Ibero-American position statement on therapeutic recommendations for the preventive management of cardiovascular complications in latin-American patients with type 2 diabetes mellitus: consensus of the prevention council of the inter-American society

Type 2 diabetes mellitus (T2DM) affects an estimated 463 million adults worldwide, nearly 80% of whom live in low- and middle-income countries. Latin America and the Caribbean (LAC) are among the regions with the fastest-growing T2DM prevalence, with ~ 32 million affected individuals- Against this background, the SIAC Prevention Council (SIAC-PREVENT) developed regionally adapted, equity-oriented recommendations for the preventive management of cardiovascular complications in T2DM. We convened a multidisciplinary panel from across LAC and followed AGREE II and RIGHT principles. A comprehensive search (MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, SciELO, LILACS, and grey literature) from 2010 to 2025. Risk of bias was assessed using RoB 2, ROBINS-I, and AMSTAR 2; certainty of evidence was graded with GRADE. Draft recommendations were iteratively reviewed and validated in virtual meetings and an in-person consensus conference, with recorded voting procedures. In LAC, T2DM prevalence reaches 13–14% in some countries, with high disability burden. Over 80% of patients are overweight or obese; MASLD and peripheral arterial disease are common. T2DM confers a 2–4-fold increased cardiovascular risk and higher rates of stroke and heart failure. The Council proposes an integrated, risk-based strategy combining: systematic cardiovascular risk stratification; early obesity management; a four-pillar cardiorenal approach (RAS blockade, SGLT2 inhibitors, finerenone, GLP-1 receptor agonists); preferential use of SGLT2 inhibitors and GLP-1 receptor agonists in high-risk patients; strict lipid and blood pressure control; and systematic screening and management of micro- and macrovascular complications. This Ibero-American position statement supports an evidence-based and equity-oriented approach to preventing cardiovascular complications in people with T2DM in Latin America and the Caribbean. By prioritizing the use of SGLT2 inhibitors, GLP-1 receptor agonists, and structured multidisciplinary care adapted to the realities of local health systems, the region could substantially reduce morbidity, mortality, and the overall burden that T2DM represents for healthcare systems. These recommendations must be explicitly integrated into primary care models and existing chronic disease management programs within health systems. Achieving this potential will require deliberate actions to reduce inequalities in access—through coherent health policies, sustainable financing mechanisms, and continuous education for both healthcare professionals and patients—so that these strategies can be implemented at scale and in a sustainable manner. Likewise, it will be necessary to strengthen multidisciplinary care networks, establish quality indicators and outcome monitoring systems, and promote procurement and coverage strategies that facilitate equitable access to high-value therapies.