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The "Early Treatment" Approach Reducing Cardiovascular Risk in Patients with Type 2 Diabetes: A Consensus From an
Giuseppina Russo1, Matteo Monami2, Gianluca Perseghin3,4
1Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. giuseppina.russo@unime.it.
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.
Insights
Expert consensus recommends early, tailored treatment for type 2 diabetes (T2DM) patients to prevent cardiovascular disease (CVD). Key strategies include using glucose-lowering agents like GLP-1RAs and SGLT2 inhibitors early, focusing on a treat-to-benefit approach.
Area of Science:
- Endocrinology
- Cardiology
- Diabetes Mellitus Research
Background:
- Optimal therapeutic strategies for newly diagnosed type 2 diabetes mellitus (T2DM) to prevent cardiovascular disease (CVD) lack consensus.
- Expert opinion is crucial for guiding treatment decisions in T2DM management.
Purpose of the Study:
- To establish an expert consensus on hypoglycemic treatment and cardiovascular risk management for newly diagnosed T2DM patients.
- To define optimal early treatment strategies and the role of specific glucose-lowering agents.
Main Methods:
- A two-round Delphi methodology survey was distributed to 80 Italian diabetes specialists.
- Participants rated 30 statements on T2DM management, CV risk, and treatment indications using a 5-point Likert scale.
- Consensus was defined as agreement among over 66% of the panel.
Main Results:
- Consensus was reached on 27 out of 30 statements.
- Early T2DM patients were defined by pathophysiological, clinical, or diagnostic timing factors.
- There was strong agreement on achieving low HbA1c levels early, using combination therapy with CV-beneficial drugs, and adopting a treat-to-benefit approach.
- Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors were identified as key strategies, beneficial even in T2DM patients without established CVD.
- GLP-1RAs were recommended for earlier use than SGLT2 inhibitors for CVD prevention, particularly in patients with subclinical atherosclerosis.
Conclusions:
- A tailored hypoglycemic treatment approach for T2DM patients based on CVD risk is essential.
- Glucose-lowering agents with proven CV efficacy, specifically GLP-1RAs and SGLT2 inhibitors, play a key role in early treat-to-benefit strategies.
- This consensus provides guidance for optimizing T2DM management to reduce cardiovascular complications.
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