Real‐world treatment trajectories preceding GLP ‐1 receptor agonist initiation in type 2 diabetes: A descriptive UK population‐based cohort study on adherence to national clinical guidelines

Abstract Aims To investigate glucose‐lowering treatment trajectories preceding glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) initiation in UK primary care, while assessing alignment with contemporary UK clinical guidelines, considering calendar time, cardiovascular disease (CVD) history, and obesity status. Materials and Methods Using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, a Cegedim Database, we included adults with type 2 diabetes initiating GLP‐1RAs in UK primary care between 01 January 2007 and 30 June 2023. We described treatment trajectories from the first glucose‐lowering therapy to GLP‐1RA initiation, stratified by calendar time (GLP‐1RA initiation pre‐ or post‐01 January 2018, when guidelines started recommending sodium‐glucose co‐transporter‐2 inhibitors [SGLT‐2is] for those at high risk or established CVD), CVD history, and body mass index (BMI) ≥35 kg/m 2 . Results We included 29 780 GLP‐1RA initiators, with 62.2% ( n = 18 517) initiating pre‐2018 and 37.8% ( n = 11 263) post‐2018. Consistent over calendar time, most GLP‐1RA initiators (63.5%) received their first GLP‐1RA as fourth‐line (35.4%) or later‐line therapy (28.1%), with fewer initiating GLP‐1RAs as first‐ (0.8%), second‐ (10.5%), or third‐line (25.2%) treatments. After 2018, 50.8% of individuals initiating GLP‐1RA therapy used SGLT‐2is concomitantly, regardless of CVD status (47.8% with established CVD vs. 51.5% without). Individuals with BMI ≥35 kg/m 2 initiated GLP‐1RA therapy earlier compared to those with BMI