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Rethinking the Diabetes-Cardiovascular Disease Continuum: Toward Integrated Care.

Alfredo Caturano1, Cassandra Morciano2, Katarzyna Zielińska3

  • 1Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma University, 00166 Rome, Italy.

Journal of Clinical Medicine
|September 27, 2025
PubMed
Summary

Type 2 diabetes and cardiovascular disease are linked. New drugs like GLP-1 agonists and tirzepatide show promise for managing cardiometabolic risk, but equitable access and integrated care are crucial.

Keywords:
GLP-1 receptor agonistsSGLT2icardiometabolic continuumcardiovascular diseasecardiovascular-kidney-metabolic syndrometirzepatidetype 2 diabetes mellitus

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Area of Science:

  • Cardiometabolic Medicine
  • Endocrinology
  • Cardiology

Background:

  • Type 2 diabetes mellitus (T2D) and cardiovascular disease (CVD) represent a shared cardiometabolic continuum.
  • Current treatments focusing on glycemic, lipid, and blood pressure control leave significant residual cardiovascular risk.
  • Siloed treatment approaches are insufficient for managing interconnected cardiometabolic conditions.

Purpose of the Study:

  • To advocate for reframing T2D and CVD as interconnected conditions.
  • To review current and emerging therapeutic strategies for cardiometabolic risk reduction.
  • To highlight the importance of integrated care models and equitable access to treatment.

Main Methods:

  • Perspective piece synthesizing evidence from landmark trials and meta-analyses.
  • Discussion of drug classes including sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dual GIP/GLP-1 receptor agonists.
  • Analysis of factors influencing real-world outcomes, including treatment response, cost, access, and health system integration.

Main Results:

  • Sodium-glucose co-transporter 2 inhibitors and GLP-1 receptor agonists demonstrate cardiorenal benefits.
  • Tirzepatide shows significant efficacy in weight and glucose management, with potential for cardiometabolic risk reduction.
  • Heterogeneity in treatment response, cost, and access are key challenges to widespread adoption.

Conclusions:

  • A paradigm shift is needed to view T2D and CVD as interconnected, driven by inflammation and metabolic dysfunction.
  • Novel therapies and integrated care models are essential for improving real-world cardiometabolic outcomes.
  • Equitable access, consideration of diverse patient profiles, and global health system adaptation are critical for advancing cardiometabolic medicine.