Sattar, N. , Presslie, C., Rutter, M. K. and McGuire,, D. K. (2024) Cardiovascular and kidney risks in individuals with type 2 diabetes: contemporary understanding with greater emphasis on excess adiposity. Diabetes Care, 47(4), pp. 531-543. (doi: 10.2337/dci23-0041) (PMID:38412040)
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Abstract
In high-income countries, rates of atherosclerotic complications in type 2 diabetes have declined markedly over time due to better management of traditional risk factors including lipids, blood pressure, and glycemia levels. Population-wide reductions in smoking have also helped lower atherosclerotic complications and so reduce premature mortality in type 2 diabetes. However, as excess adiposity is a stronger driver for heart failure (HF), and obesity levels have remained largely unchanged, HF risks have not declined as much and may even be rising in the increasing number of people developing type 2 diabetes at younger ages. Excess weight is also an underrecognized risk factor for chronic kidney disease (CKD). Based on evidence from a range of sources, we explain how excess adiposity must be influencing most risks well before diabetes develops, particularly in younger-onset diabetes, which is linked to greater excess adiposity. We also review potential mechanisms linking excess adiposity to HF and CKD and speculate on how some of the responsible pathways—e.g., hemodynamic, cellular overnutrition, and inflammatory—could be favorably influenced by intentional weight loss (via lifestyle or drugs). On the basis of available evidence, we suggest that the cardiorenal outcome benefits seen with sodium–glucose cotransporter 2 inhibitors may partially derive from their interference of some of these same pathways. We also note that many other complications common in diabetes (e.g., hepatic, joint disease, perhaps mental health) are also variably linked to excess adiposity, the aggregated exposure to which has now increased in type 2 diabetes. All such observations suggest a greater need to tackle excess adiposity earlier in type 2 diabetes.
| Item Type: | Articles |
|---|---|
| Additional Information: | NS acknowledges funding support from the British Heart Foundation Research Excellence Award (RE/18/6/34217). The work was supported by the NIHR Manchester Biomedical Research Centre. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Sattar, Professor Naveed and Presslie, Dr Calum |
| Authors: | Sattar, N., Presslie, C., Rutter, M. K., and McGuire,, D. K. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | Diabetes Care |
| Publisher: | American Diabetes Association |
| ISSN: | 0149-5992 |
| ISSN (Online): | 1935-5548 |
| Published Online: | 27 February 2024 |
| Copyright Holders: | Copyright © 2024 by the American Diabetes Association |
| First Published: | First published in Diabetes Care 47(4):531-543 |
| Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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