Cardiovascular and Kidney Risks in Individuals With Type 2 Diabetes: Contemporary Understanding With Greater Emphasis on Excess Adiposity
Open accessAbstract
In high-income countries, rates of atherosclerotic complications in type 2 diabetes have declined markedly over time due to better management of traditional risk factors including lipids, blood pressure, and glycemia levels. Population-wide reductions in smoking have also helped lower atherosclerotic complications and so reduce premature mortality in type 2 diabetes. However, as excess adiposity is a stronger driver for heart failure (HF), and obesity levels have remained largely unchanged, HF risks have not declined as much and may even be rising in the increasing number of people developing type 2 diabetes at younger ages. Excess weight is also an underrecognized risk factor for chronic kidney disease (CKD). Based on evidence from a range of sources, we explain how excess adiposity must be influencing most risks well before diabetes develops, particularly in younger-onset diabetes, which is linked to greater excess adiposity. We also review potential mechanisms linking excess adiposity to HF and CKD and speculate on how some of the responsible pathways—e.g., hemodynamic, cellular overnutrition, and inflammatory—could be favorably influenced by intentional weight loss (via lifestyle or drugs). On the basis of available evidence, we suggest that the cardiorenal outcome benefits seen with sodium–glucose cotransporter 2 inhibitors may partially derive from their interference of some of these same pathways. We also note that many other complications common in diabetes (e.g., hepatic, joint disease, perhaps mental health) are also variably linked to excess adiposity, the aggregated exposure to which has now increased in type 2 diabetes. All such observations suggest a greater need to tackle excess adiposity earlier in type 2 diabetes.
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Weight alone does not distinguish between fat and lean muscle mass, nor does it capture differences between visceral and subcutaneous fat.
“Weight alone, however, does not distinguish between fat and lean muscle mass, nor does it capture differences between visceral and subcutaneous fat-each of which may have distinct implications for cardiovascular risk.5”
From Semaglutide and cardiovascular outcomes by baseline and changes in adiposity measurements: a prespecified analysis of the SELECT trial (2025) · cites this paper as [5]
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- Authors
- Sattar, N., Presslie, C., Rutter, M. K., & McGuire, D. K.
- Affiliations
- University of Glasgow (GB)
- Manchester Academic Health Science Centre (GB)
- Parkland Health & Hospital System (US)
- Corresponding author
- Sattar, Naveed
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2024-02-27
- Volume
- 47
- Issue
- 4
- Pages
- 531-543
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W4392200504
- Cited by
- 70
- References
- 22
- Citations by year
- 2026: 26 · 2025: 35 · 2024: 9
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Funders
- British Heart Foundation (RE/18/6/34217)
- Manchester Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
- Keywords
- type 2 diabetes, excess adiposity, obesity, heart failure, chronic kidney disease, cardiovascular risk, young-onset diabetes, intentional weight loss, SGLT2 inhibitors, cardiorenal outcomes, inflammation, liver disease, joint diseases, mental health
- MeSH terms
- Cardiovascular Diseases, Diabetes Mellitus, Type 2, Heart Failure, Humans, Kidney, Obesity, Adiposity, Renal Insufficiency, Chronic
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