Introduction: The aim of this Delphi study is to
unveil the management of patients with type 2
diabetes (T2D) and different levels of complexity in the clinical practice in Spain.
Methods: Based on the common management
practices of T2D profiles reported by Spanish
endocrinologists, a Delphi questionnaire of 55
statements was developed and responded to by
a national panel (n = 101).
Results: A consensus was reached for 30 of the
55 statements. Regarding overweight patients
inadequately controlled with metformin, treatment with a sodium-glucose transport protein 2
inhibitor (SGLT2-I) is preferred over treatment
with a dipeptidyl peptidase-4 inhibitor (DPP4-I).
If the patient is already being treated with a
DPP4-I, an SGLT2-I is added on to the treatment
regimen rather than replacing the DPP4-I.
Conversely, if the treatment regimen includes a
sulfonylurea, it is usually replaced by other
antihyperglycemic agents. Current treatment
trends in uncontrolled obese patients include
the addition of an SGLT2-I or a glucagon-like
peptide-1 receptor agonist (GLP1-RA) to background therapy. When the glycated hemoglobin target is not reached, triple therapy with
metformin ? GLP1-RA ? SGLT2-I is initiated.
Although SGLT2-Is are the treatment of choice
in patients with T2D and heart failure or
uncontrolled hypertension, no consensus was
reached regarding the preferential use of SGLT2-
Is or GLP1-RAs in patients with established
cardiovascular disease.
Conclusion: Consensus has been reached for a
variety of statements regarding the management of several T2D profiles. Achieving a more
homogeneous management of complex
patients with T2D may require further evidence and a better understanding of the key drivers for
treatment choice