Second-line SGLT2-inhibitor use increased from 26% in 2019 to 63% in 2024, with 12-month HbA1c response improving from -11.3 to -12.9 mmol/mol in adults ≤70 years.
Observational (n=117,046)
Yes
Does the initiation of second-line therapies (like SGLT2-inhibitors) improve HbA1c, weight, and complication risk in adults with T2D across age and frailty groups?
The rapid increase in SGLT2-inhibitor use as second-line therapy for T2D in the UK from 2019-2024 was associated with small population-level benefits in HbA1c and weight across all age and frailty groups, without increasing complication risks.
Absolute Event Rate: -12.9% vs -11.3%
ABSTRACT Aims To assess contemporary UK trends in second‐line treatment initiations and outcomes across age‐and‐frailty groups in people with type 2 diabetes (T2D). Materials and Methods We studied 117 046 UK adults with T2D initiating second‐line therapy between 2019–2024 (Clinical Practice Research Datalink). Outcomes were assessed in three groups: age ≤ 70 years ( n = 84 589 72%); non‐frail > 70 years ( n = 18 933 16%); frail > 70 years ( n = 13 524 12%). Annual prescribing trends by drug class were described and we evaluated annual changes in 12‐month HbA 1c , weight and severe diabetes‐related complication outcomes. Results SGLT2‐inhibitor use increased from 26% of overall second‐line initiations in 2019 to 63% in 2024, with the greatest increase among frail adults > 70 (6% in 2019 vs. 60% in 2024). In adults ≤ 70, mean 12‐month HbA 1c response improved from −11.3 mmol/mol (95% CI: −11.6 to −11.0) in 2019 to −12.9 mmol/mol (95% CI: −13.2 to −12.6) in 2023 and mean weight loss increased from −1.7 kg (95% CI: −1.8 to −1.5) to −2.8 kg (95% CI: −2.9 to −2.6). Incidence of short‐term severe diabetes‐related complications remained similar: 9.9 (95% CI: 8.1 to 11.7) per 1000 person‐years in 2019 versus 8.6 (95% CI: 6.9 to 10.3) in 2022. Similar time trends in treatment outcomes were seen across all age‐and‐frailty based subgroups. Conclusions Use of SGLT2‐inhibitors rapidly increased in the UK over 2019–2024, with a 10‐fold increase among older adults with frailty. Over the same period, there were small population‐level benefits for HbA 1c and weight, with no evidence of changes in complication risk. Findings support careful use of SGLT2‐inhibitors across the wider population with T2D, including older adults with frailty.
Dinsdale et al. (Thu,) conducted a observational in Type 2 diabetes (n=117,046). Second-line therapy (predominantly SGLT2-inhibitors) vs. 2019 initiations was evaluated on 12-month HbA1c response in adults ≤ 70 years (mmol/mol). Second-line SGLT2-inhibitor use increased from 26% in 2019 to 63% in 2024, with 12-month HbA1c response improving from -11.3 to -12.9 mmol/mol in adults ≤70 years.