MDCalc

Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-Diabetes)

Predicts 10-year CVD risk in patients with type 2 diabetes.

  • Use in European adults aged 40–69 years with type 2 diabetes.
  • Do not apply when alternative risk scores or disease-specific guidance should be used, such as:
    • Known atherosclerotic cardiovascular disease (ASCVD).
    • Type 1 diabetes.
    • Age 40–69 years without diabetes (consider using SCORE2).
    • Age ≥70 years (consider using SCORE2-OP).

Sex

years

Smoking

mm Hg

Diabetes

mmol/mol
mL/min/1.73 m²

Risk region

See Evidence for definition of risk regions.

Result:

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Advice
  • Interpret risk estimates within the broader clinical context of diabetes management, including diabetes duration, glycemic control, renal function, and microvascular complications.
  • Use the risk estimate together with clinical judgement to define preventive intensity.
  • Shared decision-making is particularly important in people with diabetes, balancing the potential benefits of risk factor modification against treatment burden and patient preferences. 
  • Reassess risk periodically, especially after major changes in diabetes control, smoking status, blood pressure, lipid profile, or renal function.
  • Consider additional risk modifiers (e.g., lipoprotein[a], hs-CRP, albuminuria) or imaging in borderline-risk individuals. 
Management
  • Management strategies should be linked to estimated absolute cardiovascular risk. 
  • Higher SCORE2-Diabetes categories may warrant more intensive LDL-cholesterol lowering, stricter blood pressure control, and structured lifestyle interventions. 
  • Shared decision-making is recommended when considering pharmacologic prevention in patients with diabetes, particularly given individual variation in diabetes control and comorbidities. 
  • Management decisions should be guided by the most recent guidelines, integrating clinical judgment, comorbidities, diabetes control, renal function, expected treatment benefit, patient preferences, and risk modifiers. 
  • This tool is intended to support cardiovascular risk estimation and shared decision-making; use of the SCORE2-Diabetes algorithm to estimate 10-year CVD risk and guide initiation of SGLT2 inhibitors, GLP-1 receptor agonists, and lipid-lowering therapies is recommended in 2023 ESC Guidelines for CVD management in patients with diabetes.

CV Risk Categories in Type 2 Diabetes

  • Very high risk: Established ASCVD, severe target organ damage, or SCORE2-Diabetes ≥20%.
  • High risk: SCORE2-Diabetes 10%–<20%.
  • Moderate risk: SCORE2-Diabetes 5%–<10%.
  • Low risk: SCORE2-Diabetes <5%.
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