Strategizing Cardiovascular Management in Diabetic Patients: Insights and Advancements from the 2023 ESC Guidelines for the Management of Cardiovascular Disease in Patients with Diabetes

Hongyuan Zhang; Darren Green; Yanrong Liu

doi:10.53941/ijddp.2025.100002

Abstract

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). The 2023 European Society of Cardiology (ESC) guidelines represent a significant advancement in the management of CVD in T2DM, building on the 2019 recommendations. Unlike previous iterations, the updated guidelines focus exclusively on T2DM, excluding pre-diabetes due to limited evidence directly linking it to cardiovascular risk. A notable addition is the SCORE2-Diabetes algorithm, which integrates diabetes-specific factors with traditional risk determinants to estimate the 10-year cardiovascular risk. This personalized risk stratification tool underscores the importance of early identification and management of key contributors, such as hyperglycemia and insulin resistance. The guidelines advocate for a multidisciplinary approach, emphasizing collaboration among diabetes, cardiovascular, and chronic kidney disease specialists to address the complex interplay of these conditions effectively. Moreover, the 2023 ESC guidelines highlight the necessity of individualized treatment strategies to reduce cardiovascular complications in T2DM. By reflecting the heterogeneity of diabetic populations and the evolving pharmacological landscape, these recommendations aim to optimize cardiovascular outcomes. This comprehensive update marks a critical step toward reducing the burden of CVD and improving the quality of life for patients with diabetes.

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