Clinical characteristics and intensification patterns in subjects with "early" type 2 diabetes in Italy- an analysis from the AMD annals initiative

Purpose: Characteristics defining “early” type 2 diabetes (T2D) are unclear, and type and timing of treatment intensification with glucose-lowering drugs (GLD) in these patients are understudied. Methods: Within the AMD Annals Initiative, we evaluated the prevalence and clinical characteristics of early T2D subjects, evaluated by diabetologists and defined according to a recent Delphi Consensus. Patient characteristics of early T2D subjects were compared to those of non-early patients. We also explored the time and mode of first intensification in a longitudinal cohort from 2010 to 2023. Results: Overall, 127,456 people were seen in 2023, of whom 10,700 (8.39%) showed an early phenotype. Early patients were younger, more often females, had lower HbA1c, used less cardiovascular-related drugs, and had a lower prevalence of cardiovascular disease. Conclusion: In real life, T2D could be considered as early in only ~ 8% of people. Among them, less than 10% received treatment intensification during the first year of observation, although the timing of the introduction of add-on GLD improved during time and drugs with cardiovascular benefit were often chosen as second-line GLD. In longitudinal analysis, of 42,786 early patients initially treated with metformin, 9.37% were prescribed an add-on treatment during 12 months, more frequently represented by SGLT2i, followed by GLP1-RAs and DPP4i. Mean level of HbA1c at treatment intensification improved over time, suggesting an encouraging trend through a proactive approach.