OBJECTIVES: To investigate non-persistence with GLP-1 receptor agonists (GLP-1) among adults with type 2 diabetes (T2D) treated with basal insulin.

METHODS: A web-based survey of adults with T2D treated with basal insulin and who discontinued GLP-1 within the past 12 months (n=119) was conducted in the UK (n=61) and USA (n=58). Concept elicitation interviews with 16 physicians informed survey development, and usability testing was conducted prior to survey launch.

RESULTS: Average respondent age was 43.7 years (SD, 12.2), and 41.2% of respondents were female. Mean age at T2D diagnosis was 37.4 years (SD, 9.6). Most respondents (98.3%) discussed GLP-1 medication management and/or potential side effects with their healthcare providers. The most frequently reported reasons for discontinuing GLP-1 included: “It was too complicated to keep track of taking two different types of injectable medications” (31.9%) and “I had nausea” (31.9%). A total of 41.2% of respondents reported that discontinuing GLP-1 was the right decision, while 39.5% reported that it was the wrong decision and 19.3% were unsure. Among those who reported it was the right decision (n=49), the most frequent reason was: “I think I have fewer side effects now” (46.9%); among those who reported it was the wrong decision/unsure (n=70), the most frequent reasons were: “I don’t think I took it long enough to see results” (25.7%) and “I think I have more side effects now” (25.7%). After discontinuing GLP-1, respondents most frequently reported making the following changes to their diabetes management: improved diet (63.9%), increased exercise (50.4%), lost weight (39.5%), and increased basal dose (24.4%).

CONCLUSIONS: Treatment complexity issues and nausea were key contributors to GLP-1 non-persistence. The results suggest that complex regimens in adults with T2D may be a barrier to medication persistence and optimal diabetes control; more simplified treatment regimens may improve persistence and diabetes management.