Purpose: Some classes of glucose-lowering medications, including sodium-glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide 1receptor agonists (GLP1-RAs) have cardio-protective benefit, but it is unclear whether this influences prescribing in the United Kingdom (UK). This study aims to describe class-level prescribing in adults with type 2 diabetes mellitus (T2DM) by cardiovascular disease (CVD) history using the Clinical Practice Research Datalink (CPRD). Methods: Four cross-sections of people with T2DM aged 18e90 and registered with their general practice

Introduction: International guidelines recommend treatment with a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or glucagonlike peptide-1 (GLP-1) receptor agonist for treatment intensification in type 2 diabetes mellitus (T2DM) patients with progression on metformin. In the randomised, controlled, Digital Features To view digital features for this article go to

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Objectives: A substantial share of type 2 diabetes mellitus (T2DM) patients receives insulin. However, little is known about the real-world treatment patterns around insulin initiation. Methods: This was a retrospective claims data analysis. T2DM patients who initiated an insulin therapy between 01/01/2013 and 31/12/2015 were identified in the German AOK PLUS dataset. For validation of results, additional data on a similar T2DM patient population were collected in a Germany-wide medical chart review. Results: 284,878 T2DM patients were identified. 27,340 (9.6%) of these initiated an insulin treatment during the inclusion period (mean age: 72.2 years; 51.4% female). Mean/median weight j BMI of patients with available clinical data was 85.8/84.0 kg (SD:18.9) j 30.6/29.8 kg/m 2 (SD:6.1) at baseline. Mean/median HbA1c-value at baseline was 8.4/8.0% (SD: 1.8). Most commonly prescribed antidiabetic drugs (AD) within 6 months before insulin initiation were metformin (MET; 54.0%), DPP-4 inhibitors (DPP-4i; 37.6%) and sulfonylureas (SU; 29.5%). 23.2% of patients did not receive any AD prescription within 6 months before insulin initiation. 10,953 of above 27,340 insulin starters (40.1%) initiated their insulin therapy without concomitant ADs (insulin monotherapy); 43% of these patients did not receive any AD before insulin initiation. Of the remaining 16,387 patients (59.9%), 4,070 patients (14.9%) received MET only as concomitant AD, 6,385 (23.4%) received MET plus at least one further AD, and 5,932 (21.7%) received at least one further AD excluding MET. Throughout the first year of treatment, prescribed insulin dosage increased over time, resulting in approximately 43.3-77.9 IUs per observed patient day after 12 months of insulin treatment. Conclusions: Characteristics of German T2DM patients initiating insulin deviate substantially from the average German population, especially in terms of weight. We identified an unexpectedly high number of patients without previous AD therapy receiving insulin monotherapy, which is not in line with the clinical guidelines.