Type 2 diabetes mellitus and comorbid conditions: from clinical recommendations to daily practice

Background. Managing patients with type 2 diabetes mellitus with comorbidities remains a major challenge in real clinical practice. Cardiovascular disease and progressive decline in glomerular filtration rate are the leading causes of mortality in type 2 diabetes. According to international and Russian guidelines, glucagon-like peptide-1 receptor agonists or type 2 sodium-glucose cotransporter inhibitors are preferred for patients with established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, regardless of baseline HbA1c. Semaglutide, a glucagon-like peptide-1 receptor agonist, has been proven highly effective for the treatment of type 2 diabetes and obesity. Clinical trials have shown that semaglutide reduces major adverse cardiovascular events, lowers hospitalization rates for heart failure, and slows chronic kidney disease progression, making it an essential tool for managing cardiorenal-metabolic risk in patients with type 2 diabetes.
Results. Semaglutide exerts a wide range of effects because of the varied expression of the glucagon-like peptide-1 receptors not only in pancreatic β-cells, but also in vascular endothelium, cardiomyocytes, renal tubular cells, smooth muscle cells, and hypothalamic neurons. In daily clinical practice, physicians routinely face inherent challenges, such as economic constraints, a lack of awareness of updated therapeutic strategies among some clinicians, therapeutic inertia, and poor treatment adherence. Population clinical heterogeneity plays a crucial role, ranging from young adults with newly diagnosed diabetes and concomitant obesity to elderly patients with frailty syndrome and multiple comorbidities, who require diametrically opposed therapeutic strategies. The introduction of domestic semaglutide to the Russian market has significantly enhanced access to this treatment in the Russian Federation.

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