Cardiovascular-kidney-metabolic syndrome and type 2 diabetes mellitus: from risk stratification to multidisciplinary patient management

Abstract

Type 2 diabetes mellitus (T2DM) is a key component of cardiovascular-kidney-metabolic (CKM) syndrome, an interconnected complex of metabolic disorders, chronic kidney disease (CKD), and cardiovascular disease (CVD). T2DM is characterized by chronic hyperglycemia resulting from insulin resistance and progressive impairment of insulin secretion and is closely associated with excess adiposity and adipose tissue dysfunction. The presence of T2DM substantially increases the risk of atherosclerotic cardiovascular disease, heart failure, and CKD; their coexistence is associated with accelerated progression of multiorgan involvement, increased hospitalization rates, disability, and premature mortality. This article reviews the current concept and staging classification of CKM syndrome and describes the criteria for stages 0–4, including the role of prediabetes, T2DM, metabolic risk factors, CKD, and subclinical and clinically manifest CVD. The main preventive and therapeutic approaches according to CKM syndrome stage are presented, including lifestyle modification, weight loss, control of glycemia, blood pressure, and lipid levels, use of glucagon-like peptide-1 receptor agonists, dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors. Prospects for implementing a stage-based approach within the Russian healthcare system are discussed.