Cardiovascular Outcomes in Diabetes and Dysglycemia Management

Cardiovascular disease remains the principal cause of morbidity and mortality in individuals with diabetes and dysglycaemia. A complex interplay of hyperglycaemia, insulin resistance and associated metabolic abnormalities drives both macrovascular complications—such as coronary artery disease, stroke and peripheral arterial disease—and microvascular injury involving the small vessels of the retina, kidney and peripheral nerves. Chronic endothelial dysfunction, low-grade inflammation and accelerated atherosclerosis underlie this dual vascular burden. Early and sustained glycaemic control, blood pressure management and lipid modification collectively reduce cardiovascular risk, while multifactorial interventions have demonstrated durable survival benefits and prolonged event-free intervals. In recent years, novel glucose-lowering therapies have shifted the paradigm by conferring direct cardioprotective effects independent of glycaemic reduction. Global efforts are focusing on integrated care models, combining pharmacological innovation with personalised lifestyle and risk factor management, to attenuate the long-term cardiovascular legacy of dysglycaemia across diverse populations.

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Cardiovascular Outcomes in Diabetes and Dysglycemia Management publication trend

The graph below shows the total number of articles in cardiovascular outcomes in diabetes and dysglycemia management across all publications each year (not limited to Nature Index journals).

Technical terms

Panvascular disease: A syndrome involving simultaneous macrovascular atherosclerosis and microvascular injury across multiple organ systems.

Glycaemic legacy effect: The long-term increase in cardiovascular risk resulting from early periods of elevated blood glucose.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors): A class of agents that reduce blood glucose by promoting renal glucose excretion and provide cardiovascular and renal protection.

Microangiopathy: Damage to small blood vessels characterised by endothelial dysfunction and basement membrane thickening.

HbA1c: Glycated haemoglobin, reflecting average blood glucose levels over the preceding two to three months.

References

1. Diabetic vascular diseases: molecular mechanisms and therapeutic strategies. Signal Transduction and Targeted Therapy (2023).
2. The legacy effect of hyperglycemia and early use of SGLT-2 inhibitors: a cohort study with newly-diagnosed people with type 2 diabetes. The Lancet Regional Health - Europe (2023).
3. Years of life gained by multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: 21 years follow-up on the Steno-2 randomised trial. Diabetologia (2016).
4. Empagliflozin Reduced Mortality and Hospitalization for Heart Failure Across the Spectrum of Cardiovascular Risk in the EMPA-REG OUTCOME Trial. Circulation (2018).
5. Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: A large multinational cohort study. Diabetes Obesity and Metabolism (2020).