{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:26:28Z","timestamp":1787030788844,"version":"build-2736575974"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate glucose\u2010lowering treatment trajectories preceding glucagon\u2010like peptide\u20101 receptor agonist (GLP\u20101RA) initiation in UK primary care, while assessing alignment with contemporary UK clinical guidelines, considering calendar time, cardiovascular disease (CVD) history, and obesity status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, a Cegedim Database, we included adults with type 2 diabetes initiating GLP\u20101RAs in UK primary care between 01 January 2007 and 30 June 2023. We described treatment trajectories from the first glucose\u2010lowering therapy to GLP\u20101RA initiation, stratified by calendar time (GLP\u20101RA initiation pre\u2010 or post\u201001 January 2018, when guidelines started recommending sodium\u2010glucose co\u2010transporter\u20102 inhibitors [SGLT\u20102is] for those at high risk or established CVD), CVD history, and body mass index (BMI) \u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 29\u2009780 GLP\u20101RA initiators, with 62.2% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918\u2009517) initiating pre\u20102018 and 37.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911\u2009263) post\u20102018. Consistent over calendar time, most GLP\u20101RA initiators (63.5%) received their first GLP\u20101RA as fourth\u2010line (35.4%) or later\u2010line therapy (28.1%), with fewer initiating GLP\u20101RAs as first\u2010 (0.8%), second\u2010 (10.5%), or third\u2010line (25.2%) treatments. After 2018, 50.8% of individuals initiating GLP\u20101RA therapy used SGLT\u20102is concomitantly, regardless of CVD status (47.8% with established CVD vs. 51.5% without). Individuals with BMI \u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      initiated GLP\u20101RA therapy earlier compared to those with BMI &lt;35\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (46.3% vs. 29.1% as first\u2010, second\u2010, or third\u2010line treatment).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>GLP\u20101RAs were predominantly initiated following \u22653 glucose\u2010lowering agents, consistent with contemporary UK guidance (NG28). Post\u20102018, most GLP\u20101RA initiators received SGLT\u20102is concomitantly. However, CVD history did not influence prescribing patterns, underscoring missed opportunities to optimise the prevention of cardiovascular events and slow the progression of CVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70548","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T04:27:19Z","timestamp":1773030439000},"page":"3692-3702","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Real\u2010world treatment trajectories preceding\n                    <scp>GLP<\/scp>\n                    \u20101 receptor agonist initiation in type 2 diabetes: A descriptive\n                    <scp>UK<\/scp>\n                    population\u2010based cohort study on adherence to national clinical guidelines"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2278-7400","authenticated-orcid":false,"given":"Franziska S.","family":"Ulrich","sequence":"first","affiliation":[{"name":"Institute of Pharmaceutical Sciences ETH Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5608-1589","authenticated-orcid":false,"given":"Morten","family":"Frost Nielsen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Odense University Hospital  Odense Denmark"},{"name":"Steno Diabetes Centre Odense Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-8205","authenticated-orcid":false,"given":"Nicola","family":"Napoli","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology and Diabetes Campus Bio\u2010Medico University of Rome  Rome Italy"},{"name":"Unit of Metabolic Bone and Thyroid Disorders Fondazione Policlinico Universitario Campus Bio\u2010Medico University of Rome  Rome Italy"},{"name":"Division of Bone and Mineral Diseases Washington University  St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7082-8530","authenticated-orcid":false,"given":"Andrea M.","family":"Burden","sequence":"additional","affiliation":[{"name":"Institute of Pharmaceutical Sciences ETH Zurich  Zurich Switzerland"},{"name":"Division of Clinical Immunology and Rheumatology, Heersink School of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"IDF Diabetes Atlas","author":"International Diabetes Federation","year":"2025"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMOA0706245"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/DOM.15912"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/DC22\u20101353"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/S00125\u2010022\u201005787\u20102"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/DC25\u2010S009"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/EURHEARTJ\/EHAD192"},{"key":"e_1_2_11_9_1","unstructured":"National Institute for Health and Care Excellence.Type 2 diabetes in adults: management|guidance. 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