The clinical practice of diabetes management has undergone a paradigm shift over the past two decades. GLP-1 receptor agonists and SGLT2 inhibitors have expanded the therapeutic focus beyond glycaemic control to meaningful cardiovascular protection.
In parallel, major organisations such as the American Diabetes Association (ADA) have increasingly emphasised individualised targets, particularly for older adults and people with multimorbidity. Together, these advances have reshaped the mortality landscape: earlier reviews and scientific statements estimated that roughly two-thirds to more than 70% of deaths among people with type 2 diabetes were attributable to cardiovascular causes;1,2 by contrast, in this new analysis conducted by Dianna J Magliano and colleagues in The Lancet Diabetes & Endocrinology,3 mortality due to cardiovascular disease declined in every assessed jurisdiction in the past decade and was no longer the universally dominant cause of death.