Glucagon-like peptide-1 receptor agonists (GLP-1RAs) play an established role in type 2 diabetes mellitus (T2DM) management, yet their positioning within treatment pathways may vary in routine care. A population-based analysis published in Diabetes, Obesity and Metabolism examined glucose-lowering treatment trajectories preceding GLP-1RA initiation in UK primary care and assessed alignment with contemporary UK clinical guidance.

Using IQVIA Medical Research Data, incorporating data from The Health Improvement Network (THIN), investigators identified adults with T2DM who initiated GLP-1RAs between 01 January 2007 and 30 June 2023. Treatment sequences from first glucose-lowering therapy to GLP-1RA initiation were described and stratified by calendar period (pre- or post-01 January 2018), cardiovascular disease (CVD) history, and body mass index (BMI) threshold of 35 kg/m².

Among 29,780 GLP-1RA initiators, 62.2% began therapy before 2018 and 37.8% after. Across calendar periods, 63.5% initiated GLP-1RAs as fourth-line (35.4%) or later-line (28.1%) therapy, while smaller proportions began as first- (0.8%), second- (10.5%), or third-line (25.2%) treatment. After 2018, 50.8% received sodium-glucose co-transporter-2 inhibitors (SGLT-2is) concomitantly, with similar proportions among those with established CVD (47.8%) and without CVD (51.5%). Individuals with BMI ≥35 kg/m² initiated GLP-1RAs more frequently as first-, second-, or third-line therapy than those with lower BMI (46.3% vs 29.1%).

Overall, GLP-1RAs were predominantly initiated after three or more glucose-lowering agents, consistent with contemporary UK guidance (NG28). However, CVD history did not appear to influence prescribing patterns.