Evolving phenotype of newly diagnosed type 2 diabetes: a 15-year population-based comparison

Our aim was to describe the phenotype at diagnosis and the early therapeutic profile of newly diagnosed type 2 diabetes across two periods spanning approximately 15 years within the same integrated healthcare system.

This retrospective cohort study used electronic health record data from Clalit Health Services (Haifa & Western Galilee, Israel). Adults with incident type 2 diabetes in 2005-2008 (period 1: n=80,201) were compared with those diagnosed in 2020-2023 (period 2: n=101,392). Between-period differences are presented as crude estimates, with an age-stratified sensitivity analysis, and quantified using standardised mean differences (SMDs; values ≥0.20 indicate at least a small effect) alongside non-parametric and χ² tests.

The median age at diagnosis increased from 63.0 to 66.7 years between the two periods; the proportion aged ≥85 years nearly doubled (from 3.5% to 6.6%). The score for the Charlson comorbidity index increased from 4 to 6 (SMD 0.48); metabolic dysfunction-associated steatotic liver disease (MASLD) increased from 4.4% to 18.6%. HbA_1c at diagnosis decreased from 56 to 53 mmol/mol (7.3% to 7.0%); pre-diagnosis LDL-cholesterol decreased from 2.90 to 2.21 mmol/l (SMD 0.65). Within 31-90 days of diagnosis, use of sodium-glucose cotransporter 2 (SGLT2) inhibitors increased from 0.07% to 15.0%, use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) increased from 0% to 11.1%, and sulfonylurea use decreased more than fourfold (20.8% to 4.5%).

The phenotype of newly diagnosed type 2 diabetes has been fundamentally restructured since 2008: patients are older with a higher comorbidity burden but present with better glycaemic and lipid management, with the latter reflecting statin therapy already established before diagnosis. MASLD has emerged as a major but largely ascertainment-driven comorbidity. The shift to SGLT2 inhibitors and GLP-1RAs alongside declining sulfonylurea use indicates displacement of glucose-centric strategies by a cardiorenal- and weight-driven paradigm. These findings indicate a need for age-appropriate management and trials enrolling very elderly patients.