Comparative effectiveness of alternative second‑line oral glucose‑lowering therapies for type 2 diabetes: a precision medicine approach applied to routine data – Published online 31/05/2025
Stephen O’Neill, Patrick Bidulka, David G. Lugo‑Palacios, Orlagh Carroll, Ignacio Leiva‑Escobar, Richard Silverwood, Andrew Briggs, Amanda I. Adler, Kamlesh Khunti, Richard Grieve
Clinical guidelines recommend tailoring second-line treatment for type 2 diabetes to the individual, but data to guide this choice have been limited. In this issue, O’Neill and Bidulka et al (https://doi.org/10.1007/s00125-025-06447-x) analyse real-world electronic health records from over 40,000 people in England to compare the effectiveness of three commonly prescribed drug classes (sodium–glucose cotransporter-2 [SGLT2] inhibitors, sulfonylureas and dipeptidyl peptidase-4 inhibitors) when added to metformin. The authors report that SGLT2 inhibitors led to greater reductions in HbA1c at 1 year across all age groups, including younger adults and those with multiple long-term conditions. These benefits were consistent regardless of baseline HbA1c levels. This study provides timely evidence to support more informed, personalised treatment choices using routinely available patient characteristics. The authors conclude that given the growing use of SGLT2 inhibitors and their additional cardiovascular and renal benefits, these findings support their use as a preferred second-line option in a wide range of individuals with type 2 diabetes.
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