REVIEW article
Front. Med.
Sec. Precision Medicine
This article is part of the Research TopicPrecision Medicine in Cardiovascular Remodeling: Bridging Pathogenesis to Personalized Therapeutic StrategiesView all 14 articles
Systemic Effects of Type 2 Diabetes Therapies: An Integrated Perspective on the Cardio–Renal–Cerebral–Metabolic Axis
Provisionally accepted
- 1Department of Endocrinology, University Town hospital, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- 2Department of Endocrinology, Department of Endocrinology, University Town hospital, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- 3Department of Radiology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Type 2 diabetes (T2D) has been treated as an underlying disease — hyperglycemia, but is instead a systemic disease—mediating the network of neural, endocrine, and immune signaling. In recent years, the concept of the cardio – renal – cerebral – metabolic axis has provided an integrative pathophysiological framework for understanding the multisystem complications of diabetes. From this perspective, the present review systematically elucidates the substantial evolution in modern T2D therapeutic strategies from simple glycemic control to comprehensive multi-organ protection. The primary pathology is that high insulin resistance and chronic metabolic disturbances trigger oxidative stress and inflammation, which in turn drive a vicious cycle in the heart, kidneys, and brain. In this review, we demonstrate that new drugs based on sodium–glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and mineralocorticoid receptor antagonists, which are capable of lowering glucose to promote efficient glycemic control, decrease cardiovascular events, lower the risk of renal disease, and demonstrate neuroprotective properties as the key to organ protection. Additionally, non-pharmacological interventions and new treatments can be combined as a multi-targeting, multilayer management system. Furthermore, greater knowledge and integration of the cardio–renal–cerebral–metabolic axis could signal a shift toward precision medicine to stabilize the network's homeostasis and improve long-term patient outcomes.
Keywords: Cardio–renal–cerebral–metabolic axis, ChronicInflammation, organ protection, precision medicine, type 2 diabetes
Received: 14 Nov 2025; Accepted: 26 Jan 2026.
Copyright: © 2026 Zhu, Chen, Lu and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bingying Li
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