Prescribing trends of glucose-lowering drugs in older adults from 2010 to 2021: A population-based study of Northern Italy

•Prescriptions of GLP-1 RA and SGLT2i increased from 2015 to 2021 in older diabetics.•Use of GLP-1 RA and SGLT2i increased mainly in older diabetics with CVD.•Use of sulfonylureas and glinides decreased from 2015 to 2021 in older diabetics.•One fourth of T2DM patients over 80 years were still treated with sulfonylureas.•There is still room to improve the management in older people with diabetes. To describe glucose-lowering drugs prescribing pattern in a large population of older diabetics from 2010 to 2021. Using linkable administrative health databases, we included patients aged 65–90 years treated with glucose-lowering drugs. Prevalence rate of drugs was collected within each study year. A stratified analysis by gender, age and coexistence of cardiovascular disease (CVD) was conducted. A total of 251 737 and 308 372 patients were identified in 2010 and 2021, respectively. Use of metformin (68.4% to 76.6%), DPP-4i (1.6% to 18.4%), GLP-1-RA (0.4% to 10.2%), SGLT2i (0.6% to 11.1%) increased, while sulfonylureas (53.6% to 20.7%) and glinides (10.5% to 3.5%) decreased over time. Metformin, glitazones, GLP1-RA, SGLT2i and DPP4i (except for 2021) usage decreased with aging, in contrast to sulfonylureas, glinides and insulin. The coexistence of CVD was associated with a higher prescription of glinides, insulin, DPP-4i, GLP1-RA and SGLT2i, particularly in 2021. We found a significant increase in the prescriptions of GLP-1 RA and SGLT2i in older diabetics, mainly in those with CVD. However, drugs without CV benefits including sulfonylureas and DPP-4i continued to be highly prescribed in older patients. There is still room to improve the management in this population according to recommendations.