AIMS: These recommendations aim to improve care for patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk in Central and Eastern Europe. Cardiovascular disease (CVD) and/or chronic kidney disease (CKD) are major interdependent comorbidities in patients with T2D, accounting for 50% of mortality. Following recent CV outcomes trial (CVOT) results, including those from EMPA-REG OUTCOME®, LEADER®, SUSTAIN™-6 and, most recently, the CANVAS study, it is essential to develop regional expert consensus recommendations to aid physicians in interpreting these newest data to clinical practice. METHODS: The Central and Eastern European Diabetes Expert Group (CEEDEG) followed a Delphi method to develop treatment algorithms to aid physicians in the clinical management of patients with T2D at high CV risk. RESULTS: In light of the latest CVOT results, and in particular the EMPA-REG OUTCOME® and LEADER® trials, the diagnosis, assessment, treatment choice and monitoring of patients with T2D and established CVD and/or CKD have been considered together with existing guidelines and presented in two reference algorithms. In addition, adherence, special prescribing considerations and a proposed multidisciplinary management approach have been discussed and are presented with the proposed algorithms. CONCLUSIONS: The latest available high-level evidence on glucose-lowering drugs has enabled CEEDEG to develop practical consensus recommendations for patients with established CVD and/or CKD. These recommendations represent an update to international and country-level guidelines used for these patients, with the aim of providing a resource not only to endocrinologists, but to cardiologists, nephrologists and primary care physicians in the region.

5th Medical Department Wilhelminenspital Vienna Austria

Chaim Sheba Medical Centre Tel Hashomer Israel

Clinical Centre of Endocrinology Medical University Sofia Bulgaria

Department of Diabetology and Internal Medicine Warsaw Medical University Warsaw Poland

Department of Endocrinology and Metabolic Diseases Vuk Vrhovac University Clinic for Diabetes Endocrinology and Metabolic Diseases Merkur University Hospital School of Medicine University of Zagreb Zagreb Croatia

Department of Endocrinology Diabetes and Metabolic Diseases University Medical Centre Ljubljana Slovenia

Department of Medicine 1 Rudolfstitung Hospital Vienna Austria

Department of Medicine Semmelweis University Budapest Hungary

Diabetes Centre Charles University and General Faculty Hospital Prague Czech Republic

Division of Endocrinology and Diabetes of the University Hospital Zurich Switzerland

Endocrinology Research Centre Moscow Russia

Faculty of Internal Medicine University of Latvia Riga Latvia

National Institute of Endocrinology and Diabetology Lubochna Slovakia

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