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Trends in Diabetes Medications After Metformin in Patients at High Versus Moderate Cardiovascular Risk: The BESTMED Consortium 2014–2022
Journal article   Open access

Trends in Diabetes Medications After Metformin in Patients at High Versus Moderate Cardiovascular Risk: The BESTMED Consortium 2014–2022

M. Cecilia Lansang, Lucia C. Petito, Emma Hegermiller, Indhumathy Chelliah, Ryan M. Carnahan, Marie E. McDonnell, Andrea DeVries, Elisa Priest, Vincent Willey, Vinit Nair, …
Diabetes Obesity and Cardiometabolic CARE
07/13/2026
DOI: 10.2337/doc26-0027
url
https://doi.org/10.2337/doc26-0027View
Published (Version of record) Open Access

Abstract

OBJECTIVE To compare nationwide prescription trends in medications (dipeptidyl peptidase 4 inhibitors [DPP-4i], glucagon-like peptide 1 receptor agonists [GLP-1 RAs], sodium–glucose cotransporter 2 inhibitors [SGLT2i], or sulfonylureas [SUs]) after treatment with metformin in patients with type 2 diabetes (T2D) at high versus moderate cardiovascular risk by key sociodemographic and health characteristics. RESEARCH DESIGN AND METHODS Electronic health records and insurance claims from 2014 to 2022 from 10 health systems and two insurance plans from different U.S. regions were evaluated. Risk-stratified multinomial log-linear models were used to model trends in prescribing patterns, adjusted for sociodemographic variables. RESULTS A total of 104,474 patients were included (28% at high and 72% at moderate cardiovascular risk). Among those at high cardiovascular risk, DPP-4i (2014 24.0%; 2022 11.0%) and SU (66.4%; 35.7%) prescriptions declined, whereas GLP-1 RA (4.4%; 20.5%) and SGLT2i (5.2%; 32.8%) prescriptions increased. Among those at moderate cardiovascular risk, DPP-4i (23.7%; 11.7%) and SU (63.7%; 31.5%) prescriptions declined, whereas GLP-1 RA (5.7%; 30.0%) and SGLT2i (6.9%; 26.8%) prescriptions increased. Annual increases differed by high versus moderate cardiovascular risk for GLP-1 RAs (+2.5% vs. +3.6%/year; P < 0.001) and SGLT2i (+4.0% vs. +3.0%/year; P < 0.001). Greater annual increases in GLP-1 RA prescriptions occurred in women, those aged <65 years, and those with class 2 or 3 obesity, and greater annual increases in SGLT2i prescriptions were seen in men, those aged ≥65 years, and those without class 2 or 3 obesity (all P < 0.01). Greater increases in SGLT2i prescriptions occurred among Black patients, and greater increases in GLP-1 RA prescriptions occurred among those of Hispanic ethnicity at moderate cardiovascular risk. CONCLUSIONS Prescribing patterns for second-line T2D therapies in those at moderate cardiovascular risk are approaching guideline recommendations for those at high risk. Some trends are potentially clinically explainable, whereas certain racial/ethnic differences may warrant exploration.

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