Comprehensive Cardiovascular and Renal Protection in Patients with Type 2 Diabetes

Abstract

Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. A particular focus is given to the global control of cardiovascular risk factors, the inclusion of weight within the therapeutic objectives, the education of patients, the deprescription of those drugs without cardiovascular benefit, and the inclusion of GLP-1 receptor agonists and SGLT2 inhibitors as cardiovascular protective drugs, at the same level as statins, acetylsalicylic acid, or renin angiotensin system inhibitors.

Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?

“…SGLT2is are the glucose-lowering agents of choice in patients with T2D and CKD from the perspective of protecting target organs [ 56 , 62 , 63 ], particularly in CKD, but one-fourth of patients treated with these molecules progress to KDIGO risk status, regardless of baseline risk category [ 64 ], and DATA is fully complementary to address residual risk.…”