OBJECTIVES

: We aimed to characterize trajectories of adherence to sodium glucose cotransporter 2 inhibitors (SGLT2i) in patients with type 2 diabetes(T2D) and identify important predictors associated with adherence to SGLT2i.

METHODS

: Using 2012 - 2016 Medicare data, we selected T2D patients who filled >1 SGLT2i prescription. Index date was the date of the first SGLT2i prescription filled. We calculated the proportion of days covered (PDC) with SGLT2i over the first 12 months after index date. The monthly PDC for each patient was incorporated into group-based trajectory models to identify groups with similar adherence patterns. Finally, we performed a multinomial logistic regression model to examine the association between patient characteristics and group membership.

RESULTS

: The final sample included 6,719 patients. We identified 4 trajectories of SGLT2i adherence: continuously adherent users (49.6%), early discontinuers (27.5%), late discontinuers (14.5%), and non-adherent users (8.4%). Patient sociodemographic characteristics including age, sex, race, region of residence, Medicaid eligibility, low income subsidy eligibility and clinical characteristics including use of metformin, use of loop diuretics, history of asthma were associated with group membership. For example, compared to White patients, Black patients were associated with a higher likelihood of nonadherence [adjusted odds ratio(aOR) 2.30 95% confidence interval (CI):1.76-3.00] or early discontinuation (1.31 95% CI: 1.07-1.60).

CONCLUSIONS

: We successfully identified four trajectory groups. Only half of the sample belonged to the continuously adherent trajectory group. Both social and clinical factors were associated with adherence patterns.