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Vora J, Cherney D, Kosiborod MN, Spaak J, Kanumilli N, Khunti K, Lam CSP, Bachmann M, Fenici P. Inter-relationships between cardiovascular, renal and metabolic diseases: Underlying evidence and implications for integrated interdisciplinary care and management. Diabetes Obes Metab 2024; 26:1567-1581. [PMID: 38328853 DOI: 10.1111/dom.15485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
Cardiovascular, renal and metabolic (CaReMe) diseases are individually among the leading global causes of death, and each is associated with substantial morbidity and mortality. However, as these conditions commonly coexist in the same patient, the individual risk of mortality and morbidity is further compounded, leading to a considerable healthcare burden. A number of pathophysiological pathways are common to diseases of the CaReMe spectrum, including neurohormonal dysfunction, visceral adiposity and insulin resistance, oxidative stress and systemic inflammation. Because of the shared pathology and common co-occurrence of the CaReMe diseases, the value of managing these conditions holistically is increasingly being realized. A number of pharmacological and non-pharmacological approaches have been shown to offer simultaneous metabolic, cardioprotective and renoprotective benefits, leading to improved patient outcomes across the CaReMe spectrum. In addition, increasing value is being placed on interdisciplinary team-based and coordinated care models built on greater integration between specialties to increase the rate of early diagnosis and adherence to practice guidelines, and improve clinical outcomes. This interdisciplinary approach also facilitates integration between primary and specialty care, improving the patient experience, optimizing resources, and leading to efficiencies and cost savings. As the burden of CaReMe diseases continues to increase, implementation of innovative and integrated care delivery models will be essential to achieve effective and efficient chronic disease management and to ensure that patients benefit from the best care available across all three disciplines.
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Affiliation(s)
- Jiten Vora
- Department of Endocrinology, Royal Liverpool University Hospital, Liverpool, UK
| | - David Cherney
- Toronto General Hospital Research Institute, Department of Medicine, Division of Nephrology University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
- Banting and Best Diabetes Centre, Toronto, Ontario, Canada
- Department of Medicine, UHN, Toronto, Ontario, Canada
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jonas Spaak
- HND Centrum, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Carolyn S P Lam
- National Heart Center Singapore and Duke-National University of Singapore, Singapore, Singapore
| | | | - Peter Fenici
- School of Medicine and Surgery, Catholic University, Rome, Italy
- Biomagnetism and Clinical Physiology International Center (BACPIC), Rome, Italy
- Medical Affairs, AstraZeneca Lab, Milan, Italy
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Esdaile H, Mayet J, Hill N. Cardiovascular disease risk stratification in type 2 diabetes. Diabet Med 2022; 39:e14922. [PMID: 35892178 PMCID: PMC9543924 DOI: 10.1111/dme.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/01/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Harriet Esdaile
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College London, Hammersmith HospitalLondonUK
| | - Jamil Mayet
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Neil Hill
- Department of Metabolism, Digestion and Reproduction, Faculty of MedicineImperial College LondonLondonUK
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Rigalleau V, Larroumet A, Mohammedi K, Baillet-Blanco L, Borderie G, Delyfer MN, Korobelnik JF, Foussard N. Diabetic retinopathy is also an important marker of cardiovascular risk in type 2 diabetes, with practical implications. Diabet Med 2022; 39:e14845. [PMID: 35426164 DOI: 10.1111/dme.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Vincent Rigalleau
- Department of Endocrinology-Diabetology-Nutrition, CHU de Bordeaux, Bordeaux, France
- Ophthalmology, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, CHU de Bordeaux, Bordeaux, France
| | - Alice Larroumet
- Department of Endocrinology-Diabetology-Nutrition, CHU de Bordeaux, Bordeaux, France
| | - Kamel Mohammedi
- Department of Endocrinology-Diabetology-Nutrition, CHU de Bordeaux, Bordeaux, France
- Ophthalmology, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, CHU de Bordeaux, Bordeaux, France
| | | | - Gauthier Borderie
- Department of Endocrinology-Diabetology-Nutrition, CHU de Bordeaux, Bordeaux, France
| | - Marie-Noelle Delyfer
- Ophthalmology, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, CHU de Bordeaux, Bordeaux, France
| | - Jean-François Korobelnik
- Ophthalmology, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, CHU de Bordeaux, Bordeaux, France
| | - Ninon Foussard
- Department of Endocrinology-Diabetology-Nutrition, CHU de Bordeaux, Bordeaux, France
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