What does this research mean for the field?

Real-world adherence to ADA type 2 diabetes pharmacotherapy guidelines increased from 15.8% in 2018 to 38.2% in 2024, although the proportion of entirely untreated patients also grew significantly during this period. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To analyze adherence to the 2019 ADA pharmacotherapy guidelines for treating type 2 diabetes over six years.

June 7, 2026

2025-P: Adherence to Type 2 Diabetes Pharmacotherapy Guidelines: Six-Year Real-World Prescribing Analysis

Key Points

To analyze adherence to the 2019 ADA pharmacotherapy guidelines for treating type 2 diabetes over six years.
Multi-year cross-sectional study of electronic health records from 2018 to 2024.
Identified patients with T2D based on diagnoses, HbA1c, and BMI over two consecutive years.
Utilized unadjusted odds ratios to compare adherence among clinical groups.
Guideline adherence increased from 15.8% in 2018 to 38.2% in 2024.
Odds of guideline adherence declined from 1.20 in 2018 to 1.13 in 2024.
Adherence odds ranged from 1.10 (ASCVD) to 1.55 (obesity) in 2024.

Abstract

Introduction and Objective: The 2019 ADA Pharmacotherapy Guidelines for type 2 diabetes (T2D) recommended patient-centric prescribing based on clinical conditions such as prevalent ASCVD, high risk for CVD, heart failure (HF), CKD, and obesity. Prior analyses showed 40% guideline adoption. Methods: This multi-year cross-sectional study examined prescribing practice for patients with T2D from 2018 to 2024 using Veradigm Network Electronic Health Records (EHR). Patients active in the EHR for 2 consecutive years, with a T2D diagnosis, HbA1c, and BMI in the study year were selected. Clinical groups were defined via baseline year diagnoses; patients could meet criteria for 1 clinical group. Unadjusted odds ratios were used to compare treatment in clinical groups with no groups. Results: Guideline adherence increased from 2018 (15.8%) to 2024 (38.2%) among all patients. However, odds of guideline adherence vs. no group for the overall clinical group declined from 1.20 (2018) to 1.13 (2024), while it remained consistently higher for obesity, and improved the most HF group from 0.60 in 2018 to 1.35 in 2024 (Figure). Odds ratio of adherence ranged from 1.10 (ASCVD) to 1.55 (obesity) in 2024. Data showed untreated T2D patients increased from 21.1% in 2018 to 35.7% in 2024. Conclusion: Although guideline adherence improved between 2018 to 2024, there’s still much room for improvement in treating the untreated and targeting the recommended patients per guidelines. Disclosure J.P. Bae: Employee; Current; Eli Lilly and Company. T. Ryan: Consultant; Current; Eli Lilly and Company. K. Terrell: Employee; Current; Eli Lilly and Company. C. Adams: Consultant; Current; Eli Lilly and Company. J. Peleshok: Employee; Current; Eli Lilly and Company. B. Limone: Consultant; Current; Eli Lilly and Company. F. Tangi: Employee; Current; Eli Lilly and Company. E. Marchlewicz: Consultant; Current; Eli Lilly and Company. Funding This study was funded by Eli Lilly and Company.

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2025-P: Adherence to Type 2 Diabetes Pharmacotherapy Guidelines: Six-Year Real-World Prescribing Analysis

Key Points

Abstract

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