Integrated Management of Cardio-Renal-Metabolic Disorders in India: A Nationwide Physician Survey

Background Cardiovascular, renal, and metabolic (CaReMe) disorders represent an interlinked group of conditions. Multimorbidity is frequent among patients with diabetes; 43% also have hypertension, and nearly 28% of hypertensive individuals have diabetes. Despite growing evidence and guideline recommendations for integrated care, limited data exist on how physicians in India perceive and manage CaReMe conditions in routine practice. Objectives To describe physician-reported practices, diagnostic routines, perceptions, and barriers related to the integrated management of cardio-renal-metabolic (CaReMe) conditions among practicing physicians in India using a cross-sectional survey design. Methods A descriptive survey was conducted among 1,025 physicians, including consulting physicians, diabetologists, cardiologists, endocrinologists, and nephrologists, with at least one year of clinical experience. Data were collected using a pre-tested, structured electronic questionnaire and analysed descriptively. Results The majority of respondents were consulting physicians (57.7%, n = 591) or diabetologists (25.7%, n = 263). The majority had 11-20 years of clinical experience, and one-third reported seeing more than 200 patients per month. According to the respondents, the most common comorbid conditions were diabetes (75.8%, n = 777), dyslipidaemia (74.1%, n = 760), obesity (71.1%, n = 729), and hypertension (70.4%, n = 721). The most frequently performed routine diagnostic assessments were glycated haemoglobin (HbA1c; 82.4%, n = 845), lipid profile (80.7%, n = 827), estimated glomerular filtration rate (eGFR) (78.0%, n = 800), and microalbuminuria (74.8%, n = 767). However, only 16.1% (n = 165) of physicians recognised CaReMe conditions as direct contributors to cardiovascular and renal outcomes, while 82% (n = 841) considered integrated management to be important. The most common barriers included patient affordability (76%, n = 779), lack of awareness (74.1%, n = 760), limited consultation time (69.7%, n = 714), and inadequate guidelines (63.1%, n = 647). Across all three disease-combination categories, the largest proportion of physicians selected the five to 10 patients-per-month category for newly diagnosed cases. Conclusion This nationwide survey highlights the high adoption of recommended diagnostic practices but reveals a significant disconnect between the implementation of diagnostic practices and physician awareness of the interconnections between CaReMe. Persistent barriers, including affordability, the absence of standardized national guidelines, and limited consultation time, underscore the urgent need for coordinated policy and educational interventions. Strengthening physician training, harmonizing clinical guidelines, improving financial accessibility, and promoting holistic care models are essential steps toward improving patient outcomes and mitigating the growing CaReMe burden in India.