Diabetes mellitus increases the risk of developing coronary artery disease, stroke, aortic disease, heart failure, atrial fibrillation, and peripheral arterial disease. This condition negatively impacts prognosis by increasing the risk of future cardiovascular (CV) events. Patients with type 2 diabetes mellitus need a comprehensive and personalized assessment and definition of the CV risk profile. In very high-risk individuals, special attention is required due to the high risk of adverse events despite appropriate management and treatment. Key interventions to reduce this risk include CV prevention and cardiac rehabilitation. Traditional and non-traditional CV risk factor management, dietary modifications, regular physical activity, aerobic and resistance exercise training, psychosocial and frailty management, optimal pharmacological therapy, and investigation of comorbidities are recommended to reduce the development of CV disease and mortality. Therefore, our manuscript provides updated and critical evidence on the comprehensive management of patients with type 2 diabetes mellitus in clinical practice from the perspective of CV prevention and cardiac rehabilitation, with a focus on individuals at very high risk. Further, practical guidance on individualizing exercise prescriptions based on patient-specific risk profiles and comorbid conditions is provided.

Academy of Medical Sciences 030167 Bucharest Romania

Academy of Romanian Scientists 700050 Iasi Romania

Biruni University Research Center Biruni University 34015 Istanbul Turkey

Cardiac Rehabilitation Unit Rehabilitation Clinic 'Villa delle Magnolie' 81020 Castel Morrone Caserta Italy

Cardiology Clinic University Clinical Center of Serbia 11000 Belgrade Serbia

Department of Cardiology Cardinal Wyszynski Hospital in Lublin al Krasnicka 100 20 718 Lublin Poland

Department of Cardiology Lausanne University Hospital and University of Lausanne 1005 Lausanne Switzerland

Department of Clinical Dietetics Medical University of Lublin ul Chodzki 7 20 093 Lublin Poland

Department of Clinical Internal Anesthesiology and Cardiovascular Sciences Policlinico Universitario Umberto 1 Sapienza University of Rome 00161 Rome Italy

Department of Medical Specialties 1 Grigore T Popa University of Medicine and Pharmacy Iasi University Street No 16 700115 Iasi Romania

Department of Physiotherapy and Rehabilitation Faculty of Health Sciences Biruni University 34015 Istanbul Turkey

Department of Physiotherapy and Rehabilitation Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Public Health Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Rehabilitation Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Department of Rehabilitation University Hospital Brno 62500 Brno Czech Republic

University Hospitals Cleveland Medical Center Cleveland OH 44106 USA

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