Updated 2026/10/21 09:00
Diabetes, cardiovascular and kidney diseases developing sequentially require integrated management
Professor Darren McGuire of the University of Texas Southwestern Medical Center, who delivered a keynote address at the congress, said, “Diabetes, kidney disease and cardiovascular disease should be viewed and managed as a continuous process,” adding, “Treatment strategies need to be restructured by considering patients’ long-term outcomes, including complications, rather than focusing only on improving individual indicators such as blood glucose and weight.” This is in line with the emphasis by the American College of Cardiology, ACC, and the American Heart Association, AHA, on an integrated approach to preventing and managing cardiovascular-kidney-metabolic syndrome, or CKM syndrome.
CKM syndrome refers to a condition in which diseases related to heart, kidney and metabolic health influence one another and occur simultaneously. It is classified into stage 0, a state with no risk factors, stage 1, a state in which risk factors such as obesity, hypertension and dyslipidemia are present but clear organ damage has not appeared, stage 2, an early stage of metabolic abnormalities such as impaired fasting glucose and hyperinsulinemia, stage 3, a state in which actual diseases such as ventricular hypertrophy and reduced glomerular filtration rate have developed, and stage 4, a stage in which a disease has been clearly diagnosed and has become clinically severe. The core idea is to change the clinical care system toward comprehensive prevention by identifying early the pathophysiological risk factors that cause functional decline in each organ.
“Treatment should take a patient-centered approach”
Drug selection is also reflecting this change. In the past, medications were selected primarily for their blood glucose-lowering effects, but now they are chosen after considering a patient’s comorbidities and risk of cardiovascular and kidney complications. According to current domestic and international clinical guidelines, SGLT-2 inhibitors or GLP-1 receptor agonists are recommended as a priority for patients with type 2 diabetes who also have atherosclerotic cardiovascular disease, heart failure or chronic kidney disease. SGLT-2 inhibitors are oral medications that inhibit glucose reabsorption in the kidneys, while GLP-1 receptor agonists use incretin hormones to regulate blood glucose and appetite, among other effects.
Professor McGuire said, “In treating CKM syndrome, the focus should be on the patient rather than being overly concerned with the effects of a particular drug on specific indicators.” He explained that the necessary medications should be selected or combined according to the patient’s condition, with an emphasis on long-term outcomes.
Experts also suggested that organic cooperation among the departments responsible for each disease, including endocrinology and nephrology, and improved access to medications are needed. Professor McGuire said, “It is necessary to use electronic medical record systems that share patient information and medication prescription histories among departments so that patients can receive the treatment they need regardless of which department they visit,” adding, “Insurance and support systems should also be improved so that no patients miss treatment opportunities because of financial burdens.”
Also reflected in the Korean Diabetes Association’s ‘2027 Diabetes Clinical Practice Guidelines’
In Korea, the importance of treatment that considers CKM syndrome is also growing. Professor Kim Jinhwa of the Department of Endocrinology and Metabolism at Chosun University Hospital said, “Even when glycated hemoglobin levels are the same, treatment goals and strategies should differ depending on age, weight and comorbidities,” adding, “Even when blood glucose is currently well controlled, the risk of developing complications such as chronic kidney disease or cardiovascular disease in the future is not fully revealed. Therefore, treatment direction should be determined by examining the complications a patient may be likely to experience in the future.”
Professor Kim Jinhwa said, “The four strategies are not mutually exclusive options. If a patient has multiple risk factors, they are intended to be applied together as needed,” adding, “Lifestyle modification and diabetes self-management education should begin immediately upon diagnosis and continue throughout the entire treatment process, while medications should be selected by considering comorbidities, clinical status and social determinants of health.” Treatment is then adjusted flexibly according to whether treatment goals have been achieved and how the patient’s condition changes, including intensifying or maintaining treatment and, when necessary, reducing or simplifying it.
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