SGLT2-remmers en statinen verbeteren metabole controle bij diabetes type 2 — real-world trends

BACKGROUND: To evaluate 10-year trends in metabolic control and guideline-directed pharmacotherapy among adults with type 2 diabetes in Taiwan. METHODS: Using Taiwan's National Health Insurance Research Database (2015-2024), we analyzed annual trends in glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and medication use. Blood pressure (BP) was assessed via a nationwide Pay-for-Performance registry. Trends were evaluated overall and across subgroups with cardiovascular disease (CVD) or chronic kidney disease (CKD). RESULTS: The treated population expanded from 1.58 to 2.27 million. Target achievement improved significantly: HbA1c <7.0% rose from 42.5% to 55.3%, and LDL-C <100 mg/dL from 54.3% to 69.0% (both p-trend <0.001). Among patients with all three measurements available, triple-factor control reached 18.2% by 2024. These gains coincided with rapid sodium-glucose cotransporter-2 inhibitor (SGLT2i) uptake (from 3.3% in 2016 to 38.0% in 2024) and increased statin use. However, 23.5% of young adults (20-44 years) maintained poor glycemic control (HbA1c ≥ 8.5%). SGLT2i use was higher in patients with CVD (43.1%) or CKD (43.8%) than in those without the respective conditions (34.7% and 36.6%), while glucagon-like peptide-1 receptor agonist (GLP-1RA) use remained below 4%. CONCLUSIONS: Metabolic control in Taiwan improved substantially alongside adoption of newer therapies. Gaps among younger adults and high-risk cohorts highlight the need for targeted, risk-stratified management.