Introduction: 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.
Methods: In two US commercial claims databases (Optum and MarketScan), we identified individuals aged <30 years with T2D who initiated first-line glucose-lowering drugs between 2010 (aligning with the US market entry of liraglutide) and 2023. We examined first-line use by plotting annual trends overall and within age subgroups (≤18, 19-25, 26-29 years) and escalation patterns using Sankey diagrams, comparing the periods before (2010-2018) and after (2019-2023) the 2019 approval of GLP-1RA in youth.
Results: Metformin was the most commonly initiated first-line agent (overall: 71.1%), followed by insulin (overall: 9.4%, ≤18 years: 18.8%) (Figure A). The use of GLP-1RA increased considerably (from 2.9% in 2019 to 12.6% in 2023), yet it remained low overall. This trend was consistent across all age groups. With respect to escalation patterns (Figure B), sulfonylureas and insulin were most frequently prescribed after metformin failure in 2010-2018, whereas GLP-1RA were the most frequently prescribed after metformin in 2019-2023.
Conclusion: In youth-onset T2D, the use of GLP-1RA as first-line and subsequent therapies has increased but remains overall low.
H. Shin: None. J.M. Paik: None. D.J. Wexler: Other Relationship; Novo Nordisk. E. Patorno: Research Support; Boehringer-Ingelheim, Food and Drug Administration (FDA), National Institutes of Health, Patient-Centered Outcomes Research Institute.
