Keywords: Cardiorenal-metabolic, Type 2 Diabetes, CKD, Heart Failure, integrated care, single therapeutic challenge

Background:

It is increasingly important in clinical medicine to consider the interplay between heart failure (HF), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM) due to their frequent coexistence and shared mechanisms that worsen morbidity and mortality. This triad requires an integrated, multidisciplinary approach. Clinical Interdependence - the presence of one condition significantly increases the risk of developing the others. This bidirectional relationship creates a vicious cycle, wherein the presence of multiple conditions compounds patient risk and complicates management.
HF, CKD, and T2DM are interconnected through shared risk factors, including hypertension, obesity, dyslipidaemia, and systemic inflammation, as well as endothelial dysfunction and neurohormonal activation. The RAAS and sympathetic nervous system play significant roles in the progression of these conditions. T2DM accelerates atherosclerosis, promotes glomerular hyperfiltration, and induces myocardial fibrosis, complicating the progression of CKD and HF.

Aim of the study:

The aim is to evaluate the progress of our rural clinic and PCN in addressing CVRM as a single therapeutic challenge.

Methodology:

Retrospective analysis of national data from 2022 to 2024 to establish our clinic's and PCNs' CVRM performance and compare it with national averages, where possible.

Results:

T2DM prevalence: Clinic 8.2% (national: 5.66%); CKD: PCN 4th highest nationally; Clinic HF prevalence: 5.58% (national: 1.06%). Clinic T2DM:CKD ratio: 1.57 (national: 0.78), T2DM:HF ratio: 0.68 (national: 0.19). PCN SGLT2i prescriptions up 58%. PCN DM care processes outperform the national average, with significant improvements in PCN CKD blood pressure (10%) and ACR levels (67%) compared with national data.

Conclusions:

An integrated approach to treating T2DM, CKD, and heart failure is crucial. SGLT2 inhibitors and MRAs offer benefits across conditions, supporting individualised therapy and reducing polypharmacy. The clinical overlap of HF, CKD, and T2DM requires a unified approach for detection and treatment, leading to improved patient outcomes. Future chronic disease management should treat CVRM as a single therapeutic challenge.