Diabetes-Kidney-Heart Continuum and Its Implication on Therapeutic Management

Type 2 diabetes (T2D), along with other co-morbidities (hypertension, hyperlipidemia, etc.), causes vascular complications and atherosclerosis, leading to heart or kidney damage. The timely detection of cardiovascular disease (CVD) and chronic kidney disease (CKD) risk helps in targeted treatment, thereby reducing hospitalization/death in people with T2D. The vascular complications of T2D, including the onset of CVD or CKD, have been widely studied. However, a clear understanding of the concurrent inter-relatability of diabetes-kidney-heart or diabetes-heart-kidney continuum would further assist the clinicians in preventing morbidity and mortality. The narrative review sought to outline the stages ("prevent," "regress," and "retard"), pathophysiological mechanism, and management of the continuum with defined patient profiles and associated risk factors. Pharmacotherapies with a focus on managing both cardiac and renal vascular changes (e.g., sodium-glucose transporter-2 inhibitors {SGLT-2is}, glucagon-like peptide-1 receptor agonists {GLP-1RA}, dipeptidyl peptidase-4 inhibitors {DPP-4is}, lipid-lowering therapy, and renin-angiotensin-aldosterone system {RAAS} blockers) have been discussed. In addition, new diagnostic approaches such as levels of B-type natriuretic peptide (BNP), N-terminal prohormone, cardiac troponin, cystatin C, and single-cell transcriptome sequencing, with proven accuracy for detecting vascular complications in the heart and kidney, have been summarized. The review underscores the importance of the early detection of the vascular complications in T2D with individual risk stratification for the initiation/continuation/switching of therapies, to enhance treatment adherence and outcomes.