(B-046) Trends over time in antidiabetic medication use under age 65 in the United States: impact of obesity treatment

Background: In recent years, several antidiabetic medications’ indications have been expanded to treat overweight and obesity, particularly glucagon-like peptide-1 (GLP-1) receptor agonists (RAs). Despite being originally intended to manage type 2 diabetes mellitus (T2DM), the extent to which these medications are now being utilized for chronic weight management is unknown.

Objectives: To describe the treatment patterns of dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and other comparator antidiabetics over time in new users of these medications.

Methods: This was a retrospective descriptive analysis of new users of dapagliflozin and comparator antidiabetics with a first dispensing of a study drug between 01/09/2014 and 30/09/2023 in the US Healthcare Integrated Research Database (HIRD) as part of a larger long-term post authorization safety study for dapagliflozin. Comparator antidiabetics included all antidiabetics (including GLP-1 RAs among other drug classes) except for SGLT2 inhibitors, insulin monotherapy, metformin monotherapy, and sulfonylurea monotherapy. Patients were excluded if they were aged below 40 years or over 65 years, had a history of type 1 diabetes or invasive cancer, or had prior use of an SGLT2 inhibitor. Propensity score trimming and stratification were used to balance baseline comorbidities and medication use; T2DM and obesity were not included as covariates in the propensity score model. The proportions of patients with baseline diagnoses of T2DM and obesity were measured over time between 2014 and 2023 for all patients and by sex.

Results: In 2014, over 95% of initiators of dapagliflozin and comparator cohorts had a baseline diagnosis of T2DM. In 2023, 45% of comparator women and 60% of comparator men had a baseline diagnosis of T2DM. In contrast, 69% of dapagliflozin women and 71% of dapagliflozin men had a T2DM diagnosis. The proportion of patients with an obesity diagnosis and no T2DM diagnosis increased between 2014 and 2023 especially in initiators of comparator ADs (women: 13% to 60%; men: 8% to 57%). The increases in obesity diagnoses are not explained by background changes in obesity diagnoses in the HIRD, which were constant over time.

Conclusions: Between 2014 and 2023 the proportion of patients receiving antidiabetic medications with baseline diagnoses for T2DM decreased especially in women in the comparator cohort, which includes GLP-1 RAs. The increase in obesity diagnoses and decrease in T2DM diagnoses in initiators of antidiabetic drugs suggests that in the US these drugs are being used more commonly to treat obesity in those without T2DM, particularly in women.