Nearly one in four of Taiwan’s 2.6 million people living with diabetes faces high risk of macrovascular cardiovascular disease — and a new TADE study presented Tuesday confirms that routine kidney screening tests are not reaching the patients who need them most, leaving a known hazard undetected until it becomes a crisis. The finding does not reveal a new danger; it quantifies how many patients have fallen through a gap that glucose-centered diabetes care has always had: when blood sugar numbers look acceptable, the parallel cardiovascular and kidney risk goes unmeasured.

The Taiwan Association of Diabetes Educators (TADE, 中華民國糖尿病衛教學會) presented the findings at a Taipei press conference attended by Taiwan’s Health Promotion Administration (HPA) Director-General, ten days before World Diabetes Day November 14 — whose “Early action on diabetes” campaign centers on earlier detection and expanded access to care. The timing is deliberate: the association wants the country’s roughly 15,000 diabetes-care physicians to treat two inexpensive blood and urine tests as non-negotiable at every visit, not optional add-ons to a glucose chart.

Nearly 1 in 4 Patients at High Macrovascular Risk — and Most Have No Symptoms Yet

The TADE tracking study followed 5,097 diabetes patients — 2,544 men and 2,553 women — recruited from clinics across Taiwan, and found that 23.8% at macrovascular high risk were classified at high risk for macrovascular disease and in need of active follow-up and medication adjustment. Macrovascular disease encompasses atherosclerosis in the coronary, cerebrovascular, and peripheral arteries — the pathways to heart attack, stroke, and limb-threatening peripheral arterial disease.

Wang Ching-yuan (王景淵), a standing supervisor of TADE, clarified at the press conference that being flagged at high macrovascular risk does not mean a patient has already developed cardiovascular disease. It means they have crossed a threshold at which clinicians treat the risk as a prompt for more aggressive management — adjusting medications, tightening lipid and blood pressure targets, and introducing cardiovascular-protective therapies where indicated.

The same study found that nearly 30% at high CKD risk fell into the “orange light” (high risk) or “red light” (very-high risk) categories of chronic kidney disease (CKD) risk stratification. Wang stressed that early kidney damage typically produces no obvious symptoms — no pain, no visible change — which is precisely why it must be caught through testing rather than through clinical presentation.

Glucose Goals Met — But Cardiovascular Risk Was Never On the Checklist

TADE president Ou Hong-yi (歐弘毅) stated directly at the press conference that reaching blood glucose targets does not mean cardiovascular and kidney risks have been adequately controlled. That statement names the structural gap in Taiwan’s current care model: the standard metric of diabetes management — hemoglobin A1c — measures glycemic control. It does not measure kidney function. It does not measure cardiovascular risk. A patient whose A1c reads well can simultaneously have subclinical kidney damage and elevated cardiovascular risk that no one has checked for.

This is not a failure unique to Taiwan. It is the central problem the global cardiology and endocrinology community has been building toward addressing for years, and the reason the American Heart Association and American College of Cardiology published the first-ever joint CKM guideline on cardiovascular-kidney-metabolic (CKM) syndrome in June 2026, in both Circulation and JACC. The guideline’s core argument — made by lead author Chiadi Ndumele and co-authors from the ADA and ASN — is that heart disease, kidney disease, obesity, diabetes, high blood pressure, and metabolic dysfunction are not separate clinical problems managed in separate clinical silos. They interact. They compound each other. And they need to be screened, staged, and managed together from the moment any one of them is diagnosed.

The guideline notes that nearly 90 percent CKM risk factors affect U.S. adults. Taiwan’s numbers suggest the problem is similarly pervasive on the island.

Two Tests, Two Numbers — and What They Actually Measure

Wang’s specific call for eGFR and UACR was for every diabetes patient to confirm with their physician that they are receiving two tests: an eGFR (estimated glomerular filtration rate) and a UACR (urine albumin-to-creatinine ratio).

Each test does something the other does not. The eGFR — calculated from serum creatinine — measures how efficiently the kidneys are filtering waste from the blood. A normal eGFR exceeds 90 mL/min/1.73 m²; CKD staging progresses through five grades as the number falls, with clinical guidelines define kidney failure below 15. The eGFR tracks functional decline — how well the kidney is working.

The UACR — measured from a first-morning urine sample — detects albumin leaking through damaged kidney filters. A UACR of 30 mg/g or above indicates UACR detects early kidney damage even when the eGFR is still normal. This is the test that catches early diabetic nephropathy before glomerular filtration has visibly fallen. Together, the two tests map both the functional and structural dimensions of kidney health, which is why clinical guidelines require both — using either alone misses a substantial share of patients with kidney damage.

Under the CKM framework, these tests serve a second function beyond kidney staging. Because kidney health and cardiovascular health deteriorate together — 65% of CKD patients have cardiovascular disease, and cardiovascular disease is the leading cause of death in CKD patients — a low eGFR or elevated UACR is not merely a kidney finding. It is also a cardiovascular risk signal. The two tests function as cardiovascular triage tools embedded in what most patients understand as kidney monitoring.

Multiple Microvascular Complications Raise Stroke Risk by 73%

A second study presented alongside the main findings quantified what happens to cardiovascular risk when microvascular complications — retinopathy, nephropathy, neuropathy — are allowed to accumulate unchecked. Among Type 2 diabetes patients, those with two or more concurrent microvascular complications had a composite hazard ratio of 1.73 (95% confidence interval: 1.16–2.59) for the combined outcome of stroke, myocardial infarction, or all-cause mortality, compared to patients with no microvascular complications, according to Huang et al DRCP 2025. The component risk estimates were even higher for specific outcomes: a hazard ratio of 2.61 for stroke and 1.67 for myocardial infarction.

A hazard ratio of 1.73 in this context represents a 73% higher rate of experiencing a catastrophic cardiovascular event over the same follow-up period. The confidence interval — ranging from 1.16 to 2.59 — does not cross 1.0, confirming the finding is statistically significant and not attributable to chance.

Wang cautioned at the press conference against treating microvascular complications as isolated, single-organ problems. Diabetic nephropathy is not just a kidney problem. Diabetic retinopathy is not just an eye problem. When these conditions accumulate, they reflect a vascular system under system-wide stress — and the cardiovascular risk accumulates with them. The clinical implication is that microvascular complications, particularly in combination, should function as a mandatory trigger for cardiovascular risk assessment and intensified cardiovascular-protective management.

Where Taiwan’s Patients Stand in the CKM Staging System

The AHA/ACC CKM syndrome guideline organizes CKM syndrome into four stages that map to escalating cardiovascular risk and escalating need for intervention:

Stage 1 covers patients with overweight status or prediabetes and no other metabolic or cardiovascular complications. The focus at this stage is lifestyle modification.

Stage 2 covers patients with established Type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome, or chronic kidney disease — without yet having diagnosed cardiovascular disease. This is the stage at which the guideline explicitly recommends cardiovascular risk management and GLP-1 receptor agonist therapies for the first time in the CKM framework, not waiting for a cardiac event.

Stage 3 covers patients with subclinical cardiovascular disease or high predicted 10-year cardiovascular risk.

Stage 4 covers patients with diagnosed cardiovascular disease plus metabolic risk factors or CKD.

The majority of Taiwan’s 2.6 million diabetes patients — based on the TADE study’s prevalence findings — are likely in Stage 2 or higher, without necessarily knowing it, according to IDF Diabetes Atlas Taiwan data. The TADE call for systematic eGFR and UACR screening is, in CKM terms, a call to identify which stage each patient is actually at — and to begin Stage 2 interventions before Stage 3 or 4 disease declares itself through a stroke or heart attack.

The ‘5-Look, 3-Ask’ Campaign: A Clinic-Ready Checklist

For the World Diabetes Day run-up, TADE is jointly promoting an awareness campaign with the Diabetes Association of the Republic of China (中華民國糖尿病學會) and the Diabetes Care Foundation (糖尿病關懷基金會), structured around the slogan “5-Look Early Detection, 3-Ask Early Protection” (5看早發現、3問早守護).

The five indicators the campaign asks patients to monitor at each visit are blood glucose, blood pressure, blood lipids, kidney function, and body weight — covering the full CKM spectrum. The three questions the campaign asks patients to put to their physicians are oriented toward ensuring that cardiovascular and kidney risk assessments are part of the visit, not omitted because glucose numbers looked acceptable.

The campaign positions itself as a practical, clinic-ready tool that requires no specialized equipment and can be embedded in routine outpatient care. Its aim is not to introduce a new clinical protocol but to ensure that the existing one — which already includes eGFR and UACR in clinical guidelines — is actually happening at every visit for every patient.

Taiwan’s Diabetes Burden Is Growing Faster Among the Young

The scale of the underlying problem in Taiwan is substantial and shifting, according to IDF Diabetes Atlas Taiwan figures. Approximately 2.6 million adults — roughly 10.7% of the adult population — currently have diabetes, with the International Diabetes Federation projecting that figure will reach approximately 3.1 million by 2050, with IDF projects 3.1 million by 2050 and age-standardized prevalence climbing to around 13%.

The generational shift compounds the concern. Diabetes incidence up 25 percent among Taiwanese adults under 40, meaning younger patients face a longer disease duration and earlier exposure to the complications the TADE study documents. A 35-year-old diagnosed today with poorly managed Type 2 diabetes, left without cardiovascular-kidney screening, has decades over which microvascular complications can accumulate — and the HR 1.73 finding shows what that accumulation eventually produces.

Diabetes now ranks third among the top 20 diseases for treatment expenditure under Taiwan’s National Health Insurance system, with Taiwan NHI diabetes spending rose from NT$26.4 billion (approximately $803 million USD) in 2016 to NT$40.1 billion (approximately $1.22 billion USD) in 2022 — a 52% increase in six years. That trajectory reflects both growing prevalence and growing complexity of treatment as patients develop complications. Catching those complications earlier, before they require hospitalization and cardiovascular procedures, would affect not only patient outcomes but the system’s fiscal sustainability.

Government Aligns With the Clinical Call

HPA Director-General Shen Ching-fen (沈靜芬), who attended the TADE press conference, called for diabetes prevention to begin before diagnosis — noting that overweight status, increasing waist circumference, and abnormalities in blood pressure, blood sugar, or blood lipids may all be early metabolic warning signs. She encouraged the public to make use of Taiwan’s adult preventive health services and metabolic syndrome prevention programs to track health indicators regularly and detect abnormalities early.

The government’s presence at the press conference signals official alignment with the TADE call for integrated CKM screening — a signal that is relevant to whether Taiwan’s NHI system will adjust reimbursement incentives and care protocols to reflect the CKM framework, moving from a glucose-management-focused payment model toward one that rewards integrated cardiovascular-kidney monitoring.

What This Means for the 2.6 Million

Ou Hong-yi’s statement — that glucose targets alone do not control cardiovascular and kidney risk — is both a clinical argument and a systems argument. It is a clinical argument because the evidence now demonstrates, through the HR 1.73 finding and the 23.8% prevalence figure, that the existing paradigm has been leaving identifiable, high-risk patients unprotected. It is a systems argument because correcting that gap requires that eGFR and UACR become non-negotiable, reimbursed, and uniformly applied components of every diabetes management visit — not ordered only when symptoms appear or when a physician suspects kidney disease.

For Taiwan’s roughly 2.6 million diabetes patients, the practical question the TADE campaign poses is a simple one: does your physician order both tests at each visit? If the answer is no or uncertain, the TADE recommendation is to ask — explicitly and at the next appointment.

World Diabetes Day, November 14 falls on Saturday, ten days from Tuesday’s press conference. The IDF and WHO 2026 campaign, “Early action on diabetes,” is led by the International Diabetes Federation in partnership with the World Health Organization, with the explicit goal of moving care earlier in the disease trajectory — before the complications the Taiwan study has now quantified at scale.

Frequently Asked Questions

What are eGFR and UACR tests, and why do people with diabetes need both?

The eGFR (estimated glomerular filtration rate) and UACR (urine albumin-to-creatinine ratio) are the two standard tests for detecting kidney damage in diabetes patients. The eGFR, calculated from a blood creatinine measurement, tracks how efficiently the kidneys are filtering waste — with values below 60 indicating established kidney disease. The UACR, from a first-morning urine sample, detects albumin leaking through damaged kidney filters — a sign of early diabetic nephropathy that can appear before the eGFR has fallen at all. Because each test catches different types of kidney damage at different stages, clinical guidelines require both tests. Neither test alone is sufficient. The TADE recommendation is for every diabetes patient to confirm at each clinical visit that both tests are being ordered.

What is CKM syndrome, and how is it different from traditional diabetes management?

Cardiovascular-kidney-metabolic (CKM) syndrome is a framework — formally codified in the AHA ACC ADA ASN CKM guideline published in June 2026 — that recognizes heart disease, kidney disease, and metabolic conditions like Type 2 diabetes as deeply interconnected rather than separate clinical problems. Traditional diabetes management has focused primarily on blood glucose control (measured by A1c). The CKM framework requires concurrent monitoring and management of kidney function (eGFR, UACR), cardiovascular risk (lipids, blood pressure, predicted event risk), and metabolic health from the moment any one of these conditions is diagnosed. The difference is not new tests — it is treating glucose management as one component of a system-wide approach rather than the endpoint of care.

Why does having multiple microvascular complications increase heart attack and stroke risk so significantly?

Microvascular complications — diabetic nephropathy, retinopathy, and neuropathy — arise from the same underlying mechanism: advanced glycation end products (AGEs) formed when glucose permanently binds to proteins, stiffening and damaging small blood vessels throughout the body. When these complications accumulate in multiple organs simultaneously, they signal that systemic vascular dysfunction has progressed beyond any single organ. The Huang 2025 DRCP hazard ratio finding of 1.73 (95% CI: 1.16–2.59) from a 4,527-patient study reflects this: two or more concurrent microvascular complications are not merely more of the same problem — they are evidence that the vascular system as a whole has sustained extensive damage, leaving large vessels (coronary, cerebrovascular) with compromised protective mechanisms. The component stroke hazard ratio of 2.61 is especially notable — more than a doubling of stroke rate.

Why isn’t integrated cardiovascular-kidney screening already standard practice at every diabetes visit in Taiwan?

The gap reflects a paradigm that developed around glucose management because that was the first and most measurable lever in diabetes care. Clinical guidelines — including Taiwan’s — do specify that eGFR and UACR should be tested regularly in diabetes patients. The TADE finding is not that the guidelines are absent; it is that the guidelines are not being uniformly applied at the clinical level, and that most patients are not aware they should be asking for these specific tests. The CKM framework, the AHA/ACC 2026 guideline, and campaigns like TADE’s “5-Look, 3-Ask” are all aimed at the same gap: raising awareness among patients and clinicians alike that blood sugar control and cardiovascular-kidney monitoring are both mandatory, not sequential — and that meeting glucose targets does not mean the other risks have been addressed.