ESCUDERO LECTURE: A person with type 2 diabetes mellitus and metabolic-renal-cardiovascular syndrome. Evidence, doubts, omissions

Abstract

In this lecture a review of the mechanisms involved in the syndrome will be done, its therapy through evidences interpreted by the acting professional and finally, the interaction of the latter with other specialists.

Based on a patient with obesity (Class 2), T2DM, hypertension, metabolic associated liver disease and chronic kidney disease, with prior transient ischemic attack and angioplasty for unstable angina (Stage 4 Cardiovascular-Kidney-Metabolic Syndrome [CKM])¹ the possible evolution of the syndrome is hypothesized (rearranging it as Metabolic-Kidney-Brain-Cardiovascular) as well as the little-explored evidences on interactions in the syndrome (liver/kidney, kidney/liver/brain, and cerebrovascular/heart ).

Evidences are also taken into account on the opportunities lost with interventions prior to the current stage and those available at this advanced stage (non-pharmacological and pharmacological with antihyperglycemic medications with cardiorenal events prevention and their combinations) ^2,3 to improve quality and duration of life at this advanced stage. We also explore new lipid-lowering and renal protective drugs available in our country that could be used in interaction with other specialists.

The above inevitably leads to evaluating how the diabetologist clinician has a fundamental role in managing the evidence so that, without losing fidelity to it, he makes its transposition to the patient possible. And this can be done through his own training and the transdiciplinary availability.

The latter involves multiple actors (for example hepatologists, lipidologists, nutritionists and physical trainers, that should have been added to the large group of specialists who were summonted by the American Heart Association for the aforementioned document).

Thinking that this is a stage that goes beyond multidisciplinary and interdisciplinary approaches, and that there is little tansdisciplinary information in our area of activity (which at this moment can be enriched with a few experiences that come from similar topics) ⁴ I believe that its realization is a challenge for the future, probably supported by progress in the area of biomedical informatics that can be transferred to the medical office)⁵.