Evolving trends of antidiabetic agents stratified by age, kidney function and body mass index: Insights from a nationwide claims database

Abstract

Aims: To analyse prescribing trends in antidiabetic agents stratified by background characteristics among individuals with type 2 diabetes. Materials and Methods: This retrospective study used a large-scale database between 2015 and 2024 in Japan. Adults with type 2 diabetes receiving at least one antidiabetic prescription were included, and annual prescription rates were assessed by drug class. Trends were evaluated overall and stratified by age, sex, heart failure (HF) status, estimated glomerular filtration rate (eGFR), body mass index, haemoglobin A1c and clinical setting, because these factors are important determinants of efficacy and safety in prescribing antidiabetic agents. Results: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) prescriptions showed a marked increase, rising from 4.1% (95% confidence interval [CI], 4.0%–4.2%) in 2015 to 38.9% (95% CI, 38.7%–39.0%) in 2024. Particularly high prescription rates were seen in individuals aged <65 years, with HF, eGFR <30 mL/min/1.73 m2, and obesity. A temporal increase was also noted among individuals aged ≥80 years, reaching 33.1% (95% CI, 32.8%–33.3%) in 2024. Glucagon-like peptide-1 receptor agonists were prescribed at a relatively low rate, reaching only 8.0% (95% CI, 7.9%–8.1%) in 2024; however, an upward trend was observed among individuals aged <65 years and with obesity, especially after the launch of oral semaglutide in 2021. Conclusions: In this large-scale analysis, SGLT2i use increased substantially across diverse individual traits, supporting their integration into diverse clinical contexts in real-world practice. Our findings may provide valuable insights into diabetes care in the forthcoming era of super-aged societies.