Expert Consensus on the Role of Pharmaco-complementary Medicine for the Management of Diabetic Complications Using Modified Delphi Method

Background: Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia resulting from insulin resistance and/or deficiency. It is associated with numerous complications, including microvascular and macrovascular complications. Micronutrient deficiencies are commonly observed in individuals with diabetes due to the metabolic changes that occur in the body and the increased renal excretion. Several studies have shown that diabetes patients are at an increased risk of developing micronutrient deficiencies such as vitamin D, thiamine, vitamin B12, folate, magnesium, and zinc. The consequences of micronutrient deficiencies in diabetic patients can be significant. The aim of this study was to achieve a consensus on the use of complementary pharmacological therapies in the management of diabetic complications, through a modified Delphi methodology. Methods: A three-round modified Delphi Procedure was conducted to define recommendations regarding the role of Pharmaco-Complementary medicine in the management of Diabetic complications using a web-based questionnaire. The questionnaire included a set of 65 questions. The level of Consensus was defined based on the level of agreement among the panelists on specific scientific statements. Strong Consensus was defined as ≥80% agreement, Moderate Consensus with Agreement between 65% and up to 79%, and Low Consensus level with statements below 65% agreement. Results: Eighteen experts in the field of diabetes participated in the development of this consensus. Three rounds of voting were held, followed by data analysis and consensus level calculation. Out of 47 statements, a total of 33 statements achieved moderate – strong consensus (moderate: 65% - 79% agreement, strong: ≥80% agreement). Conclusion: Experts concluded that the use of pharmaco-complementary medications such as CoQ10, Benfotiamine, Magnesium, and EPA can potentially improve glycemic control, insulin sensitivity, and manage diabetic complications. This consensus can serve as a valuable tool for clinicians in managing diabetes, and its complications, and can provide direction for future research. Keywords: Diabetes, Consensus; Pharmaco-complementary, Delphi, Complications