Matthew Budoff, MD: Determining Treatment for T2D Patient at Risk of CV Event

At the 2021 American Diabetes Association Virtual Meeting, conversations surrounding the best individualized treatment option for a patient with type 2 diabetes (T2D) at a high risk of cardiovascular event are being held.

In an interview with HCPLive, Matthew Budoff, MD, Endowed Chair of Preventive Cardiology Lundquist Institute, spoke on treatment options for these patient populations, including GLP-1 receptor agonists, SGLT2 inhibitors, PCSK9 inhibitors, and icosapent ethyl.

He discussed the need for individualized therapy in cardio-diabetes field, noting his own preferences such as GLP-1 for weight and CV event reduction, or SGLT-2 for kidney disease and heart failure.

“So, it just depends on the comorbid conditions in the patient and then I try to individualize it,” Budoff said.  Unfortunately, patients can’t afford everything, at some point, you almost would like to just put them on all 4 and get the full benefit of each of those classes.”

He also noted that a lot of options come down to nuances of individual practice as well as patient preference, citing the need for injection in certain treatments such as PCSk9 and GLP-1 receptor agonists.

Budoff mentioned his previous research into icosapent ethyl in the REDUCE-It trial, which reduced the risk of CV event in patients with elevated triglycerides .

“So we have diabetes or ASCVD with elevated triglycerides, that is a place where I would focus that therapy,” Budoff said. “I think you have to put that in perspective and try to emulate some of the positive trials.”

Finally, Budoff spoke on the need for new guidelines between a variety of fields, including endocrinology, nephrology, and cardiology to make an easier pathway to balance the different disease states.

“I think we need to continue to develop algorithms to help doctors go through the process and figure out based on these risk factors, this drug would have the most benefit,” Budoff said. “It’s hard, I feel like I am well connected to all of the data and yet, when I am seeing patients in a clinic, it is still tough to think which drug might be preferential in that exact environment.”