OBJECTIVES:

Non-adherence to antidiabetic medications is associated with worse clinical outcomes including poorer hemoglobin A1c (HbA1c). Both sodium-glucose cotransporter 2 (SGLT2I) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists demonstrate clinical benefits in type 2 diabetes (T2DM) patients with an increased risk for cardiovascular disease. However, differences in route of administration and side effect profile may affect adherence. Therefore, the objective of this study is to evaluate and compare medication adherence among new adult users of SGLT2I and GLP-1 agonists.

METHODS:

This retrospective cohort study utilized the 10% random sample of enrollees within IQVIA PharMetrics^® Plus for Academics database. New users of GLP-1 agonists (i.e., dulaglutide, exenatide, liraglutide, semaglutide) or SGLT2I (i.e., canagliflozin, dapagliflozin, ertugliflozin or empagliflozin) naive to the index classes in the prior 6 months were identified from January 1, 2013, to December 31, 2019. Patients were required to have a T2DM International Classification of Diseases (ICD) diagnosis claim; ≥6 months pre-index (baseline) and ≥9 months post-index (follow-up) continuous enrollment. Covariates were balanced across index treatment group using 1:1 propensity score matching. Main outcome measure was adherence to the index class (proportion of days covered, PDC) during the 9-months follow-up period. PDC was dichotomized as adherent or nonadherent (≥80% vs. <80%). Logistic regression models evaluated the likelihood of nonadherence.

RESULTS:

The matched treatment groups included 7694 patients. A greater proportion of patients receiving an SGLT2I were adherent to therapy as compared to patients receiving a GLP-1 (49.7% vs 41.8%, P < 0.05) during the follow up period. The estimated adjusted odds ratio of adherence was 1.36; 95% confidence interval [CI], 1.24–1.49; P <.01).

CONCLUSIONS:

In this real-world study, patients who newly initiated treatment with SGLT2I were more likely to adhere to treatment than patients who newly initiated treatment with a GLP-1 during the 9-month follow-up period.