Time to Insulin Initiation Among Patients With Type 2 Diabetes Treated With Second‐Line Antidiabetic Drugs
Authors' conclusion
This study provides real-world evidence that TZDs, DPP-4 inhibitors and SGLT-2 inhibitors may offer an advantage over insulin secretagogues in delaying insulin initiation after metformin monotherapy.
Study context
- Population
- Patients with T2D initiating second-line treatment (2013–2021) after metformin monotherapy (1998–2021), Clinical Practice Research Datalink (CPRD) Aurum
- Participants
- 64,404 patients
- Exposure
- Second-line antidiabetic drug classes vs insulin secretagogues after metformin monotherapy
- Outcome
- Time to insulin initiation
- Follow-up
- Mean 2.9 years
Methodological detailspropensity score trimming, inverse probability of treatment weighted Cox models
- Propensity score trimming
- Inverse probability of treatment weighted Cox models
Main finding
As reported in the abstract
Insulin initiation
Each group vs insulin secretagoguesHazard ratio (95% CI)
TZDs
0.59(0.43–0.83)
SGLT-2 inhibitors
0.62(0.56–0.68)
- DPP-4 inhibitors
- HR 0.75 (95% CI 0.69–0.80)
Observational data: associations, not effects.
Secondary outcomes
Time to treatment modification (addition of or switch to another antidiabetic drug class)
- Risk higher among TZD and DPP-4 inhibitor initiators vs insulin secretagogue initiators
- Risk slightly lower among SGLT-2 inhibitor and GLP-1 receptor agonist initiators vs insulin secretagogue initiators
Original publication
Time to Insulin Initiation Among Patients With Type 2 Diabetes Treated With Second‐Line Antidiabetic Drugs. Diabetes Obes Metab. Published 6 August 2026. doi:10.
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