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• 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. [ABSTRACT FROM AUTHOR]