A Modified Delphi consensus on early management of combined cardiovascular risk factors in adult patients with type 2 diabetes in Italy

BACKGROUND: Type 2 diabetes (T2D) is a complex chronic disease often associated with other metabolic conditions that increase the risk of cardiovascular (CV) disease and early mortality. Hence, early, integrated management of T2D may prevent long-term CV complications. METHODS: To determine the appropriateness of early multifactorial intervention in people with T2D we conducted an online modified Delphi study. The study involved a multidisciplinary panel of 17 Italian experts, ensuring maintenance of study design and rigorous execution throughout the consensus process, in line with the core principles of Delphi studies. Main areas of investigation included: (1) targets of disease control for adults with T2D; (2) early treatment, CV risk assessment, and multi-factorial strategy; (3) unmet needs, including treatment adherence; and (4) public health aspects. RESULTS: Consensus was unanimous (100% agreement) regarding T2D management based on the simultaneous control of glycemia, body weight, blood pressure, and lipids through an early multi-factorial approach as well as maintenance of target levels over time. Most panelists agreed on the need for a simplified therapeutic approach (88% agreement), supported by improved availability of appropriate pharmacological treatments and increased adherence (82% agreement). CONCLUSIONS: Italian experts strongly support the adoption of an early, multi-factorial approach to disease management to reduce long-term CV risk. To this end, the need for simplified treatment regimens and improved adherence to therapy emerged as key unmet needs.