Can Clinical Biomarkers Guide Optimal Therapeutic Selection in Type 2 Diabetes Mellitus? A Scoping Review

Type 2 diabetes mellitus (T2DM) affects millions of adults worldwide and is associated with a 2 to 4-fold increased risk of cardiovascular disease, the leading cause of morbidity and mortality in this population. Traditional risk assessment tools have limitations in capturing the heterogeneity of cardiovascular risk among T2DM patients, prompting extensive research into novel biomarkers for enhanced risk stratification.

Recent evidence demonstrates that imaging, circulating, and body composition biomarkers have emerged as strong predictors of renal and cardiovascular outcomes allowing for further refinement in risk stratification. Coronary artery calcium scoring, hepatic steatosis, cardiac steatosis, and pericardial fat volume, provide superior prognostic value compared to conventional risk factors alone. Likewise, N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T, and inflammatory markers, have demonstrated independent prognostic value in this population. Lastly, anthropometric and body composition measures such as waist-to-hip ratio and visceral adiposity indices have emerged as stronger predictors of cardiovascular outcomes than body mass index. Moreover, T2DM treatment has evolved to prioritize cardiovascular and renal protection given recent landmark trials showed that specific new therapies, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1), provide benefits independent of glycemic effects. Research has shown that some well-known as well as newly released biomarkers could guide therapy choice with the goal of providing optimal therapy to T2DM patients.  The aim of this paper is to examine how current imaging, body composition, and laboratory biomarkers can guide treatment decisions for T2DM, focusing on which altered biomarker profiles indicate the preferential use of specific pharmacotherapies.