(099) Treatment Trends in Youth-Onset Type 2 Diabetes: Changing Landscape After GLP-1RA Approval

Background: The approval of glucagon-like peptide-1 receptor agonists (GLP-1RA), starting with liraglutide in 2019, has expanded treatment options in youth-onset type 2 diabetes (T2D). However, the uptake of GLP-1RA in this population is unknown.

Objectives: We examined the initiation of first- and second-line glucose-lowering drugs among youth with T2D.

Methods: Using data from two large US commercial health insurance claims databases (Clinformatics and MarketScan), we identified individuals aged under 30 years with T2D who initiated first-line glucose-lowering drugs between January 2010 (aligning with the US market entry of liraglutide) and August 2023 (December 2021 for MarketScan). We examined first-line glucose-lowering drug use by plotting annual utilization trends overall and within age subgroups (≤18, 19–25, 26–29 years) over the study period. We also assessed the escalation patterns to second-line treatments after metformin as first-line treatment, using Sankey diagrams to compare the periods before (2010–2018) and after (2019–August 2023) the 2019 approval of GLP-1RA.

Results: We identified 24,612 individuals under 30 years with T2D from January 2010 to August 2023. Metformin was the most commonly initiated first-line agent (overall: 71.1% average over the study period), with insulin being the second most initiated (overall: 9.4%), particularly among those under 18 years (18.8%). The use of first-line GLP-1RA increased considerably (from 2.9% in 2019 to 12.6% in 2023) and consistently across all age groups. With respect to escalation patterns, sulfonylureas (10.6%) and insulin (8.5%) were the most common second-line choices after metformin in 2010–2018, whereas GLP-1RA (9.4%) became the most frequently initiated second-line medications in 2019–2023. Despite this shift, the use of GLP-1RA as first- or second-line treatment remained low overall. Additionally, 42% of those who initiated a first-line glucose-lowering medication discontinued their initial treatment (63% within three months and 81% within six months), not attributed to administrative censoring, such as the end of data.

Conclusions: In youth-onset T2D, metformin was the most frequently initiated first-line treatment for T2D, followed by insulin, consistent with treatment guidelines. Higher use of insulin in individuals under 18 years indicates limited treatment options in this age group. The increased uptake of GLP-1RA as first- and second-line treatment highlights the evolving treatment landscape, although their use remained low.