Use of sodium‐glucose cotransporter‐2 inhibitors among older adults with type 2 diabetes mellitus in British Columbia

Aims Clinical guidelines recommend sodium‐glucose cotransporter‐2 inhibitors (SGLT2is) for individuals with type 2 diabetes mellitus (T2DM) and established or high risk of cardiorenal disease. This study examined real‐world SGLT2i use patterns among older adults with T2DM in British Columbia, Canada. Materials and Methods We conducted a drug utilisation study on all individuals aged ≥75 years with T2DM in British Columbia between January 1, 2016, and December 31, 2023, using administrative healthcare databases. We examined prevalence, incidence, characteristics of incident users, and discontinuation. Results The prevalence of SGLT2i use increased gradually from 2.0% in the first half of 2016 to 14% in the second half of 2022, then more sharply to 21% in the second half of 2023, with comparable prevalence in individuals with and without cardiorenal disease (20% vs. 22% in 2023). SGLT2i initiation increased from 1.3 to 2.8 per 1000 individuals between 2016 and 2022, spiked to 5.4 per 1000 individuals in January 2023, and then stabilised. Of the 14 320 SGLT2i initiators between 2021 and 2023, 62% had cardiorenal disease, most used other glucose‐lowering drugs concomitantly (particularly metformin [68%], sulfonylureas [39%], and insulins [19%]), and 62% were started on treatment by a general practitioner. Additionally, 17% discontinued treatment within a year. Conclusions SGLT2i use among older adults with T2DM in British Columbia increased steadily from 2016 to 2022, followed by a spike in 2023, aligned with the expansion in publicly funded drug coverage. By the end of 2023, around one in five used SGLT2is, regardless of cardiorenal disease status.