Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus
Authors: Di Mario Carlo , Genovese Stefano , Lanza Gaetano A. , Mannucci Edoardo , Marenzi Giancarlo , Sciatti Edoardo , Pitocco Dario ,   the Expert Panel Group, Avogaro Angelo , Bertuzzi Federico , Bonora Enzo , Borghi Claudio , Buzzetti Raffaella , Carugo Stefano , Capodanno Davide , Consoli Agostino , Conti Antonio , Danesi Rossella , Bartolo Paolo , Ferrari Gaetano Maria De , Favale Stefano , Giorda Carlo , Giorgino Francesco , Girelli Angela , Golino Paolo , Grigioni Francesco , Indolfi Ciro , Irace Concetta , Lovati Elisabetta , Maffettone Ada , Masulli Maria , Oliva Fabrizio G , Oltrona Visconti Luigi , Orsi Emanuela , Pagotto Uberto , Paloscia Leonardo , Parati Gianfranco , Perrone Pasquale , Piccirillo Gianfranco , Pozzilli Paolo , Pugliese Giuseppe , Purrello Francesco , Ribichini Flavio , Rubboli Andrea , Senni Michele , Trevisan Roberto , Tubili Claudio , Uguccioni Massimo 
Published: August 2022

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.