{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:36:00Z","timestamp":1793126160332,"version":"4.5.0"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W003988\/1"],"award-info":[{"award-number":["MR\/W003988\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["227070\/Z\/23\/Z"],"award-info":[{"award-number":["227070\/Z\/23\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To assess contemporary UK trends in second\u2010line treatment initiations and outcomes across age\u2010and\u2010frailty groups in people with type 2 diabetes (T2D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      We studied 117\u2009046 UK adults with T2D initiating second\u2010line therapy between 2019\u20132024 (Clinical Practice Research Datalink). Outcomes were assessed in three groups: age\u2009\u2264\u200970\u2009years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200984\u2009589 [72%]); non\u2010frail &gt;\u200970\u2009years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918\u2009933 [16%]); frail &gt;\u200970\u2009years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913\u2009524 [12%]). Annual prescribing trends by drug class were described and we evaluated annual changes in 12\u2010month HbA\n                      <jats:sub>1c<\/jats:sub>\n                      , weight and severe diabetes\u2010related complication outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SGLT2\u2010inhibitor use increased from 26% of overall second\u2010line initiations in 2019 to 63% in 2024, with the greatest increase among frail adults &gt;\u200970 (6% in 2019 vs. 60% in 2024). In adults \u2264\u200970, mean 12\u2010month HbA\n                      <jats:sub>1c<\/jats:sub>\n                      response improved from \u221211.3\u2009mmol\/mol (95% CI: \u221211.6 to \u221211.0) in 2019 to \u221212.9\u2009mmol\/mol (95% CI: \u221213.2 to \u221212.6) in 2023 and mean weight loss increased from \u22121.7\u2009kg (95% CI: \u22121.8 to \u22121.5) to \u22122.8\u2009kg (95% CI: \u22122.9 to \u22122.6). Incidence of short\u2010term severe diabetes\u2010related complications remained similar: 9.9 (95% CI: 8.1 to 11.7) per 1000 person\u2010years in 2019 versus 8.6 (95% CI: 6.9 to 10.3) in 2022. Similar time trends in treatment outcomes were seen across all age\u2010and\u2010frailty based subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Use of SGLT2\u2010inhibitors rapidly increased in the UK over 2019\u20132024, with a 10\u2010fold increase among older adults with frailty. Over the same period, there were small population\u2010level benefits for HbA\n                      <jats:sub>1c<\/jats:sub>\n                      and weight, with no evidence of changes in complication risk. Findings support careful use of SGLT2\u2010inhibitors across the wider population with T2D, including older adults with frailty.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70960","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:19:58Z","timestamp":1780618798000},"page":"7471-7482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Second\u2010Line Initiations and Treatment Outcomes Across Age and Frailty Groups in People With Type 2 Diabetes:\n                    <scp>UK<\/scp>\n                    Population\u2010Based Study, 2019\u20132024"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8545-5833","authenticated-orcid":false,"given":"M. M.","family":"Dinsdale","sequence":"first","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. G.","family":"Young","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1014-9058","authenticated-orcid":false,"given":"P.","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6933-3653","authenticated-orcid":false,"given":"L. M.","family":"G\u00fcdemann","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. T.","family":"Jansz","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. P.","family":"McGovern","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0883-7599","authenticated-orcid":false,"given":"A. G.","family":"Jones","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. R.","family":"Pearson","sequence":"additional","affiliation":[{"name":"Division of Diabetes, Endocrinology and Reproductive Medicine Ninewells Hospital and Medical School, University of Dundee  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. T.","family":"Hattersley","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T. J.","family":"McKinley","sequence":"additional","affiliation":[{"name":"Clinical and Biomedical Sciences University of Exeter Medical School  Exeter UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3785-327X","authenticated-orcid":false,"given":"B. 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