{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T19:30:53Z","timestamp":1786390253416,"version":"build-2736575974"},"reference-count":19,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100006093","name":"PCORI","doi-asserted-by":"crossref","award":["DB-2020C2-20308"],"award-info":[{"award-number":["DB-2020C2-20308"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006093","name":"PCORI","doi-asserted-by":"crossref","award":["RI-MISSOURI-01-PS1"],"award-info":[{"award-number":["RI-MISSOURI-01-PS1"]}],"id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To compare nationwide prescription trends in medications (dipeptidyl peptidase 4 inhibitors [DPP-4i], glucagon-like peptide 1 receptor agonists [GLP-1 RAs], sodium\u2013glucose cotransporter 2 inhibitors [SGLT2i], or sulfonylureas [SUs]) after treatment with metformin in patients with type 2 diabetes (T2D) at high versus moderate cardiovascular risk by key sociodemographic and health characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Electronic health records and insurance claims from 2014 to 2022 from 10 health systems and two insurance plans from different U.S. regions were evaluated. Risk-stratified multinomial log-linear models were used to model trends in prescribing patterns, adjusted for sociodemographic variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 104,474 patients were included (28% at high and 72% at moderate cardiovascular risk). Among those at high cardiovascular risk, DPP-4i (2014 24.0%; 2022 11.0%) and SU (66.4%; 35.7%) prescriptions declined, whereas GLP-1 RA (4.4%; 20.5%) and SGLT2i (5.2%; 32.8%) prescriptions increased. Among those at moderate cardiovascular risk, DPP-4i (23.7%; 11.7%) and SU (63.7%; 31.5%) prescriptions declined, whereas GLP-1 RA (5.7%; 30.0%) and SGLT2i (6.9%; 26.8%) prescriptions increased. Annual increases differed by high versus moderate cardiovascular risk for GLP-1 RAs (+2.5% vs. +3.6%\/year; P &amp;lt; 0.001) and SGLT2i (+4.0% vs. +3.0%\/year; P &amp;lt; 0.001). Greater annual increases in GLP-1 RA prescriptions occurred in women, those aged &amp;lt;65 years, and those with class 2 or 3 obesity, and greater annual increases in SGLT2i prescriptions were seen in men, those aged \u226565 years, and those without class 2 or 3\u00a0obesity (all P &amp;lt; 0.01). Greater increases in SGLT2i prescriptions occurred among Black patients, and greater increases in GLP-1 RA prescriptions occurred among those of Hispanic ethnicity at moderate cardiovascular risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Prescribing patterns for second-line T2D therapies in those at moderate cardiovascular risk are approaching guideline recommendations for those at high risk. Some trends are potentially clinically explainable, whereas certain racial\/ethnic differences may warrant exploration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                  <\/jats:sec>","DOI":"10.2337\/doc26-0027","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:01:22Z","timestamp":1783954882000},"page":"638-648","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Trends in Diabetes Medications After Metformin in Patients at High Versus Moderate Cardiovascular Risk: The BESTMED Consortium 2014\u20132022"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7364-5550","authenticated-orcid":false,"given":"M. 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