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Diabetes and Cardiovascular Disease: Addressing Mechanisms and Therapeutic Strategies Across the Cardiometabolic Continuum

A Special Issue of Medicina (ISSN 1648-9144) belonging to the section "Cardiology".

Deadline for manuscript submissions: 30 October 2026 | Viewed by 2082

Editors


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Guest Editor Assistant
Department of Cardiovascular Diseases, University Hospital Centre Zagreb, Zagreb, Croatia
Interests: clinical cardiology; angiology; cardiovascular imaging; diabetic heart disease; cardiometabolism

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Guest Editor
Faculty of Kinesiology, University of Zagreb, 10000 Zagreb, Croatia
Interests: diabetes treatment; cardiovascular disease prevention; antidiabetic agents; exercise; hypoglycemia; continuous glucose monitoring
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Special Issue Information

Dear Colleagues,

We are pleased to introduce this Special Issue on “Diabetes and Cardiovascular Disease: Addressing Mechanisms and Therapeutic Strategies Across the Cardiometabolic Continuum”.

Diabetes mellitus represents a major global public health challenge and is among the leading causes of morbidity and mortality worldwide. In addition to its detrimental effects on quality of life and functional capacity, diabetes is associated with a broad spectrum of chronic complications encompassing both microvascular and macrovascular disease, as well as acute metabolic disturbances.

Macrovascular complications, namely coronary artery disease, stroke, and peripheral artery disease—collectively referred to as atherosclerotic cardiovascular disease—account for the majority of deaths and healthcare expenditures in people living with diabetes.

Cardiovascular disease remains the dominant cause of mortality in this population, with approximately 70% of individuals with diabetes aged ≥65 years dying from cardiovascular causes.

Beyond atherosclerotic disease, diabetes mellitus is an independent risk factor for heart failure, with observational studies demonstrating a two- to five-fold increased risk compared with individuals without diabetes, accompanied by poorer clinical outcomes.

These data underscore that diabetes and cardiovascular disease are interrelated, co-evolving manifestations along a shared cardiometabolic continuum.

Despite substantial progress in glycemic control, lipid management, and blood pressure reduction, residual cardiometabolic risk remains high, highlighting persistent gaps in mechanistic understanding and therapeutic implementation. This evolving field represents both significant challenges and important opportunities, particularly in elucidating pathogenic pathways linking metabolic dysfunction to cardiovascular injury and in developing integrated, disease-modifying treatment strategies.

This Special Issue aims to present the most recent advances related to mechanisms and therapeutic strategies addressing diabetes and cardiovascular disease across the cardiometabolic continuum. We welcome contributions covering basic, translational, and clinical research, including cardiometabolic pathophysiology, atherosclerotic cardiovascular disease, heart failure in diabetes, cardioprotective glucose-lowering therapies, residual cardiovascular risk, and integrated cardiometabolic care models.

We look forward to your contributions and to sharing research that advances the understanding, prevention, and management of diabetes and cardiovascular disease in an integrated, patient-centered manner.

Dr. Petra Grubić Rotkvić
Guest Editor Assistant

Dr. Maja Cigrovski Berković
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetes mellitus
  • cardiovascular disease
  • cardiometabolism
  • diabetic heart disease
  • atherosclerosis
  • diabetic macrovascular complications
  • diabetes treatment
  • obesity

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Published Papers (2 papers)

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Research

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12 pages, 284 KB  
Article
Association of Continuous Glucose Monitoring with Glycaemic, Distress, and Quality of Life Outcomes in Insulin-Treated Type 2 Diabetes: A 12-Month Prospective Study
by Klara Dzojic, Ema Schönberger, Matea Petrinović, Daria Sladić Rimac, Ema Erzic, Maja Cigrovski Berkovic, Miro Bakula, Ines Bilić-Ćurčić and Silvija Canecki-Varžić
Medicina 2026, 62(5), 938; https://doi.org/10.3390/medicina62050938 - 11 May 2026
Viewed by 691
Abstract
Background and Objectives: Continuous glucose monitoring (CGM) improves glycemic control in type 2 diabetes (T2DM), but its effects on diabetes-related distress and quality of life (QoL), particularly in patients on intensive insulin therapy, are less well studied. Aim: We aim to assess [...] Read more.
Background and Objectives: Continuous glucose monitoring (CGM) improves glycemic control in type 2 diabetes (T2DM), but its effects on diabetes-related distress and quality of life (QoL), particularly in patients on intensive insulin therapy, are less well studied. Aim: We aim to assess the impact of CGM on glycemic control, diabetes distress, and QoL in adults with T2DM on intensified insulin therapy. Materials and Methods: This prospective observational study included 226 adults with T2DM using multiple daily insulin injections or basal–bolus therapy. CGM was initiated at baseline. HbA1c, fasting glucose, and lipid profile were measured at baseline, 3, 6, 9, and 12 months. Diabetes-related distress (DDS-17) and quality of life (MDQoL-17) were assessed at the same time points. Longitudinal changes were analyzed using linear mixed-effects models. Results: Mean age was 66 ± 9.1 years; 55% were male. HbA1c decreased from 8.56 ± 1.87% to 7.20 ± 0.90% at 3 months (p < 0.001) and remained improved at 12 months (7.21 ± 1.04%). Diabetes distress declined significantly over time (β = −0.025/month; p = 0.001). Older age and lower income were associated with higher distress. Quality of life improved significantly during follow-up; higher income predicted better QoL, while greater distress predicted poorer QoL. HbA1c did not independently influence QoL. CGM metrics (GMI, mean glucose, TIR, glycemic variability) remained stable after initial improvement. Conclusions: In 226 insulin-treated T2DM patients, implementation of CGM as part of a structured insulin intensification strategy was associated with sustained improvements in glycaemic control, reduced diabetes-related distress, and enhanced quality of life over 12 months. These findings support routine CGM use and highlight the importance of addressing psychosocial outcomes in diabetes care. Full article

Other

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17 pages, 534 KB  
Systematic Review
MASLD and Atherosclerosis in Patients with Type 2 Diabetes Mellitus: A Systematic Review
by Cosmina-Theodora Vulpescu (Diaconu), Delia Reurean-Pintilei, Marius-Costin Chitu, Teodor Salmen, Anca Pantea Stoian and Cristian Guja
Medicina 2026, 62(5), 919; https://doi.org/10.3390/medicina62050919 - 9 May 2026
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Abstract
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes (T2D) and has been increasingly recognized as a potential contributor to cardiovascular (CV) disease. However, the relationship between MASLD and subclinical/clinical atherosclerosis remains controversial, with inconsistent [...] Read more.
Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes (T2D) and has been increasingly recognized as a potential contributor to cardiovascular (CV) disease. However, the relationship between MASLD and subclinical/clinical atherosclerosis remains controversial, with inconsistent findings across imaging modalities and study populations. Methods: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420261347480). Literature searches were performed across the PubMed, Scopus, and Web of Science library databases from 1 January 2016 to 27 March 2026, using the terms: “MASLD AND (type 2 diabetes OR type 2 diabetes mellitus OR T2DM) AND atherosclerotic plaque” for each of the three databases. Inclusion criteria comprised original full-text English-language studies, published in the last 10 years and conducted in adults, reporting data regarding the evaluation of atherosclerosis in patients with T2D and MASLD/NAFLD. Exclusion criteria are letters to the editor, expert opinions, case reports, conference or meeting abstracts, reviews, and redundant publications; having unclear or incomplete data; and being performed in vitro (cell cultures) or in animal models. The quality of included studies was assessed using the Newcastle–Ottawa Scale. Results: The included studies, predominantly cross-sectional and a single longitudinal study, as well as different modalities of evaluating atherosclerosis, showed heterogeneous findings. MASLD is associated with increased carotid plaque progression, including in lean individuals. Its relationship with carotid intima-media thickness (CIMT) is inconsistent across studies, with some reporting higher values and others finding no significant association after adjustment. Hepatic fibrosis appears more strongly linked to vascular aging than steatosis alone, with variability likely due to differences in study methods and populations. Conclusions: The presence of both MASLD and T2D may be associated with atherosclerosis across different stages, from subclinical changes to clinically manifest disease, particularly at more advanced stages such as plaque presence or progression, whereas its relationship with early markers like pulse wave velocity or CIMT remains inconsistent. Liver fibrosis may represent a stronger determinant of atherosclerosis than hepatic steatosis alone. Although the evidence base is limited and largely derived from a small number of predominantly cross-sectional studies, further standardized and prospective research is warranted to better define these relationships and evaluate CV risk stratification in patients with T2D. Full article
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