<p>Objective: We evaluated
recent utilization trends and predictors of first-line antidiabetic treatment in patients
with type 2 diabetes.</p>
<p>Research Design and Methods: Using two
large U.S. health insurance databases (Clinformatics and Medicare), we
identified adult type 2 diabetes patients who initiated antidiabetic treatment from 2013
through 2019. Quarterly trends in use of first-line antidiabetic treatment were
plotted overall and stratified by cardiovascular disease (CVD). Multinomial
logistic regressions were fit to estimate predictors of first-line antidiabetic
treatment, using metformin, the recommended first-line treatment for type 2
diabetes, as the common referent.</p>
<p>Results: Metformin was the
most frequently initiated medication used by 80.6% of Medicare beneficiaries
and 83.1% of commercially insured patients. Sulfonylureas were used by 8.7% (Medicare)
and 4.7% (commercial). Both populations had low use of sodium-glucose
cotransporter 2 inhibitors (SGLT-2i, 0.8% [Medicare] and 1.7% [commercial])
and glucagon-like peptide
1 receptor agonists (GLP-1RA, 1.0% [Medicare] and 3.5% [commercial]), with
increasing trends over time (P < 0.01). Initiators of antidiabetic drugs
with established cardiovascular benefits (SGLT-2i and GLP-1RA) were more likely
to be younger, and had prevalent CVD or higher socioeconomic status compared
with initiators of metformin. </p>
<p>Conclusions:
Among adult patients with type 2 diabetes, metformin was by far the most frequent first-line treatment.
While the use of SGLT-2i and GLP-1RA was low from 2013 through 2019, it increased
among patients with CVD.</p>
Trends in First-Line Glucose-Lowering Drug Use in Adults With Type 2 Diabetes in Light of Emerging Evidence for SGLT-2i and GLP-1RA
