2375-P: Trends in Utilization of Glucose Lowering Medications among Patients with Type 1 Diabetes in the United States

Introduction and Objective: There is growing interest in the off-label use of non-insulin glucose-lowering medications (GLM), including metformin, glucagon-like peptide-1 receptor agonists (GLP-1RA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i), in people with type 1 diabetes (T1D), given their demonstrated weight, cardiometabolic, and renal benefits. However, trends in the utilization of these agents remain poorly characterized in adults with T1D. Methods: In a U.S. commercial claims database, we identified adults with T1D using basal-bolus insulin regimens who initiated a GLP-1RA, SGLT2i, or metformin, between January 2017 and June 2025. We assessed initiation trends every 6 months and compared the uptake of individual GLP-1RAs across the 8-year study period. Results: Among 79,496 patients with T1D on insulin, GLP-1RA initiation increased from 0.4% in early 2017 to 3.3% in early 2025, and SGLT2i initiation from 0.3% to 1.0%, while metformin initiation remained stable at ~1.0% (Figure A). Among GLP-1RAs, semaglutide and tirzepatide demonstrated rapid and sustained uptake following approval, whereas dulaglutide and liraglutide use was low and declined over the study period (Figure B). Conclusion: There has been an 8-fold increase in the use of GLP-1RA and 3-fold increase in the use of SGLT2i in adults with T1D in combination with insulin. Despite limited randomized controlled trial evidence, the off-label adoption of these agents continues to expand. Disclosure J. Ortega Montiel: None. H. Cho: None. S. Cromer: Other - Spouse is employee of Depuy Synthes; Current; Johnson Ended; Novo Nordisk. Other - Data Monitoring Committee; Current; Amgen Inc. J. Paik: None. E. Patorno: Research Support; Current; Boehringer Ingelheim International GmbH, AstraZeneca, Bayer AG, National Institute of Diabetes and Digestive and Kidney Diseases, Patient-Centered Outcomes Research Institute. Other - Royalties; Current; UpToDate.