As the number of people living with diabetes continues to rise globally, the management of diabetes‑related complications has become a central topic in clinical research.The International Diabetes Federation World Diabetes Congress (IDF 2025), under the theme “Shape the future of diabetes”, brought together global experts to discuss new advances, technologies and strategies in diabetes care, injecting new momentum into worldwide diabetes prevention and treatment.In this context, Professor Chantal Mathieu from University Hospitals Leuven, Belgium, shared her insights in an interview, focusing on the integrated cardiorenal metabolic management model for diabetes.
Addressing the recent focus by academic organizations on the comanagement of diabetes with cardiovascular, renal and metabolic diseases, Professor Mathieu noted that researchers have long established that patients with type 2 diabetes (T2DM) carry a significantly higher risk of cardiovascular disease than the general population, and cardiovascular disease has become the leading cause of death among people with diabetes.Meanwhile, the impact of kidney disease in diabetic patients has become increasingly prominent.In fact, kidney disease, diabetes and cardiovascular disease interact closely, forming a dangerous “perfect storm” driven by multiple factors including hyperglycemia, dyslipidemia, hypertension and excessive inflammation.For this reason, we must recognize that individuals who are overweight or obese — especially those with T2DM and/or impaired renal function — are exposed to this perfect storm, leading to adverse outcomes.
It is critically important to emphasize that we must adopt a holistic therapeutic strategy — not focusing only on single parameters such as lipids, blood glucose or blood pressure, but managing all risk factors comprehensively.For patients with T2DM complicated by cardiovascular and kidney disease, early and aggressive intervention is key: timely, adequate and intensive treatment should be initiated at the stage of microalbuminuria.
On the basis of weight management, lifestyle modification, physical activity and healthy diet, medications with direct cardioprotective and renoprotective effects can be added:sodium‑glucose cotransporter 2 (SGLT2) inhibitors and glucagon‑like peptide‑1 (GLP‑1) receptor agonists.These agents are decisive for such patients and can significantly improve cardiovascular and renal outcomes.
In fact, DCRM (Diabetes, Cardiorenal, and Metabolic syndrome) and CKM (Cardiometabolic‑Kidney Syndrome) represent only terminological differences.Regardless of how academic bodies define these conditions, clinicians must be clear that all individuals who are overweight/obese or have T2DM face substantially elevated cardiovascular and renal risks.That is the core message.
We must remain vigilant and proactive in screening:All overweight/obese and T2DM patients should be monitored for microalbuminuria — intervention (such as initiation of an SGLT2 inhibitor or GLP‑1 receptor agonist) should be implemented immediately once present, together with strict control of blood glucose and blood pressure.Regular cardiovascular screening is also needed, with special attention to easily overlooked conditions such as heart failure.As clinicians, we should actively ask patients, “Do you feel short of breath?” and test biomarkers such as proBNP when necessary.
Essentially, regardless of evolving terminology or definitions, the clinical pathway for this population remains consistent:early screening (for cardiovascular and renal disease) and timely intervention (lifestyle management + multifactorial risk reduction).If complications develop, organ‑protective medications (SGLT2 inhibitors, GLP‑1 receptor agonists, etc.) should be prescribed.