Trends in Sodium-Glucose Cotransporter 2 Inhibitor and Glucagon‑Like Peptide‑1 Receptor Agonist Prescription Rates Among Patients With Type 2 Diabetes: An Epic Cosmos Real-World Data Analysis, 2014-2024.

Objective: This study examined decade-long trends and differences in sodium-glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide-1 receptor agonist (GLP-1 RA) prescriptions among adults with type 2 diabetes using real-world data from Epic Cosmos. Research Design and Methods: We analyzed electronic health records of 1 517 594 adults with type 2 diabetes without end-stage renal disease from 2014 to 2024. Annual prescribing trends were evaluated by patient race and insurance type using negative binomial regression. Medication exposure was defined using active prescriptions/orders recorded in Epic Cosmos during the calendar year. In pooled descriptive analyses, we also characterized patients prescribed these medications by clinical characteristics, neighborhood-level social vulnerability, and prescriber specialty. Results: From 2014 to 2024, SGLT2i use rose from 0.5% to 12.1% and GLP-1 RA use increased from 0.9% to 15.9%. Black patients had consistently lower prescription rates than White patients across insurance groups. Primary care physicians prescribed about one-third of these medications. In pooled descriptive analyses, endocrinology was associated with higher observed prescribing rates than primary care or cardiology. Patients from neighborhoods with lower social vulnerability were more likely to receive these therapies. Conclusions: Use of SGLT2i and GLP-1 RA increased substantially over the past decade, significant racial, socioeconomic, and insurance-related differences persist in prescribing these therapies.