DISABILITY AND ADHERENCE TO GLP-1 RECEPTOR AGONISTS AND SGLT2 INHIBITORS AMONG U.S. ADULTS WITH DIABETES: EVIDENCE FROM THE MEDICAL EXPENDITURE PANEL SURVEY
Author(s)
Regina N. Nechi, BPharm, Ahmed I. Soliman, PhD, Macarius M. Donneyong, PhD, MPH;
The Ohio State University, Outcomes and Translational Sciences, College of Pharmacy, Columbus, OH, USA
The Ohio State University, Outcomes and Translational Sciences, College of Pharmacy, Columbus, OH, USA
OBJECTIVES: GLP-1 receptor agonists (GLP-1 RAs) and SGLT2 inhibitors reduce cardiometabolic complications in type 2 diabetes, conditions that disproportionately affect adults with disability. For patients with diabetes and disability, sustained adherence to these therapies is important to prevent downstream morbidity. We examined whether disability is associated with adherence among adults with diabetes using GLP-1 RAs or SGLT2 inhibitors and whether this association differs by drug class.
METHODS: We analyzed adults aged ≥18 years with diabetes from the Medical Expenditure Panel Survey (MEPS) Panels (2017-2023) who completed all interview rounds and had at least one prescription fill for a GLP-1 RA or an SGLT2 inhibitor. Adherence was measured using a refill-based metric and classified as adherent (≥80%) versus non-adherent. Disability was defined using the CDC six-domain functional limitation measure, indicating serious difficulty in hearing, vision, cognition, mobility, self-care, or independent living. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) for adherence among GLP-1 RA and SGLT2 users, and a pooled model tested interaction by medication class. Covariates were selected using a directed acyclic graph and included sociodemographic, clinical, and healthcare access factors.
RESULTS: Among 5,807 adults with diabetes, 1,219 used a GLP-1 RA or SGLT2 inhibitor; 41.8% reported disability. Adherence prevalence was 20.5% among GLP-1 users and 25.3% among SGLT2 users. Disability was not associated with adherence among GLP-1 users (aOR 1.26; 95% CI 0.64-2.49; p=0.51) or SGLT2 users (aOR 1.26; 95% CI 0.50-3.20; p=0.63). There was no evidence that the association between disability and adherence differed by medication class (interaction p=0.965).
CONCLUSIONS: In a nationally representative cohort of U.S. adults with diabetes, disability was not associated with adherence to GLP-1 RAs or SGLT2 inhibitors. The low adherence observed in this study underscores the need for strategies that support sustained use of cardiometabolic-protective treatments in populations with complex health needs.
METHODS: We analyzed adults aged ≥18 years with diabetes from the Medical Expenditure Panel Survey (MEPS) Panels (2017-2023) who completed all interview rounds and had at least one prescription fill for a GLP-1 RA or an SGLT2 inhibitor. Adherence was measured using a refill-based metric and classified as adherent (≥80%) versus non-adherent. Disability was defined using the CDC six-domain functional limitation measure, indicating serious difficulty in hearing, vision, cognition, mobility, self-care, or independent living. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) for adherence among GLP-1 RA and SGLT2 users, and a pooled model tested interaction by medication class. Covariates were selected using a directed acyclic graph and included sociodemographic, clinical, and healthcare access factors.
RESULTS: Among 5,807 adults with diabetes, 1,219 used a GLP-1 RA or SGLT2 inhibitor; 41.8% reported disability. Adherence prevalence was 20.5% among GLP-1 users and 25.3% among SGLT2 users. Disability was not associated with adherence among GLP-1 users (aOR 1.26; 95% CI 0.64-2.49; p=0.51) or SGLT2 users (aOR 1.26; 95% CI 0.50-3.20; p=0.63). There was no evidence that the association between disability and adherence differed by medication class (interaction p=0.965).
CONCLUSIONS: In a nationally representative cohort of U.S. adults with diabetes, disability was not associated with adherence to GLP-1 RAs or SGLT2 inhibitors. The low adherence observed in this study underscores the need for strategies that support sustained use of cardiometabolic-protective treatments in populations with complex health needs.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR83
Topic
Patient-Centered Research
Topic Subcategory
Adherence, Persistence, & Compliance, Patient Behavior and Incentives
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)