Real-World Comparison of Adherence and Persistence between Glucagon-like Peptide-1 Receptor Agonist (GLP-1) and Sodium-Glucose Cotransporter 2 (SGLT-2) in Patients with Type 2 Diabetes (T2D)

OBJECTIVES: To assess adherence and discontinuation of glucagon-like peptide-1 (GLP-1) and sodium-glucose cotransporter-2 (SGLT-2) among adult type-2 diabetes mellitus (T2D) patients in the United States based on real-world claims and linked clinical data from ICON’s Symphony Health Integrated Dataverse (IDV).

METHODS: Adults with T2D, with ≥ 1 year of follow-up, naïve to the drug class and who initiated a newer GLP-1 or SGLT-2 (index date) between 2017 to 2021 were identified using IDV. A subgroup of patients was selected that matched the inclusion criteria and had an HbA1C ≥ 7% within 60 days of the index date.

IDV pharmacy and medical claims and lab data were integrated into a single enriched dataset using tokenization. Adherence was measured by the proportion of days covered (PDC) ≥ 80%. Persistence was measured as time from index date to discontinuation and as a proportion on treatment at 90, 180, 360 and 720 days.

RESULTS: In IDV, 1,789,151 and 1,953,547 patients newly initiated a GLP-1 or SGLT-2 in the main cohort and 165,758 and 233,222 patients respectively met the HbA1C criteria (subgroup).

Starting a GLP-1 or SGLT-2, the subgroup population was primarily female (51% and 56%, respectively) with a mean age of 59.0 and 59.7 years, respectively. HbA1C at the index date (9.3% vs 9.1%, respectively) and years of follow-up (3.9 vs 4.1 years, respectively) were similar.

PDC was higher for SGLT-2 subgroup (mean 0.784, SD 0.258) compared to GLP-1 (mean 0.744, SD 0.270), p < 0.001. In the patient subgroup, GLP-1 and SGLT-2 persistence at 360 (48.1% vs 46.8%, respectively) and 720 days (31.9% vs 31.4%) were similar.

CONCLUSIONS: Real-world data suggest greater adherence to SGLT-2 than GLP-1 treatment, however overall persistence data over two years was similar. Further investigation of effectiveness and reasons of low persistence are warranted, of which this large dataset may be useful.