Implementing sodium–glucose co-transporter 2 inhibitors in cardiovascular–kidney–metabolic syndrome: a multidisciplinary expert perspective

Aims: Cardiovascular–kidney–metabolic (CKM) syndrome defines a pathophysiological continuum driven by reciprocal dysfunction across the cardiovascular, renal and metabolic systems. Although sodium–glucose co-transporter 2 inhibitors (SGLT2i) provide consistent, organ-protective benefits across this spectrum, clinical implementation remains suboptimal. This expert opinion, developed by a multidisciplinary Italian board, aims to translate current evidence and guideline recommendations into practical, integrated strategies for the early and effective implementation of SGLT2i in patients at risk of or affected by CKM syndrome. Methods and results: The panel reviewed the latest clinical trial data, international guidelines, and real-world evidence to identify implementation gaps and propose actionable solutions across diabetology, cardiology, and nephrology. Clinical recommendations were formulated via informal multidisciplinary roundtable discussions. Despite strong evidence and broad guideline endorsement, SGLT2i remain underutilized due to fragmented care, therapeutic inertia, and misconceptions regarding safety. To address these barriers, we advocate for early risk-based screening, simplified treatment algorithms, cross-specialty collaboration, and educational efforts to empower both clinicians and patients. Conclusion: Shifting from reactive to proactive CKM management requires an integrated care model aligning specialties around early, organ-protective interventions. SGLT2i should be recognized as foundational, disease-modifying therapy, supported by multidisciplinary coordination, clear clinical algorithms, and patient-centered communication.