Matthew J. Budoff, MD: Impact of Obesity on Cardiometabolic Health in T1D

In this expert interview at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Matthew Budoff, MD, a professor of medicine at the David Geffen School of Medicine at UCLA and an investigator at The Lundquist Institute, highlighted the rising prevalence of obesity among patients with type 1 diabetes (T1D) and its implications for cardiovascular health.

Traditionally considered a disease of lean individuals, T1D now frequently overlaps with obesity and associated cardiometabolic complications, including hypertension, dyslipidemia, and increased risks of myocardial infarction and stroke. This shift parallels the broader obesity epidemic, with projections indicating that 50% of U.S. adults will be obese by 2030.

Budoff emphasized the need for a paradigm shift in managing T1D to address obesity and its cardiovascular consequences. With current treatment largely revolving around insulin, which may exacerbate atherosclerosis, new therapies like sodium-glucose co-transporter (SGLT) 1/2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists offer promise. Although GLP-1 receptor agonists are not yet approved for glucose control in T1D, Budoff indicated their significant benefits in weight reduction and cardiovascular risk mitigation could transform care. Notably, the early use of calcium scoring or CT angiography in patients with T1D is recommended to identify subclinical atherosclerosis and guide aggressive preventive strategies.

Budoff identified the "obesity revolution" as the year's most significant cardiology breakthrough, highlighting the expanding evidence supporting GLP-1 receptor agonists, demonstrating efficacy across a spectrum of indications—from weight loss to cardiovascular risk reduction and heart failure with preserved ejection fraction (HFpEF). He noted this versatility underscores their role as a game-changing therapeutic class poised to address the complex interplay between obesity, diabetes, and cardiovascular health.

Relevant disclosures for Budoff include AstraZeneca, Amarin, Merck, Novo Nordisk, Regeneron, and others.

Reference

_{Budoff MJ. Contemporary T1D- Obesity and Cardiometabolic Complications. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.}