Shifts in Incident Glucose Lowering Drug Initiation in Type 2 Diabetes From 2014 to 2024: A Population‐Based Study

AIMS: This study aimed to analyse incident glucose lowering drug (GLD) utilisation in Australia between the period 2014 and 2024. MATERIALS AND METHODS: Australian Pharmaceutical Benefits Scheme (PBS) data (10% PBS dataset) were analysed to assess the proportions of incident monotherapy, dual therapy and triple therapy and the proportion of prescriptions dispensed for each GLD class. Annual changes in age at incident GLD initiation were also quantified. RESULTS: 49 129 individuals were included. The proportion of individuals prescribed incident GLD as monotherapy decreased from 90.4% in 2014 to 77.2% in 2024, while incident dual therapy rose from 9.3% to 21.8% and incident triple therapy from 0.2% to 1.0%. The overall proportion of incident metformin therapy (monotherapy or in combination with other GLDs) decreased from 83.9% in 2014 to 40.1% in 2024, with incident metformin as monotherapy falling from 82.7% to 29.1% over the same period. Proportions of incident SGLT2i and GLP-1 RA (monotherapy or in combination with other GLDs) were 35.7% and 11.2%, respectively, in 2024. Over the study period, age at the time of incident prescribing increased for all GLD classes, except GLP-1 RA, which decreased. CONCLUSIONS: Over the past decade, substantial changes in incident GLD prescribing have occurred in Australia. While metformin continues to play a central role as initial treatment, major shifts toward use of initial dual therapy, including SGLT2i and GLP-1RA, have occurred.