemic episodes were considered relevant in the management of diabetic patients with heart disease (92.5% for TIR, 95% for GV, 97.5% for time spent in hypoglycaemia) and can improve the prognosis of those with ischaemic heart disease (100% for hypoglycaemia, 90% for hyperglycaemia) or with heart failure (87.5% for hypoglycaemia, 85% for TIR, 87.5% for GV). The experts retained that CGM can be used and can impact the short- and long-term prognosis during an acute cardiovascular event. Lastly, CGM has a recognized educational role for diabetic subjects. CONCLUSIONS: According to this Delphi consensus, the clinical and prognostic use of CGM in diabetic patients at high cardiovascular risk is promising and deserves dedicated studies to confirm the experts' feelings.