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Importance Little is known about how new and expensive drugs diffuse into practice affects health care costs. Objective To describe the variation in second-generation diabetes drug use among Medicare enrollees between 2007 and 2015. Design, setting, and participants This population-based, cross-sectional study included data from 100% of Medicare Parts A, B, and D enrollees who first received diabetes drug therapy from January 1, 2007, to December 31, 2015. Patients with type 1 diabetes were excluded. Data were analyzed beginning in the spring of 201