Trends in utilization of glucagon-like peptide‑1 receptor agonists, sodium-glucose cotransporter‑2 inhibitors, and metabolic bariatric surgery in U.S. Adults with diabetes and obesity.

AIMS: To characterize trends in utilization of glucagon-like peptide‑1 receptor agonists (GLP‑1RAs), sodium-glucose cotransporter‑2 inhibitors (SGLT2is), and metabolic/bariatric surgery among US adults with type 2 diabetes (T2D) and obesity. METHODS: We conducted a cohort study using electronic health record and claims data from Optum Labs Data Warehouse for US private and Medicare Advantage plan enrollees aged 18-79 with T2D and obesity initiating GLP‑1RAs or SGLT2is or undergoing MBS (2010-2024). We evaluated initiation, adherence (≥80% of days with medication), and persistence. RESULTS: Among 342,932 treatment initiations (335,605 individuals), 60.8% initiated GLP‑1RAs, 35.7% SGLT2is, and 3.6% MBS. Use of both medication classes increased over time (GLP-1RAs: 1,988 to 44,852; SGLT2is: 861 to 19,892). In 2024, semaglutide (62.2%) and tirzepatide (32.6%) were the most initiated GLP-1RAs; MBS was rare (0.7% of treatments). Median treatment duration was 240 days for GLP‑1RAs and 254 days for SGLT2is; ∼50% were adherent. Tirzepatide had the highest adherence and persistence. At one-year, 53.0% of GLP‑1RA and 56.0% of SGLT2i initiators were using their initiated treatment; transition to other therapies was uncommon. CONCLUSIONS: Initiation of GLP‑1RAs and SGLT2is, but not MBS utilization, has expanded in recent years, although adherence and persistence remain low. Further studies should evaluate how these shifting patterns affect health outcomes.