Comprehensive Care: The Key to Managing Diabetes and Its Complexities

Ian Neeland, MD, director of cardiovascular prevention and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease at the University Hospitals Harrington Heart & Vascular Institute, sees the CMS-negotiated drug prices under the Inflation Reduction Act (IRA) as a positive step to improve access to essential therapies for patients with Medicare.

He also recommended a team-based, comprehensive approach to managing diabetes and its related complications. Although Neeland eagerly anticipates new developments in glucagon-like peptide-1 (GLP-1) medications and other cardio-renal-metabolic therapies, he noted that medication adherence concerns in patients with cardiovascular disease highlight the risks of access barriers.

Neeland is also an associate professor of medicine at the Case Western Reserve University School of Medicine.

This transcript has been lightly edited for clarity.

Transcript

CMS recently announced the negotiated drug prices for the first 10 drugs under the IRA. What is your reaction to the announced prices?

I think it's a very positive move. I think that access to evidence-based therapies has been hindered by cost, especially for folks with Medicare who can't afford the donut hole and those issues that go along with it, so I think this is a great step forward. As many people who can access appropriate care as possible is always a positive thing.

What does a team approach look like when treating a patient with diabetes to prevent or address other health issues they have?

Because diabetes is a complex disease with issues related to not just blood sugar control but cardiovascular, kidney, other metabolic [diseases], and obesity, you need a comprehensive team and a management plan that can address all of those different issues together in a way that can attack the central problem and, therefore, resolve many of the issues together.

So, a team-based approach that's patient centered and comprehensive is, in my opinion, the best way forward in treating diabetes and its complications.

Are there patients who we know are likely to benefit the most from the use of GLP-1s?

Patients who have multiple comorbidities, for example, diabetes, obesity, and cardiovascular disease, those patients would most likely benefit from GLP-1–related therapies, because they address many of those different comorbidities together in a comprehensive fashion.

What is the prevalence of adherence to medication among patients with cardiovascular disease and how does that impact the risk of developing something else down the line?

It depends on the type of medication in terms of how adherent one may be. In general, it's about 80% adherence to therapies, with about 20% of individuals who can't tolerate certain therapies and are unable to take them.

There's also an issue of access. Even if patients want to take the therapies, they may not be able to get the therapy paid for, so that can have deleterious consequences down the line. If patients are not on appropriate therapies, they're at high risk for recurrent cardiovascular events and even death.

What changes in the cardio-renal-metabolic landscape are you keeping an eye on for 2025?

I think new compounds and new advances in therapies are very exciting. There [are] GLP-1–related therapies, and there [are] more coming down the market in terms of different agonists, dual- [and] triple-agonists, and even antagonists, that are now out there.

I think those are very exciting, because the more we learn about those therapies, the more we see benefits across different cardiovascular-kidney-metabolic areas. The more comprehensive and the more overarching we can be to address multiple comorbidities and cardiovascular events is going to be a great step forward for us.