European journal of internal medicine · 2026
Implementation of guideline-directed cardioprotective therapy in patients living with type 2 diabetes in outpatient cardiology ambulatory setting: the Italian CardioMET registry.
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Gargiulo Paola, Marzano Federica, Liccardi Laura, Nodari Savina, Cameli Matteo, Giallauria Francesco, Guerra Federico, Imbalzano Egidio, Sinagra Gianfranco, Carugo Stefano, Pizzi Carmine, Cipollone Francesco, Grigioni Francesco, Muscoli Saverio, Polimeni Alberto, Perrone Filardi Pasquale, CardioMET investigators
Аннотация
BACKGROUND: To assess the implementation of guideline-directed glucose-lowering therapies with proven cardiovascular (CV) benefit in individuals with type 2 diabetes mellitus (T2DM) attending Italian outpatient cardiology clinics.
METHODS: CardioMET is a multicenter, real-world registry including 2527 consecutive patients with T2DM enrolled between January 2022 and December 2025. Clinical characteristics, CV risk profile, and prescription rates of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) were assessed. Multivariable logistic regression was performed to identify predictors of non-prescription.
RESULTS: Overall, 70.7% of patients had established atherosclerotic CV disease (ASCVD), while 86.1% of those without ASCVD were classified at high or very high CV risk. Heart failure (HF) was present in 48.9% of patients with available data. SGLT2i were prescribed in 42.2% and GLP-1 RA in 27.7% of patients, whereas 14.8% received combination therapy. SGLT2i use was higher in patients with ASCVD than in high/very high CV risk no ASCVD patients (45.0%vs. 34.9%; p < 0.001) and in patients with HF, whereas no differences between groups in prescription rates of GLP-1 RA were observed. Prescription of both drug classes significantly increased after publication of 2023 ESC Guidelines (SGLT2i: 54.7% vs. 35.0%; GLP-1 RA: 48.4% vs. 15.8%; both p < 0.001). Older age, female sex (for SGLT2i), and absence of established ASCVD independently predicted non-prescription.
CONCLUSIONS: Implementation of cardioprotective glucose-lowering therapies remains suboptimal in Italian outpatient cardiology practice, underscoring the need for a multidisciplinary approach integrating recommendations from CV, T2DM, and kidney guidelines to optimize implementation of therapy in patients with T2DM.
METHODS: CardioMET is a multicenter, real-world registry including 2527 consecutive patients with T2DM enrolled between January 2022 and December 2025. Clinical characteristics, CV risk profile, and prescription rates of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) were assessed. Multivariable logistic regression was performed to identify predictors of non-prescription.
RESULTS: Overall, 70.7% of patients had established atherosclerotic CV disease (ASCVD), while 86.1% of those without ASCVD were classified at high or very high CV risk. Heart failure (HF) was present in 48.9% of patients with available data. SGLT2i were prescribed in 42.2% and GLP-1 RA in 27.7% of patients, whereas 14.8% received combination therapy. SGLT2i use was higher in patients with ASCVD than in high/very high CV risk no ASCVD patients (45.0%vs. 34.9%; p < 0.001) and in patients with HF, whereas no differences between groups in prescription rates of GLP-1 RA were observed. Prescription of both drug classes significantly increased after publication of 2023 ESC Guidelines (SGLT2i: 54.7% vs. 35.0%; GLP-1 RA: 48.4% vs. 15.8%; both p < 0.001). Older age, female sex (for SGLT2i), and absence of established ASCVD independently predicted non-prescription.
CONCLUSIONS: Implementation of cardioprotective glucose-lowering therapies remains suboptimal in Italian outpatient cardiology practice, underscoring the need for a multidisciplinary approach integrating recommendations from CV, T2DM, and kidney guidelines to optimize implementation of therapy in patients with T2DM.