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Clinical complexity and diabetes: a multidimensional approach for the management of cardiorenal metabolic syndrome

  • Author Footnotes
    1 These authors contributed equally.
    Alessandro Mattina
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
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  • Author Footnotes
    1 These authors contributed equally.
    Christiano Argano
    Footnotes
    1 These authors contributed equally.
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Giuseppe Brunori
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Umberto Lupo
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Massimo Raspanti
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Marika Lo Monaco
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Raffaella Mallaci Bocchio
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Giuseppe Natoli
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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  • Maria Ausilia Giusti
    Affiliations
    Diabetes and Islet Transplantation Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), Palermo, Italy
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  • Salvatore Corrao
    Correspondence
    Corresponding author. Dipartimento di Medicina Clinica, UOC Medicina Interna iGR, ARNAS Civico, Di Cristina, Piazza Nicola Leotta, 2, Benfratelli, 90127 Palermo, Italy.
    Affiliations
    Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy

    Dipartimento di Promozione Della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, PROMISE, University of Palermo, Palermo, Italy
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  • Author Footnotes
    1 These authors contributed equally.
Published:September 26, 2022DOI:https://doi.org/10.1016/j.numecd.2022.09.008

      Highlights

      • Diabetes mellitus is the main cause of chronic kidney disease. Diabetic nephropathy increases cardiovascular risk in patients with diabetes.
      • CardioRenal Metabolic Syndrome is a condition in which a purely metabolic alteration is responsible for heart and kidney diseases that coexist.
      • A proactive and multiprofessional approach is important for patients with diabetes affected with cardiorenal comorbidities.
      • Through our multidimensional approach one can correctly classify the clinical complexity in each patient for a personalized health-care plan.

      Abstract

      Diabetes mellitus (DM) is one of the fastest-growing health emergencies of the 21st century, and one of the chronic diseases with the highest socio-economic impact on health care systems. DM is the main cause of chronic kidney disease, and is associated with a significant increase in cardiovascular risk and clinical and care complexity. The presence of a constellation of cardiac, metabolic, and renal diseases, in a complex patient with DM, constitutes the CardioRenal Metabolic Syndrome (CRMS). The management of these patients should include a paradigm shift from a reactive strategy to a proactive approach, and the integration of territorial, hospital and social assistance services according to the Chronic Care Model (CCM). Complexity science suggests an alternative model in which disease and health arise from complex, dynamic, and unique interactions among the different components of the overall system. The hospital should be viewed as a highly specialized hub of the chronic care system, which interacts with the outpatient specialist and primary care. In order to create effective communication among territorial care units and highly specialized hospitals, levels of clinical complexity are here proposed and included in a multidimensional management model for the complex patient with diabetes and cardiorenal comorbidity.

      Keywords

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