National Trends in Expenditures on Glucose-Lowering Medications in U.S. Adults With Diabetes: 2000–2022

Objective: Expenditures on glucose-lowering prescriptions may have changed due to the introduction of new medication classes and changes in insurance policies. This study analyzed national trends in per capita expenditures on glucose-lowering medications among U.S. adults with diabetes during 2000-2022. Research Design and Methods: Using Medical Expenditure Panel Surveys data, we analyzed annual per capita expenditures on glucose-lowering medications among persons aged ≥ 18 years with self-reported diabetes. Expenditures were calculated overall and by subgroups defined by age, race/ethnicity, income, and insurance status. Medications were grouped as older oral agents (metformin, sulfonylureas, thiazolidinediones, α-glucosidase inhibitors, meglitinides), newer noninsulin agents (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, amylin analogs, combination products), human insulin, and analog insulin. Joinpoint regression was used to identify trend changes. We also estimated the change in number of users and expenditure per user for each medication category. Expenditures were adjusted to 2022 U.S. dollars. Results: Total per capita expenditures on glucose-lowering medications increased by 335%, from $856 in 2000 to $3,725 in 2022. Expenditures rose by $29 per year during 2000–2012, then accelerated by $224 annually. Expenditures increased substantially on newer noninsulin agents, while declining on older oral agents and human insulin declined. Analog insulin expenditures rose initially but plateaued after 2016. The upward trend in newer high-cost therapies was primarily driven by an increased number of users. Conclusions: Per capita expenditures on newer medications— have risen markedly. Identifying key drivers of these expenditures may enhance affordability and access to effective diabetes treatments.