This retrospective cohort study used Clalit Health Services records from Haifa and Western Galilee, Israel. Adults diagnosed with type 2 diabetes in 2005-2008 (n=80,201) were compared with those diagnosed in 2020-2023 (n=101,392). Median age at diagnosis rose from 63.0 to 66.7 years and Charlson comorbidity score from 4 to 6. HbA1c fell from 56 to 53 mmol/mol and pre-diagnosis LDL-cholesterol from 2.90 to 2.21 mmol/l. Within 31-90 days of diagnosis, SGLT2 inhibitor use rose from 0.07% to 15.0% and GLP-1 agonist use to 11.1%. Sulfonylurea use fell from 20.8% to 4.5%; recorded steatotic liver disease rose from 4.4% to 18.6%, largely ascertainment-driven.
Why it is interesting: Diabetes is now detected at older ages with better glycaemic and lipid profiles, altering the baseline risk of incident cohorts. Prescribing has shifted rapidly from sulfonylureas to cardiorenal and weight-acting agents.
Abstract — the authors' own words, CC BY
Abstract
Aims/hypothesis
Our aim was to describe the phenotype at diagnosis and the early therapeutic profile of newly diagnosed type 2 diabetes across two periods spanning approximately 15 years within the same integrated healthcare system.
Methods
This retrospective cohort study used electronic health record data from Clalit Health Services (Haifa & Western Galilee, Israel). Adults with incident type 2 diabetes in 2005–2008 (period 1:
n
=80,201) were compared with those diagnosed in 2020–2023 (period 2:
n
=101,392). Between-period differences are presented as crude estimates, with an age-stratified sensitivity analysis, and quantified using standardised mean differences (SMDs; values ≥0.20 indicate at least a small effect) alongside non-parametric and χ
2
tests.
Results
The median age at diagnosis increased from 63.0 to 66.7 years between the two periods; the proportion aged ≥85 years nearly doubled (from 3.5% to 6.6%). The score for the Charlson comorbidity index increased from 4 to 6 (SMD 0.48); metabolic dysfunction-associated steatotic liver disease (MASLD) increased from 4.4% to 18.6%. HbA
1c
at diagnosis decreased from 56 to 53 mmol/mol (7.3% to 7.0%); pre-diagnosis LDL-cholesterol decreased from 2.90 to 2.21 mmol/l (SMD 0.65). Within 31–90 days of diagnosis, use of sodium–glucose cotransporter 2 (SGLT2) inhibitors increased from 0.07% to 15.0%, use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) increased from 0% to 11.1%, and sulfonylurea use decreased more than fourfold (20.8% to 4.5%).
Conclusions/interpretation
The phenotype of newly diagnosed type 2 diabetes has been fundamentally restructured since 2008: patients are older with a higher comorbidity burden but present with better glycaemic and lipid management, with the latter reflecting statin therapy already established before diagnosis. MASLD has emerged as a major but largely ascertainment-driven comorbidity. The shift to SGLT2 inhibitors and GLP-1RAs alongside declining sulfonylurea use indicates displacement of glucose-centric strategies by a cardiorenal- and weight-driven paradigm. These findings indicate a need for age-appropriate management and trials enrolling very elderly patients.
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