The paper presents a clinical case of a patient with newly diagnosed type 2 diabetes mellitus (T2 DM), in whom severe decompensation of carbohydrate metabolism probably contributed to the worsening of chronic heart failure with a reduced ejection fraction against the background of chronic kidney disease of mixed genesis. Special attention is paid to the strategy of choosing cardio- and renoprotective therapy using drugs from the group of sodium-glucose cotransporter type 2 inhibitors, angiotensin converting enzyme inhibitors and highly selective antagonists of mineralocorticoid receptors in order to timely multifactorial therapeutic effects on various components of cardioreno-metabolic syndrome in a multimorbid patient. In the presented clinical case, a long-term asymptomatic course of T2DM2 (glycated hemoglobin level – 17.5%), against the background of cardio-reno-metabolic syndrome, could serve as a trigger in the development of rhythm disturbances that required electro-pulse therapy. The clinical case demonstrates the need for active screening of carbohydrate metabolism in patients at high and very high risk of cardiovascular complications, as well as the importance of an interdisciplinary approach in the management of such patients.