Role of continuous glucose monitoring in diabetic patients at high cardiovascular risk: an expert-based multidisciplinary Delphi consensus

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.

Insulin pump treatment vs. multiple daily insulin injections in patients with poorly controlled Type 2 diabetes mellitus: a comparison of cardiovascular effects

“…However, in the last few decades, CSII pumps have been developed, with the advantage of removing the need for multiple insulin injections throughout the day. Furthermore, novel devices, such as glucose sensors, have recently been developed to continuously measure glucose levels throughout the day, which alleviates the need to measure capillary blood glucose multiple times throughout the day [30]. Importantly, several studies have shown comparable control of glycaemic status in patients treated with CSII compared to standard MDI [31][32][33][34].…”

Association between perioperative glucose profiles assessed by the continuous glucose monitoring (CGM) system and prognosis in patients with ST-segment elevation myocardial infarction (STEMI): protocol for a cohort study

“…The optimisation of time in range (TIR) and glycaemic variability and the reduction of the time spent in hypoglycaemia can improve the long-term prognosis in individuals with acute cardiovascular events. 11 A prospective cohort study showed that lower TIR was associated with an increased risk of all-cause and cardiovascular mortality among patients with type 2 diabetes, 12 supporting the validity of core CGM-derived metrics as a surrogate marker of longterm adverse clinical outcomes.…”

Glucose variability: a new risk factor for cardiovascular disease

“…Recently, a survey of diabetologists and cardiologists was conducted to obtain expert consensus on the use of CGM in diabetic patients at high risk of CV or with a history of CV events [ 70 ]. The experts agreed that CGM is a prognostic tool for T1DM and T2DM treated with multiple daily insulin injections.…”