Cardio–diabetology Care Pathway: A Multidisciplinary Approach for Patients With High Cardiovascular Risk

Background Type 2 diabetes mellitus (T2DM) is a major health issue worldwide due to its increasing prevalence and strong association with cardiovascular morbidity and mortality. Chronic hyperglycemia and insulin resistance cause endothelial dysfunction, vascular inflammation, and accelerated atherosclerosis. In T2DM patients, plaques tend to have higher lipid content, increased inflammation, and greater thrombotic burden, which increases vulnerability and the risk of acute cardiovascular events. Additionally, insulin resistance leads to myocardial alterations, contributing to heart failure and diabetic cardiomyopathy, even in the absence of coronary artery disease (CAD) or hypertension. Recent ESC guidelines highlight the need for early cardiovascular risk stratification and integrated management in T2DM. The SCORE2–Diabetes algorithm introduced in 2023 is a significant tool for predicting 10–year cardiovascular risk in these patients. Methods A multidisciplinary cardio–diabetology pathway was implemented for patients with T2DM, with or without established atherosclerotic cardiovascular disease (ASCVD). Patients underwent comprehensive cardiovascular risk assessment using the SCORE2–Diabetes algorithm, classifying them into low, moderate, high, and very high–risk categories. The pathway involved systematic screening for coronary, cerebrovascular, peripheral, and aortic disease, including clinical evaluation, laboratory tests (HbA1c, natriuretic peptides, renal function), transthoracic echocardiography, and carotid ultrasound. Further imaging and tests were prescribed based on risk profiles, and management was coordinated by an integrated cardiology–diabetology team, with nursing staff supporting procedures and follow–up. Results This pathway allowed early identification of high–risk patients, optimizing cardiovascular and glucose–lowering therapies. It also improved continuity of care, reducing unnecessary hospitalizations and emergency visits through structured outpatient monitoring. Conclusion A structured cardio–diabetology pathway offers a personalized approach to cardiovascular prevention and treatment in T2DM, potentially improving patient outcomes and supporting healthcare sustainability.