Cardio-Reno-Microvascular Phenotypes and Multifactorial Cardiometabolic Target Achievement in Type 2 Diabetes

Background: Patients with type 2 diabetes (T2D) have high morbidity and mortality rates, mainly due to cardiovascular diseases (CVDs). Given the heterogeneity of this population, in whom atherosclerotic CVD may coexist with varying degrees of microvascular and renal involvement, preventive and therapeutic needs differ among these patients. Multifactorial CV risk factor control has proven beneficial in T2D; however, it remains suboptimal, particularly for lipid and weight targets. Aims: The aims were to evaluate, in a real-world cohort of patients with T2D, whether different cardio-reno-microvascular phenotypes are associated with differences in multifactorial cardiometabolic control and to assess individual target attainment along with the use of cardioprotective therapies across phenotypes. Methods: In a single-center, cross-sectional study, 174 patients with T2D were enrolled and clustered into four phenotypes based on the presence of atherosclerotic CVD (ASCVD), chronic kidney disease, retinopathy and neuropathy. Achievement of individual and multifactorial cardiometabolic risk factor control was examined across phenotypes. Results: More than three quarters of the cohort had ASCVD, microvascular/renal disease, or both. While approximately half of the patients had optimal glycemic control, achievement of LDLC and normal BMI was modest. Target attainment did not differ significantly across phenotypes, with most patients achieving one or two targets and less than one third achieving three or more. Statin use was significantly higher in phenotypes with ASCVD, whereas use of other lipid-lowering therapies remained low. Use of SGLT2is and GLP-1 RAs was also limited. Higher BMI was independently associated with lower odds of multifactorial control. Conclusions: In this real-world cohort of patients with T2D, individual and multifactorial cardiometabolic risk factor control was suboptimal, particularly for LDLC and body weight. A phenotype-based approach may help clinicians identify vulnerable subgroups requiring more intensive, risk-based preventive strategies.