A multicentre study found that more than one-third of Vietnamese adults with type 2 diabetes had advanced cardiovascular-kidney-metabolic risk, while blood pressure and lipid targets remained out of reach for many.
A multicentre Vietnamese study published by Wiley adds to growing evidence that type 2 diabetes should be viewed through a cardiovascular-kidney-metabolic lens rather than as a blood sugar problem alone. Drawing on patients without established cardiovascular disease, the research found that a sizeable share were already in an advanced CKM risk category, even before any overt heart event had occurred. That fits with the broader CKM framework now being promoted by the American Heart Association and other groups, which treats metabolic dysfunction, kidney disease and cardiovascular risk as a single, interlinked continuum requiring earlier and more coordinated care.
The Vietnamese team studied 1,436 adults with type 2 diabetes treated at six hospitals across the country between January 2024 and August 2025. Participants had a mean age of 58 and a median 10-year predicted cardiovascular risk of 15.1%, while the median estimated glomerular filtration rate, a measure of kidney function, was 72.9 mL/min/1.73 m². Nearly one in four reported current smoking, and about two-thirds were taking blood pressure medication. The researchers used the PREVENT risk tool, which has been incorporated into recent CKM guidance, to help classify patients’ cardiovascular risk alongside kidney measures.
What stood out was the gap between risk and control. More than one-third of the cohort was classified as having advanced CKM risk when high predicted cardiovascular risk was combined with reduced kidney function. Yet treatment targets were achieved by only a minority of patients. About one-third reached the study’s glycaemic target, a similar proportion met blood pressure goals, and even fewer achieved lipid targets, including just 18.8% for LDL cholesterol, 12.0% for triglycerides and 21.1% for non-HDL cholesterol. The pattern was especially concerning because many of these patients were already on treatment, suggesting that medication use alone was not translating into adequate control.
Blood pressure was the clearest weak point. Patients with advanced CKM risk were markedly less likely to reach target blood pressure than those with less advanced risk, and the association held up in several sensitivity analyses. The finding remained statistically significant even when the researchers altered the kidney thresholds, used different blood pressure cut-offs, or accounted for clustering by hospital. By contrast, the link between advanced CKM risk and poor glycaemic or cholesterol control was less consistent after adjustment, although triglyceride control still appeared weaker in the higher-risk group. In practical terms, the study suggests that blood pressure management may be the most immediate and durable intervention gap in this population.
The broader context helps explain why these findings matter. New CKM guidance from the American Heart Association, American College of Cardiology, American Diabetes Association and American Society of Nephrology promotes earlier identification of patients whose metabolic, renal and cardiovascular risks overlap, and encourages clinicians to act before disease becomes clinically obvious. The Vietnamese study aligns with that shift, showing that many people with type 2 diabetes who have never had a cardiovascular event are already far from low risk. It also underscores the importance of looking beyond body mass index alone, particularly in Asian populations where adverse metabolic profiles can emerge at lower BMI levels than in Western cohorts.
The authors say the findings support more structured risk stratification in routine diabetes care, with greater attention to kidney function and predicted cardiovascular risk, and, where available, albuminuria testing to sharpen kidney assessment further. They also argue that better follow-up, treatment intensification and adherence checks are needed, especially for blood pressure and triglyceride-rich dyslipidaemia. But the study has limits: it was cross-sectional, relied on hospital-based recruitment, and used a risk model developed largely in non-Vietnamese populations. Even so, it offers a clear message for clinicians: in type 2 diabetes, advanced CKM risk is common, and control of the most important modifiable factors is still far from where it should be.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
