[Grey zones on diabetes in cardiovascular disease. Expert opinion]
Roberto Trevisan1, Aurelia Grosu2, Angelo Avogaro3
1U.O.C. Malattie Endocrine 1-Diabetologia, Dipartimento di Medicina, ASST Papa Giovanni XXIII, Bergamo.
Insights
Experts discuss uncertainties in cardiology guidelines for diabetes patients. This review clarifies cardiovascular screening and glycated hemoglobin targets, incorporating recent trial evidence for better clinical practice.
Area of Science:
- Cardiology
- Endocrinology
- Clinical Evidence Synthesis
Background:
- Clinical guidelines offer therapeutic direction but contain evidence gaps ('grey zones').
- Cardiology and diabetes mellitus present significant areas needing clarification.
- Expert consensus is crucial for navigating clinical practice uncertainties.
Purpose of the Study:
- To identify and address key evidence gaps in cardiology related to diabetes mellitus.
- To compare expert opinions on controversial topics in cardiovascular disease management for diabetic patients.
- To provide evidence-based conclusions to guide clinical decision-making.
Main Methods:
- A conference symposium focused on grey zones in cardiology for diabetic patients.
- Expert comparison and discussion were used to reach shared conclusions.
- Inclusion of recent randomized trial evidence published post-conference.
Main Results:
- The symposium addressed the appropriateness of universal second-level cardiovascular screening in diabetic populations.
- The validity of specific glycated hemoglobin targets was evaluated in light of recent clinical trials.
- Consensus statements were developed to clarify clinical practice.
Conclusions:
- Expert consensus can help resolve ambiguities in clinical guidelines.
- Evidence-based recommendations for cardiovascular screening and glycemic control in diabetes are refined.
- This work aims to improve therapeutic choices in managing cardiovascular disease in diabetic patients.
Abstract:
Clinical guidelines, while representing an objective reference to perform correct therapeutic choices, contain grey zones, where recommendations are not supported by solid evidence. In a conference held in Bergamo in October 2018, an attempt was made to highlight some of the main grey zones in Cardiology and, through a comparison between experts, to draw shared conclusions that can illuminate our clinical practice. This manuscript contains the statements of the symposium concerning the controversies in diabetes mellitus and cardiovascular disease. The first topic concerns the appropriateness of second level cardiovascular screening of the entire population of diabetic patients. The second gap in evidence concerns the validity of a target of glycated hemoglobin considering the last trials. The work has also been implemented with the evidences deriving from important randomized studies published after the date of the Conference.
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