Alexander Turchin, MD

Guideline recommendations for patients with Type 2 diabetes (T2D) and high cardiovascular disease (CVD) risk are well established, but recommendations for patients at moderate CVD risk are less clear.

In a recent study, researchers sought to determine how second-line diabetes prescribing patterns differ in the United States according to CVD risk.

Cleveland Clinic’s M. Cecilia Lansang, MD, and Mass General Brigham’s Alexander Turchin, MD, along with collaborators in the BESTMED consortium, analyzed electronic health records and insurance claims from nearly 104,500 U.S. adults with T2D who had been treated with metformin and subsequently initiated a second-line diabetes medication.

They found that from 2014 to 2022, prescribing of older medications (sulfonylureas and DPP-4 inhibitors) declined, while prescribing of newer medications (GLP-1 receptor agonists and SGLT2 inhibitors) increased substantially among both CVD risk groups.

For example, GLP-1 prescribing for moderate-risk patients increased from ~6% of new prescriptions in 2014 to 30% in 2022 and from ~4% to ~21% for high-risk patients.

The researchers also explored how prescribing trends varied across patient demographics and health characteristics. Increases in GLP-1 prescribing were greater among women, younger patients and patients with severe obesity, whereas increases in SGLT2 prescribing were greater among men, older patients and patients without severe obesity.

The findings highlight changing treatment patterns, with prescribing practices for moderate-risk patients increasingly mirroring those for high-risk patients despite the absence of specific guidelines. Further research is needed to better understand these trends and guide care.

Published in Diabetes, Obesity, and CardioMetabolic CARE on July 13, 2026 | Read the paper: “Trends in Diabetes Medications After Metformin in Patients at High Versus Moderate Cardiovascular Risk: The BESTMED Consortium 2014–2022”

Summary reviewed by: Alexander Turchin, MD, senior author