Initiation of sodium-glucose cotransporter-2 (SGLT2) inhibitors as second-line therapy increased sharply among adults with type 2 diabetes (T2D) in the UK. Data from the European Association for the Study of Diabetes (EASD) 2025 show trends across age and frailty subgroups.

In a population-representative cohort of 94,435 adults initiating second-line treatment after metformin, SGLT2 inhibitor initiation rose from 26% in 2019 to 63% in 2024. The increase was most pronounced in frail adults over 70 years, rising from 6% to 60%. Twelve-month glycaemic response improved modestly, with mean HbA1c reductions increasing from -10.6 mmol/mol (95% CI -10.9, -10.3) in 2019 to -12.0 mmol/mol (95% CI -12.3, -11.7) in 2023. Mean weight loss also increased from -1.6 kg (95% CI -1.7, -1.5) to -2.6 kg (95% CI -2.7, -2.5). Rates of heart failure hospitalizations (IRR 1.1, 95% CI 0.98–1.2) and acute diabetes complications including severe diabetic ketoacidosis or hypoglycaemia (IRR 1.2, 95% CI 0.9–1.4) remained stable. These trends were consistent across all age and frailty subgroups.

The findings indicate a major shift in second-line therapy prescribing, particularly for frail older adults, with modest improvements in glycaemic and weight outcomes and no increase in short-term complications.