Type 2 Diabetes and Central Obesity in the Cardiovascular Kidney–Metabolic Continuum: A Critical Narrative Review
Abstract
Type 2 diabetes and central obesity frequently coexist, but coexistence does not establish a distinct disease entity, biological interaction, or treatment indication. This critical narrative review examines whether confirmed type 2 diabetes plus a standardised waist measurement can serve as a low-cost risk-recognition trigger within the cardiovascular–kidney–metabolic (CKM) continuum. PubMed and authoritative guideline, government, and publisher repositories were searched for English-language evidence published from January 2010 through July 2026, with earlier landmark outcome trials retained when needed. Evidence most directly addressing the joint construct remains limited. Broader cohorts show that waist-based measures can be associated with cardiovascular and mortality outcomes in type 2 diabetes, but findings vary by population, adiposity metric, model specification, and sex. Only a minority evaluated incremental predictive performance, and none established that the proposed trigger improves clinical decisions or identifies differential treatment response. Visceral and ectopic adipose dysfunction provides biological coherence through altered lipid flux, insulin resistance, inflammation, endothelial injury, and cross-organ effects. Randomised trials support sodium–glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in defined cardiorenal–metabolic populations, but not prescribing on the basis of diabetes plus waist measurement alone. We therefore position this combination as a risk-recognition trigger that should prompt standardised anthropometry, CKM staging, and comprehensive risk assessment while management remains indication-based. Prospective studies must test interaction, calibration, discrimination, net benefit, feasibility, cost, and equity, particularly in Indonesia and other Asian populations. If validated and equitably implemented, this pathway could support Sustainable Development Goal 3 Targets 3.4 and 3.8.