Diabetic kidney disease (DKD) is a major complication of type 2 diabetes mellitus (T2DM), yet patient awareness remains low, limiting early intervention. Effective care requires active patient-physician discussions on kidney and heart health, which may shape treatment decisions and outcomes. iCaReMe registry is a prospective, multinational, observational study collecting real-world data on T2DM patients with renal impairment. This interim Taiwan cohort analysis examines the link between patients’ cardiorenal awareness, engagement in physician discussions, and their impact on guideline-directed medical therapy (GDMT) use and comorbidity management.

We analyzed data from 12 tertiary medical centers in Taiwan. Eligible patients (≥18 years, T2DM, and renal impairment: eGFR≧90ml/min/1.73 m² and UACR>30 mg/g; or eGFR≧30 ml/min/1.73 m² and < 90 ml/min/1.73 m²) completed a questionnaire on cardiorenal awareness and capability of discussing heart and kidney function with physicians. Clinical parameters, awareness scores, and capability of engaging discussion were analyzed.

A total of 562 patients were included (mean age 63.8 years, diabetes duration 13.2 years, 58.7% male), with 95.0% in CKD stages 1-3. Patients with higher cardiorenal awareness scores (2-3) were more capable of engaging discussion with physicians (89.1% vs. 82.1%, p=0.058). Capable patients demonstrated higher ABC target achievement rate (p=0.030), eGFR (75.3 vs. 65.8, p=0.014) and greater proportion with low albuminuria (p<0.001), indicating better metabolic control and kidney function. Patients capable of engaging discussion with physicians were more likely to use insulin (p=0.014), glucagon-like peptide-1 receptor agonists (GLP-1 RAs; p=0.039). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) use also showed an increasing trend (49.7% vs. 39.2%), though not statistically significant (p=0.166).

This analysis highlights the importance of patient cardiorenal awareness and patient-physician discussions, which may facilitate GDMT use, includingSGLT2i and GLP-1 RAs, to improve disease control. Our findings suggest that patient capability of discussion is associated with better treatment alignment and clinical profiles, reinforcing its role in DKD care. Structured education and shared decision-making may enhance care by closing awareness gaps, fostering discussions, and optimizing GDMT use for better long-term outcomes.