Trends in Second-Line Initiations and Treatment Outcomes Across Age and Frailty Groups in People With Type 2...

To assess contemporary UK trends in second-line treatment initiations and outcomes across age-and-frailty groups in people with type 2 diabetes (T2D).

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.

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.

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.