Cardiac Rehabilitation and Cardiovascular Prevention in Patients with Type 2 Diabetes Mellitus: From Initial Assessment to Comprehensive Management

Diabetes mellitus increases the risk of developing coronary artery disease, stroke, aortic disease, heart failure, atrial fibrillation, and peripheral arterial disease. This condition negatively impacts prognosis by increasing the risk of future cardiovascular (CV) events. Patients with type 2 diabetes mellitus need a comprehensive and personalized assessment and definition of the CV risk profile. In very high-risk individuals, special attention is required due to the high risk of adverse events despite appropriate management and treatment. Key interventions to reduce this risk include CV prevention and cardiac rehabilitation. Traditional and non-traditional CV risk factor management, dietary modifications, regular physical activity, aerobic and resistance exercise training, psychosocial and frailty management, optimal pharmacological therapy, and investigation of comorbidities are recommended to reduce the development of CV disease and mortality. Therefore, our manuscript provides updated and critical evidence on the comprehensive management of patients with type 2 diabetes mellitus in clinical practice from the perspective of CV prevention and cardiac rehabilitation, with a focus on individuals at very high risk. Further, practical guidance on individualizing exercise prescriptions based on patient-specific risk profiles and comorbid conditions is provided.