Cardiovascular disease (CVD) is a serious risk in people with diabetes. Yet despite increased understanding of the interrelationship between diabetes and CVD [1, 2, 3], and clear guidelines for optimal management, everyday clinical practice often does not follow suit. Not only is one in two adults with diabetes unaware of their condition , but even after diagnosis, they may be equally unaware of their heightened risk of CVD, and common risk factors are often inadequately managed [4, 5, 6].
These gaps come at an enormous cost. Diabetes already affects almost half a billion people globally and by 2030 its prevalence is projected to increase by 25% ; type 2 diabetes accounts for 90% of these cases . People with diabetes have a twofold increased risk of CVD [9, 10], the leading cause of mortality in this group . Treating people who have diabetes and CVD costs two to three times higher than treating those with diabetes alone .
In an effort to better understand the gaps in care as well as the structural barriers behind them, the World Heart Federation and the International Diabetes Federation put out a global survey of experts in diabetes and CVD, culminating in A roadmap on the prevention of cardiovascular disease among people living with diabetes . They identified a number of barriers, including lack of awareness, limited adherence to clinical guidelines, inadequate communication between healthcare professionals, and lack of access to medicines.
Recognising the need for stronger patient voice in this area, in 2020 the Global Heart Hub brought together representatives of the diabetes and CVD patient communities in a series of round tables. They arrived at a unified consensus of the policy and care gaps in cardio-diabetes, which overlapped with the roadmap, verifying its findings and grounding them into the experience of patients. The round tables resulted in the publication of Promoting cardiovascular health in people living with, or at risk of, type 2 diabetes, a report outlining priority areas to focus on .
Building on this work, in May 2022 the Global Heart Hub organised a Cardio-Diabetes Think Tank to define a shortlist of critical advocacy goals and prioritise tangible, consistent demands for decision-makers grounded in the patient experience.
The think tank engaged representatives of global and regional organisations, including four patient groups (Diabetes UK, Pacientes de Corazón, ParSirdi.lv and Diabetes Sisters), three umbrella organisations (Global Heart Hub, World Heart Federation and International Diabetes Federation) and professional societies of nursing, primary and secondary care (Preventive Cardiovascular Nurses Association, International Primary Care Cardiovascular Society, Worldwide Cardiodiabetes).
The participants agreed on four pressing issues which should unite CVD and diabetes advocacy communities and help prioritise the policy demands for to decision-makers:
The think tank then went further by outlining priority actions to help address these issues on a global and national scale (see Table 1 and the full report, Cardio-Diabetes Think Tank: call to action ).
|PRIORITY ACTION 1: DOCUMENT A CLEAR PICTURE OF THE STATE OF PLAY IN CARDIO-DIABETES|
|PRIORITY ACTION 2: DEVELOP COMMUNICATION RESOURCES AND CAMPAIGNS TO IMPROVE PUBLIC UNDERSTANDING OF CARDIO-DIABETES RISK AND DISEASE PREVENTION|
|PRIORITY ACTION 3: DEVELOP SUPPORT TOOLS TO EMPOWER PATIENTS TO BECOME EQUAL PARTNERS IN THE MANAGEMENT AND TREATMENT OF THEIR CONDITIONS|
|PRIORITY ACTION 4: IMPROVE ACCESS TO AN INTEGRATED CARE PATHWAY FOR CARDIO-DIABETES|
The think tank was able to achieve a modernised, succinct and highly pragmatic consensus for joint advocacy actions between CVD and diabetes stakeholders that address the priorities of patients. The round tables and think tank represent the first time that the patient community led the way in developing tangible advocacy and policy actions in cardio-diabetes, with close input from leading advocacy organisations and specialists.
The consensus put forward by the think tank presents a new opportunity for global clinical and patient communities across diabetes and CVD to work together more closely to a shared agenda, and for individual organisations to take ownership of specific actions and commit to their implementation.
The actions identified will require significant effort, but the think tank consensus also gives hope that a renewed focus across different sectors and disciplines will forge a more defined cardio-diabetes community, with a clear and actionable agenda.
The Cardio-Diabetes Think Tank was initiated by the Global Heart Hub with the support of unrestricted grants from Boehringer Ingelheim, Novo Nordisk and Roche Diagnostics.
This report is an initiative by the Global Heart Hub with the support of unrestricted grants from Boehringer Ingelheim, Novo Nordisk and Roche Diagnostics.
Olive Fenton has no competing interests to share.
Karolay Lorenty and Ed Harding work for The Health Policy Partnership, which has several clients in the life sciences industry, but received no funding for this work.
Carlos Castro, patient, CEO Pacientes de Corazón, Mexico
Jean-Luc Eiselé, CEO, World Heart Federation
Emma Elvin, Senior Clinical Advisor, Diabetes UK
Richard Hobbs, Chair, European Primary Care Cardiovascular Society; President, International Primary Care Cardiovascular Society; Professor of Primary Care, University of Oxford; Head of Nuffield Department of Primary Care Health Sciences
Neil Johnson, Executive Director, Global Heart Hub; CEO Croi, the Heart & Stroke Charity and National Institute for Prevention and Cardiovascular Health, Ireland
Cindy Lamendola, Board Member, Preventive Cardiovascular Nurses Association; Nurse Practitioner/Clinical Research Nurse Coordinator, Stanford University School of Medicine
Inese Maurina, patient, CEO, ParSirdi.lv, Latvia
Anna Norton, patient, CEO, Diabetes Sisters, USA
Jorge Plutzky, Board Member, Worldwide Cardiodiabetes; Director, PreventiveCardiology, Brigham and Women’s Hospital; Principal Investigator and AssociateProfessor, Harvard Medical School
Naveed Sattar, Board Member, Worldwide Cardiodiabetes; Professor of MetabolicMedicine, University of Glasgow; Honorary Consultant in Metabolic Medicine, Glasgow Royal Infirmary
Beatriz Yáñez Jiménez, Advocacy Lead, International Diabetes Federation
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