{
  "release_id": "f6f6f1b6f50379ed",
  "id": "cardio:type-2-diabetes",
  "owner": "cardio",
  "kind": "condition",
  "slug": "type-2-diabetes",
  "name": "Type 2 diabetes",
  "aliases": [
    "Type 2 diabetes mellitus"
  ],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "A long-term condition in which the sugar (glucose) level in the blood is too high, because the body does not make enough insulin or does not use insulin well. If it is not managed, diabetes can lead to problems such as heart disease, stroke and kidney disease. This atlas links it to the medicines and trials that look at heart and kidney outcomes in people with type 2 diabetes.",
  "summary_technical": "Hub condition for the cardiovascular and kidney outcome trials in type 2 diabetes in this atlas: LEADER (liraglutide), SURPASS-CVOT (tirzepatide against dulaglutide), FLOW (semaglutide in chronic kidney disease), EMPA-REG OUTCOME (empagliflozin), DECLARE-TIMI 58 (dapagliflozin), FIDELIO-DKD (finerenone) and Look AHEAD (lifestyle intervention). Health care professionals can diagnose it with blood tests, including the HbA1c test.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-14",
  "last_evidence_check": null,
  "next_review_due": null,
  "identifiers": [
    {
      "scheme": "mesh",
      "value": "D003924",
      "normalized_value": "D003924",
      "match": "exact",
      "version": "2026",
      "label": null,
      "from_source": false
    }
  ],
  "navigation": {
    "cardio": {
      "system": [
        "metabolism"
      ],
      "condition-area": [
        "diabetes-and-metabolic-disease"
      ]
    }
  },
  "payload": {
    "recognition": "Symptoms often develop slowly, and many people have none.",
    "assessment": "A health care professional can diagnose type 2 diabetes with blood tests.",
    "burden_claims": []
  },
  "content_digest": "fb232e459ed555887f32ebb7a23c0fc4c2815e04424cd810ee204212403358e9",
  "review": {
    "content_digest": "fb232e459ed555887f32ebb7a23c0fc4c2815e04424cd810ee204212403358e9",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [
    {
      "release_id": "f6f6f1b6f50379ed",
      "id": "cardio:claim-diabetes-ckd-cause",
      "owner": "cardio",
      "subject_entity_id": "cardio:type-2-diabetes",
      "category": "descriptive",
      "statement": "The NIDDK chronic kidney disease page says that diabetes and high blood pressure are the most common causes of chronic kidney disease in adults. The MedlinePlus chronic kidney disease summary says the same.",
      "context": {
        "id": "cardio:ctx-adults-with-or-at-risk-of-ckd-nih-pages",
        "label": "Adults with chronic kidney disease or at risk of it (NIDDK and MedlinePlus patient pages)",
        "recipient": "adult",
        "population": "Adults with chronic kidney disease, or at higher risk of it, for example because of diabetes or high blood pressure.",
        "care_setting": "Not stated; patient information pages",
        "geography": "Not stated; United States federal health agencies",
        "life_stage_note": "Adults",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Not applicable (descriptive page)",
        "eligibility": {
          "inclusion": [],
          "exclusion": []
        }
      },
      "evidence_stage": "not_applicable",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "Patient-information pages. Both pages say diabetes without separating type 1 from type 2, so this atlas does not claim the statement is specific to type 2 diabetes. The pages give no size of the risk.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "Causes of Chronic Kidney Disease, para 1",
          "applicability_note": "NIDDK states the most common causes of CKD in adults.",
          "snapshot": {
            "id": "cardio:niddk-ckd-2026-10-14",
            "retrieved_at": "2026-10-14T18:30:07Z",
            "content_hash": "d37c0d57296c0ed6c81b18b6461672abf5a711391f75f470650102dfb6f8c0db",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:niddk-ckd",
            "source_type": "webpage",
            "title": "NIDDK: Chronic Kidney Disease (CKD)",
            "canonical_url": "https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd",
            "identifiers": [],
            "publication_date": null,
            "publisher": "National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health",
            "edition": "NIDDK page fetched 2026-10-14. The review date shown on the page itself was not recorded.",
            "reuse_basis": "The NIDDK copyright page (fetched 2026-10-14 as ch-niddk-copyright.html, sha256 c11dd24f95f0, hash only) says the majority of information on the NIDDK site is copyright free and can be freely downloaded and reproduced, with NIDDK acknowledged as the source, and warns of a few exceptions such as documents sponsored with private companies.The raw page is committed at research/snapshots/ch-niddk-ckd.html.",
            "public_text": "quote"
          }
        },
        {
          "evidence_role": "supports",
          "locator": "Summary, para 2",
          "applicability_note": "MedlinePlus states the same.",
          "snapshot": {
            "id": "cardio:medlineplus-chronickidneydisease-2026-10-14",
            "retrieved_at": "2026-10-14T18:30:06Z",
            "content_hash": "87cee69068b737077ddf49505e4d90258c5f55d2962d805baa645b7e0d7036a2",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:medlineplus-chronickidneydisease",
            "source_type": "webpage",
            "title": "MedlinePlus health topic: Chronic Kidney Disease",
            "canonical_url": "https://medlineplus.gov/chronickidneydisease.html",
            "identifiers": [],
            "publication_date": null,
            "publisher": "U.S. National Library of Medicine (MedlinePlus)",
            "edition": "MedlinePlus page fetched 2026-10-14; the page footer says last updated September 21, 2025.",
            "reuse_basis": "The MedlinePlus page on using its content (fetched 2026-10-14 as ch-medlineplus-usingcontent.html, sha256 31267ce9db01, hash only) says works produced by the federal government are not copyrighted, and lists summaries on health topic pages and medical test information as public domain; A.D.A.M. Medical Encyclopedia articles are copyrighted, and this atlas cites none. Please acknowledge MedlinePlus, National Library of Medicine, as the source. The raw page is committed at research/snapshots/ch-medlineplus-chronickidneydisease.html.",
            "public_text": "quote"
          }
        }
      ],
      "review": {
        "content_digest": "20c7ac85d18fac5347d676634592dd0bbea49168eb4ffca514715568bae077bb",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-diabetes-ckd-cause.json"
    },
    {
      "release_id": "f6f6f1b6f50379ed",
      "id": "cardio:claim-diabetes-stroke-risk",
      "owner": "cardio",
      "subject_entity_id": "cardio:type-2-diabetes",
      "category": "descriptive",
      "statement": "The NIDDK type 2 diabetes page says that, if not managed, diabetes can lead to problems such as heart disease and stroke, and also to nerve damage, kidney disease, foot problems and eye disease.",
      "context": {
        "id": "cardio:ctx-people-with-type-2-diabetes-nih-pages",
        "label": "People with type 2 diabetes (NIDDK and MedlinePlus patient pages)",
        "recipient": "mixed",
        "population": "People with type 2 diabetes. The NIDDK page says type 2 diabetes can develop at any age, including childhood, and occurs most often in middle-aged and older people.",
        "care_setting": "Not stated; patient information pages",
        "geography": "Not stated; United States federal health agencies",
        "life_stage_note": "All ages; most common in middle-aged and older people",
        "life_stage_terms": null,
        "gestational_age_min_days": null,
        "gestational_age_max_days": null,
        "gestational_age_basis": null,
        "postnatal_age_min_days": null,
        "postnatal_age_max_days": null,
        "gestational_age_status": null,
        "postnatal_age_status": null,
        "followup_description": "Not applicable (descriptive page)",
        "eligibility": {
          "inclusion": [],
          "exclusion": []
        }
      },
      "evidence_stage": "not_applicable",
      "certainty": "not_assessed",
      "certainty_method": null,
      "limitations": "A patient-information page. It says diabetes can lead to these problems if it is not managed, and gives no size for the risk, no time frame and no comparison with people who do not have diabetes. This atlas treats it as a description, not as an estimate.",
      "editorial_state": "draft",
      "checked_at": "2026-10-14",
      "next_review_due": null,
      "valid_from": null,
      "valid_to": null,
      "citations": [
        {
          "evidence_role": "supports",
          "locator": "What health problems can people with diabetes develop?, para 1; What health problems can people with diabetes develop?, list",
          "applicability_note": "NIDDK lists the problems diabetes can lead to if not managed.",
          "snapshot": {
            "id": "cardio:niddk-type-2-diabetes-2026-10-14",
            "retrieved_at": "2026-10-14T18:30:07Z",
            "content_hash": "3c2f58d4cd354c770c922c16ad8f978fb230d35db7999b26c237e068d9f55a9a",
            "source_effective_date": null,
            "public_archive_url": null,
            "source_state": "current"
          },
          "source": {
            "id": "cardio:niddk-type-2-diabetes",
            "source_type": "webpage",
            "title": "NIDDK: Type 2 Diabetes",
            "canonical_url": "https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes",
            "identifiers": [],
            "publication_date": null,
            "publisher": "National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health",
            "edition": "NIDDK page fetched 2026-10-14. The review date shown on the page itself was not recorded.",
            "reuse_basis": "The NIDDK copyright page (fetched 2026-10-14 as ch-niddk-copyright.html, sha256 c11dd24f95f0, hash only) says the majority of information on the NIDDK site is copyright free and can be freely downloaded and reproduced, with NIDDK acknowledged as the source, and warns of a few exceptions such as documents sponsored with private companies.The raw page is committed at research/snapshots/ch-niddk-type-2-diabetes.html.",
            "public_text": "quote"
          }
        }
      ],
      "review": {
        "content_digest": "5be9191fec7dd854793a960d94724c3fa9ee1befa3b46c888150602727dbba04",
        "current": [],
        "conflicting": [],
        "stale": [],
        "inactive": []
      },
      "api_path": "api/v1/claims/cardio--claim-diabetes-stroke-risk.json"
    }
  ],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "increases_risk_of",
        "label": "NIDDK and MedlinePlus name diabetes as a most common cause of chronic kidney disease in adults",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:chronic-kidney-disease",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-diabetes-ckd-cause",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "increases_risk_of",
        "label": "NIDDK says unmanaged diabetes can lead to heart disease and stroke",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "core:stroke",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-diabetes-stroke-risk",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "subtype_of",
        "label": "Type 2 diabetes is a form of diabetes mellitus",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "core:diabetes-mellitus",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": true,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "part_of",
        "label": "Filed under this front",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:front-kidney-and-metabolic-care",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": true,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": [
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "core:medlineplus",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:hba1c",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-hba1c-use",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "related_to",
        "label": "Related to",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:cardiovascular-kidney-metabolic-health",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:dapagliflozin",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-declare-timi-58-effect",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:empagliflozin",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-empa-reg-outcome-primary-effect",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:glp1-receptor-agonists",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-glp1-ra-meta-analysis-mace",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "evaluated_for",
        "label": "Evaluated for this",
        "clinical_claim_not_fact": true,
        "family": "clinical",
        "other_entity_id": "cardio:tirzepatide",
        "other_entity_in_atlas": true,
        "claim_id": "cardio:claim-surpass-cvot-noninferiority",
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:declare-timi-58",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:pubmed-30415602-2026-10-14",
          "locator": "Abstract, METHODS, sentence 1"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:empa-reg-outcome",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct01131676-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[0]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:fidelio-dkd",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:pubmed-33264825-2026-10-14",
          "locator": "Abstract, METHODS, sentence 1"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:flow-trial",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct03819153-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[0]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:leader-trial",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct01179048-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[1]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:look-ahead",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:pubmed-23796131-2026-10-14",
          "locator": "Abstract, METHODS, sentence 1, fragment 1 of 3"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      },
      {
        "predicate": "investigates",
        "label": "Investigated in",
        "clinical_claim_not_fact": false,
        "family": "sourced",
        "other_entity_id": "cardio:surpass-cvot",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": {
          "snapshot_id": "cardio:ctgov-nct04255433-2026-10-14",
          "locator": "protocolSection.conditionsModule.conditions[0]"
        },
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ]
  },
  "page_path": "conditions/type-2-diabetes/",
  "context_path": "api/v1/context/cardio--type-2-diabetes.md"
}