Kidney and Cardiovascular Protection in Diabetes: Beyond Diabetes Typology.

Despite the abundance of new therapies designed to delay or prevent kidney and cardiovascular events in people with type 2 diabetes mellitus (T2DM), a stark gap remains in the evidence supporting their efficacy and safety for other types of diabetes. Individuals without T2DM are frequently excluded from clinical trials based on the assumptions that their event risk, pathogenesis, and potential for adverse events differ significantly. It is anticipated that treatments will eventually be expanded to include this population, yet the uptake of new therapies even with clear evidence is often disappointingly low. In this perspective, we critically examine the characteristics of diabetes types other than T2DM and evaluate the available evidence for novel therapies in these underrepresented populations. Future small trials of surrogate end points and real-world studies, including individuals without T2DM, will be essential to understand and use recent advancements in treatments for preventing kidney failure and cardiovascular events and death.