SAT-526 Trends In Diabetes Medications After Metformin In High Versus Moderate Cardiovascular Risk Patients

Abstract Disclosure: M. Lansang: Abbott Laboratories, Dexcom, Neuro Solutions 100. L.C. Petito: None. E. Hegermiller: None. C. Indhumathy: None. R. Carnahan: None. M.E. McDonnell: Dexcom. G. Sylwestrzak: None. A. DeVries: None. E. Priest: AstraZeneca, Boehringer Ingelheim, CSL Vifor, Lilly USA, LLC, Owkin. V. Willey: None. V. Nair: None. S. Goel: None. A. Kaul: None. A. Turchin: Eli Lilly & Company, Novo Nordisk, Proteomics International. Introduction and Objective: Though newer ADA guidelines recommend initiating GLP1 receptor agonists (GLP1) or SGLT2 inhibitors (SGLT2i) for T2DM with high CV risk, metformin was previously 1st-line and there are no guidelines for moderate CV risk. We assessed US-wide trends in 2nd-line medication (med) use: (DPP4 inhibitor [DPP4i], GLP1, SGLT2i and sulfonylurea [SU]) after metformin in high vs moderate CV risk T2DM from 2013-2023. Methods: This was a secondary analysis of BESTMED data (https://bestmed.org) using electronic health records and insurance claims for T2DM with high and moderate CV risk in10 health systems and 2 insurance plans. Prescription (Rx) class was regressed on calendar time via multinomial logistic regression to model trends in Rx patterns, adjusted for sociodemographic variables; CIs and p-values for differences were calculated via nonparametric bootstrap. Significance was interpreted at p<0.05 and annual rate of change ≥0.5%. Results: Of 104,474 eligible, 28% had high CV risk. After metformin, meds initiated were DPP4i (high/moderate CV risk: 17%/18%), GLP1(12%/17%), SGLT2i (20%/18%), and SU (51%/47%). The uptake of GLP1(2.5 vs 3.6%/year) and SGLT2i (4.0 vs 3.0%/year) rose but differed by high vs moderate CV risk. Greater annual increases in GLP1 occurred in women, <65y old, and obesity class >2. In moderate but not high CV risk, GLP1 increase was higher in privately insured (3.6 vs 3%/year), Hispanic vs non (3.8 vs 3.1%/year) and lower (better) than higher social deprivation index (<30th vs >70th percentile: 3.9 vs 3.2%/year) (all p<0.01). Greater annual increases in SGLT2i were seen in men, ≥65y, less than class 2 obesity. Among moderate CV risk, increase for SGLT2i was higher in Black vs white (3.4 vs 2.9%/year, p =0.001). In high CV risk, increase was higher in publicly vs privately insured (5.3 vs 3.8%/year, p<0.001). Conclusion: GLP1 and SGLT2i increased, not just in high but also in moderate CV riskT2DM even if there are no guidelines. Difference in rise in SGLT2i and GLP1 among socioeconomic strata merit further exploration. Presentation: Saturday, July 12, 2025