Characterization of cardiovascular risk profile and therapeutic management in patients with type 2 diabetes mellitus: insight from the CardioMET Italian registry

Background/Introduction Cardiovascular (CV) disease remains the primary cause of morbidity and mortality among individuals with type 2 diabetes mellitus (T2DM). However, real-world data on the risk profile and therapeutic optimization in patients with T2DM followed in cardiac and internal medicine outpatient clinics are limited. Purpose The aim of the CardioMET registry was to collect data on T2DM patients attending internal medicine and cardiac outpatient clinics to characterize CV risk profile and pharmacological management of T2DM in Italy, in accordance with current ESC and AHA guidelines for primary and secondary prevention of CV disease. Methods CardioMET is an Italian, multicenter, observational registry. The study included a T0 phase – retrospective data collection (October 2022–March 2023), an Educational Activities phase, and a T1 phase – prospective data collection (March–October 2023). In this analysis, we describe clinical characteristics and prescribed pharmacological treatment of patients enrolled during the T0 phase, focusing on glucose-lowering agents with proven CV benefits. Results This analysis included 1927 patients with T2DM (median age 70 years; 67.7% male) enrolled during the T0 phase. Median duration of diabetes was 13 years (IQR 8; 15), median glycated hemoglobin was 6.8% (IQR 6.2; 7.6), median body mass index was 27.5 kg/m2 (IQR 24.9; 31). Overall, 56.7% of patients were treated with metformin, 26.3% with insulin, 9.9% with dipeptidyl peptidase-4 inhibitors, 5.6% with sulfonylureas, 2.2% with thiazolidinediones, 22.2% of patients were prescribed with glucagon-like peptide-1 receptor agonists (GLP1-RA), and 39.8% with sodium-glucose cotransporter-2 inhibitors (SGLT2i), and 12.3% of patients were treated with a combination of GLP1-RA and SGLT2i. Of 1927 patients, 1388 (72%) had ASCVD of whom 57.9% suffered a previous ischemic event (MI or stroke); in patients with ASCVD a significant increase in prescription of GLP1-RA (23.8% vs 18.2%; p=0.01), SGLT2i (42.4% vs 33.3%; p<0.001), and of the combination (13.5% vs 9.1%; p=0.009) was observed compared to patients without ASCVD. Patients with ASCVD and a previous ischemic event were significantly more prescribed with SGLT2i (46.1% vs 37.3%; p=0.001) compared to ASCVD patients without previous events, with no significant difference for GLP1-RA. However, when comparing patients with ASCVD to those without ASCVD at high and very high CV risk, SGLT2i were significantly less prescribed in the latter group, despite guidelines indication (42.4% vs 33.3%; p<0.001). Conclusion(s) In this large Italian outpatient T2DM cohort, ASCVD was highly prevalent. Despite a higher use of GLP1-RA and SGLT2i in patients with established ASCVD, overall uptake of glucose-lowering therapies with proven CV benefit remained low, indicating substantial need for treatment optimization in routine care.