Matthew Budoff, MD: Improving Screening, Referral for SGLT2 Inhibitors

An expert weighs in on improving guidelines to reflect optimal real-world care for patients at high risk of cardiovascular events.

The evolving research and cross-indication adoption of the SGLT2 inhibitor drug class by diabetologists and cardiologists alike is one of the many instances of modern bridge-building between the 2 fields that constitute a very collaborative cardiometabolic care strategy in 2021.

But at least one expert believes there’s better protocol to set in using the drug class to treat the fields’ most at-risk patient populations.

In an interview with HCPLive during The Metabolic Institute of America’s (TMIOA) 2021 Heart in Diabetes sessions in New York, NY this weekend, Matthew Budoff, MD, Professor of Medicine, David Geffen School of Medicine at UCLA, explained how patients including those with atherosclerotic cardiovascular disease (ASCVD) risk factors are going to benefit from timely initiation of event risk-reducing agents like SGLT2 inhibitors in a way that a patient with diabetes may not.

“I think that we need to risk-stratify a little bit better,” Budoff said. The same sentiment is shared for the utility of the GLP-1 agonist class, he explained.

When considering the role of US guidelines in setting precedent for patient cardiovascular risk factor screening and prescribing, Budoff said the field needs to find a “cogent middle ground” between such guidelines and the more rigid standards for indicated therapy use set by pivotal clinical trials.

Namely, trial-informed guidelines need to be better representative of optimal real-world use, Budoff said.

Budoff also discussed the significant role of the primary care physician in identifying risk factors for and helping to prevent the 3 events most commonly treated with SGLT2 inhibitors or GLP-1 agonists: ASCVD, heart failure, and renal disease.