PMID- 33768493 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210521 IS - 1869-6953 (Print) IS - 1869-6961 (Electronic) IS - 1869-6961 (Linking) VI - 12 IP - 5 DP - 2021 May TI - The "Early Treatment" Approach Reducing Cardiovascular Risk in Patients with Type 2 Diabetes: A Consensus From an Expert Panel Using the Delphi Technique. PG - 1445-1461 LID - 10.1007/s13300-021-01045-7 [doi] AB - INTRODUCTION: There is no consensus on the optimal therapeutic approach to adopt in patients with newly diagnosed type 2 diabetes mellitus (T2DM) to prevent cardiovascular disease (CVD). The study aimed to gather an expert consensus on the hypoglycemic treatment and CV risk management in patients with newly diagnosed T2DM through the Delphi methodology. METHODS: To address this issue, a list of 30 statements concerning the definition of "early T2DM patient", early treatment, CV risk in T2DM, treat-to-benefit approach, and indications for treatment with glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors was developed. Using a two-round Delphi methodology, the survey was distributed to 80 Italian diabetes specialists 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: A total of 27/30 statements achieved consensus. A patient was defined as "early" according to pathophysiological or clinical interpretation, and/or the timing of the diagnosis. There was agreement on the importance to reach the lowest possible HbA1c level, since diagnosis, also using combination therapy with hypoglycemic drugs with a proven CV benefit. There was a consensus that a treat-to-benefit approach involves the addition of a glucose-lowering agent with proven CV benefits to metformin since diagnosis. The use of GLP-1RAs and SGLT2 inhibitors was considered a key strategy in this approach and the benefits were recognized also for patients with T2DM without established CVD. GLP-1RAs should be used at an earlier stage than SGLT2 inhibitors to prevent CVD, especially in patients with evidence of subclinical atherosclerotic disease. CONCLUSION: This Delphi consensus recognized the importance to adopt a tailored hypoglycemic treatment of patients with T2DM according to their CVD risk and the key role of glucose-lowering agents with proven CV efficacy, GLP-1RAs and SGLT2 inhibitors, in the context of an early treat-to-benefit approach. FAU - Russo, Giuseppina AU - Russo G AUID- ORCID: 0000-0002-4565-3131 AD - Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. giuseppina.russo@unime.it. FAU - Monami, Matteo AU - Monami M AD - Unit of Diabetology and Metabolic Disease, Careggi Teaching Hospital and University of Florence, Florence, Italy. FAU - Perseghin, Gianluca AU - Perseghin G AD - Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy. AD - Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy. FAU - Avogaro, Angelo AU - Avogaro A AD - Department of Medicine, Section of Diabetes and Metabolic Diseases, University of Padova, Padova, Italy. FAU - Perrone Filardi, Pasquale AU - Perrone Filardi P AD - Department of Advanced Biomedical Sciences, Federico II University of Naples and Mediterranea Cardio Center Clinic of Naples, Naples, Italy. FAU - Senni, Michele AU - Senni M AD - Division of Cardiology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy. FAU - Borghi, Claudio AU - Borghi C AD - Medical and Surgery Sciences Department, Dyslipidemia and Atherosclerosis Research Unit, Alma Mater Studiorum University of Bologna, Bologna, Italy. FAU - Maggioni, Aldo P AU - Maggioni AP AD - ANMCO Research Center, Florence, Italy. LA - eng PT - Journal Article DEP - 20210325 PL - United States TA - Diabetes Ther JT - Diabetes therapy : research, treatment and education of diabetes and related disorders JID - 101539025 PMC - PMC8099991 OTO - NOTNLM OT - Delphi method OT - Expert consensus OT - GLP-1 receptor agonists OT - Glucose-lowering agents OT - SGLT2 inhibitors OT - Type 2 diabetes EDAT- 2021/03/27 06:00 MHDA- 2021/03/27 06:01 PMCR- 2021/03/25 CRDT- 2021/03/26 07:13 PHST- 2020/12/30 00:00 [received] PHST- 2021/03/02 00:00 [accepted] PHST- 2021/03/27 06:00 [pubmed] PHST- 2021/03/27 06:01 [medline] PHST- 2021/03/26 07:13 [entrez] PHST- 2021/03/25 00:00 [pmc-release] AID - 10.1007/s13300-021-01045-7 [pii] AID - 1045 [pii] AID - 10.1007/s13300-021-01045-7 [doi] PST - ppublish SO - Diabetes Ther. 2021 May;12(5):1445-1461. doi: 10.1007/s13300-021-01045-7. Epub 2021 Mar 25.