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Background: In the past 5 years, type 2 diabetes practice guidelines have shifted to prioritize agents with cardiovascular (CV) and renal benefit. This study assessed whether real-world medication use has changed in line with these evolving guidelines. Methods: We retrospectively examined the treatment patterns (12 months pre and post) of people with T2D (PwT2D) who initiated basal insulin (BI) in either 2015 (cohort 1) , 2017 (cohort 2) , or 2019 (cohort 3) using IBM® MarketScan® Databases. Between-group differences were analyzed via t-test or chi-square as appropriate. Results: In the study period, 6,396,441 PwT2D were identified. The number of PwT2D initiating BI was 17,801/948,805 (1.88%) in 2015 vs. 10,870/622,455 (1.75%) in 2019 and a progressively larger share of BI initiators had prior GLP-1RA use (14.8% in cohort 1 vs. 25.2% in cohort 3; p < 0.001) or SGLT-2i use (11.4% in cohort 1 vs. 20.5% in cohort 3; p < 0.001) . Furthermore, in patients without prior GLP-1RA, SGLT-2i, or bolus use who initiated GLP-1RA or SGLT-2i in the first year of BI, time to first GLP-1RA (132.4 days in cohort 1 vs. 120.5 days in cohort 3; p = 0.02) or SGLT-2i (131.5 days in cohort 1 vs. 113.3 days in cohort 3; p = 0.002) decreased. Conclusions: Real-world data suggests growing and earlier use of GLP-1RA and SGLT-2i among BI users, and a growing proportion of PwT2D on BI-GLP-1RA combination treatment, in line with changing practice guidelines. Disclosure D. Schapiro: Employee; Eli Lilly and Company. A. Meeks: Employee; Eli Lilly and Company. D. Liu: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Gelsey: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. R. Juneja: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. Huang: None. Funding Eli Lilly and Company

Background: HbA1c is a primary measure of glycemic control and managing HbA1c may help reduce the risk of complications. This study aimed to describe trends in HbA1c by insulin regimen. Methods: This was a retrospective analysis of cross-sectional surveys collected from the National Health and Nutrition Examination Survey between 2009-2018. Mean HbA1c and proportion achieving guideline- and HCP-recommended (i.e. personalized) HbA1c targets were evaluated in aggregate and over time in adults (18-64 years) with type 1 (T1DM) or type 2 (T2DM) diabetes using mealtime insulin (MTI) or basal insulin only. Trends over time between 2009-2018 were evaluated after adjusting for age, gender, race/ethnicity. The analysis included the strata, clusters, and weighting of the complex survey design. Results: From 2009-2018, 26.1% of people with T1DM (weighted n=891,194; mean HbA1c [SE] 7.9% [0.2]) , 24.8% with T2DM MTI (weighted n=1,591,183; mean HbA1c [SE] 8.6% [0.2]) , and 11.2% with T2DM basal only (weighted n=1,087,895; mean HbA1c [SE] 8.6% [0.2]) achieved the ADA recommended HbA1c goal of Conclusions: Across all insulin regimens based off the most recent NHANES data, ∼75-90% of individuals are not achieving ADA-recommended or personalized HbA1c goals. Emerging treatment tools (e.g. new technologies, advanced insulins, and time in range metrics) may facilitate improved diabetes outcomes. Disclosure E.R.Hankosky: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. D.Schapiro: Employee; Eli Lilly and Company. K.B.Gunn: Employee; Eli Lilly and Company. E.Lubelczyk: Employee; Eli Lilly and Company. J.Mitroi: None. D.R.Nelson: Employee; Eli Lilly and Company. Funding Eli Lilly and Company

Limited US real-world evidence exists on the effect of substantial changes in weight on HbA1c among people with T2D. People with T2D were identified from 2010-2018 in the IQVIA Ambulatory EMR database. The date of the first observed weight value was defined as the index date and patients were required to have an additional weight value at 1 year (±90 days) post-index date. Patients were stratified by weight change between index and 1 year post-index date. HbA1c was evaluated at index, 6 months, and 1 year post-index date. Of the 1,061,354 patients evaluated, 20.2% gained weight, 53.9% had no weight change, and 10.6% lost 3-5%, 10.7% lost 5-10%, 2.8% lost 10-15%, and 1.7% lost ≥15% of their weight at the index date (i.e., index weight) at 1 year of follow-up. Of note, patients with the largest weight loss had the highest index weight (range: 203.7lb in patients with weight gain to 245.9lb in patients with ≥15% weight loss) . Mean index HbA1c was similar across subgroups as was the percent of patients with index HbA1c In summary, HbA1c reduction was greater with increasing amount of weight lost during the one year of follow-up. Patients with weight loss ≥15% reduced HbA1c by an average of 1.2% of the index value at 1 year of follow-up. Disclosure S.Shinde: None. V.Thieu: None. A.Kwan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. K.F.Houghton: None. D.Schapiro: Employee; Eli Lilly and Company. J.Meyers: Other Relationship; Eli Lilly and Company.