Trends in metabolic risk factor control and medication use among adults with type 2 diabetes in Taiwan, 2015-2024

To evaluate 10-year trends in metabolic control and guideline-directed pharmacotherapy among adults with type 2 diabetes in Taiwan.

Using Taiwan's National Health Insurance Research Database (2015-2024), we analyzed annual trends in glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and medication use. Blood pressure (BP) was assessed via a nationwide Pay-for-Performance registry. Trends were evaluated overall and across subgroups with cardiovascular disease (CVD) or chronic kidney disease (CKD).

The treated population expanded from 1.58 to 2.27 million. Target achievement improved significantly: HbA1c <7.0% rose from 42.5% to 55.3%, and LDL-C <100 mg/dL from 54.3% to 69.0% (both p-trend <0.001). Among patients with all three measurements available, triple-factor control reached 18.2% by 2024. These gains coincided with rapid sodium-glucose cotransporter-2 inhibitor (SGLT2i) uptake (from 3.3% in 2016 to 38.0% in 2024) and increased statin use. However, 23.5% of young adults (20-44 years) maintained poor glycemic control (HbA1c ≥ 8.5%). SGLT2i use was higher in patients with CVD (43.1%) or CKD (43.8%) than in those without the respective conditions (34.7% and 36.6%), while glucagon-like peptide-1 receptor agonist (GLP-1RA) use remained below 4%.

Metabolic control in Taiwan improved substantially alongside adoption of newer therapies. Gaps among younger adults and high-risk cohorts highlight the need for targeted, risk-stratified management.