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Adherence to GLP-1 Receptor Agonist Treatment Among Patients With Type 2 Diabetes
TAKE-HOME MESSAGE
- This study evaluated the adherence to GLP-1 receptor agonist treatment among 44,343 patients with type 2 diabetes and assessed the factors associated with treatment discontinuation. The risk of treatment discontinuation within 6 and 12 months was 14.1% and 21.2%, respectively. Adherence at 12 months was associated with older age, higher household income, weekly treatment administration, a higher education level, a longer diabetes duration, better glycemic control, and concomitant chronic kidney disease. Younger and older age, lower household income, a higher comorbidity burden, a longer diabetes duration, education level, and cardiovascular disease were the factors associated with a higher risk of discontinuing therapy. HbA1c was not associated with the risk of treatment discontinuation.
- Given the changing landscape of who should be treated with GLP-1 receptor agonists, it is important to prioritize future research regarding adherence to GLP-1 receptor agonist treatment and potential interventions to improve it.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS
To assess the level of adherence to glucagon-like peptide-1 receptor agonist (GLP-1RA) treatment using real-world data and to investigate the sociodemographic and clinical factors associated with discontinuation of GLP-1RAs.
METHODS
First-time users of GLP-1RAs with type 2 diabetes mellitus (T2DM), aged ≥18 years, in the period 2007 to 2020, were identified using Danish registries, allowing all participants a minimum of 18 months' follow-up. Adherence to GLP-1RA therapy (medication possession ratio >0.80) and discontinuation of GLP-1RA therapy was estimated at 6- and 12-month follow-ups. Multivariable cause-specific Cox regression was used to identify sociodemographic and clinical factors associated with risk of discontinuation.
RESULTS
In total, 44 343 first-time users of GLP-1RAs with T2DM were identified (mean age 58.6 years, 42.7% female, median duration of T2DM 6.8 years, median glycated haemoglobin level 65 mmol/mol). The absolute risk of discontinuing GLP-1RA treatment within 6 months was 14.2% (95% confidence interval [CI] 13.9-14.6) and 21.2% (95% CI 20.8-21.5) within 12 months. At 6 months, 50.4% were adherent to GLP-1RA therapy and at 12 months, 48.6% remained adherent. In the multivariable model, younger (<40 years) and older age (>75 years), higher Charlson Comorbidity Index score, lower household income, high school and longer university degree as educational attainment level, and longer diabetes duration were associated with a higher risk of discontinuing GLP-1RA treatment.
CONCLUSION
Approximately one in five patients discontinued GLP-1RA therapy within the first 12 months and only half were adherent. Overall, lower socioeconomic status and higher comorbidity burden were associated with higher risk of discontinuing GLP-1RA treatment.
Additional Info
Disclosure statements are available on the authors' profiles:
Adherence to glucagon-like peptide-1 receptor agonist treatment in type 2 diabetes mellitus: A nationwide registry study
Diabetes Obes Metab 2024 Aug 31;[EPub Ahead of Print], MCH Lassen, ND Johansen, D Modin, AM Catarig, BK Vistisen, H Amadid, E Zimmermann, G Gislason, T Biering-SørensenFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have gained popularity owing to their significant benefits in managing type 2 diabetes (T2D), cardiovascular health, renal function, and weight loss. Despite these advantages, adherence to these medications remains suboptimal, owing to multiple factors, such as concerns about side effects and the cost of the medications. In their study, Lassen et al investigated adherence to GLP-1RAs among first-time users in a nationwide registry, examining factors associated with discontinuation in patients with T2D.
The study analyzed data from 44,343 first-time GLP-1RA users between May 2007 and June 2020. It found that the 6-month discontinuation risk was 14.1%, increasing to 21.2% at 12 months, with the highest risk occurring during the initial months of treatment. Factors influencing discontinuation included sex, age, household income, frequency of administration, education level, diabetes duration, chronic kidney disease, cardiovascular disease, and the year of inclusion. Notably, patients receiving once-weekly injections had a higher discontinuation risk than those on once-daily injections; however, this trend shifted following the introduction of semaglutide in 2018.
Adherence rates were concerning, with only 50.4% of participants remaining on therapy at 6 months and 48.6% at 12 months. Those who adhered tended to be older, have higher household incomes, receive weekly GLP-1RA injections, possess higher education levels, have longer diabetes durations, and exhibit better glycemic control. Conversely, younger age, lower income, higher comorbidity burden, and the presence of cardiovascular disease were linked to increased discontinuation risks. Interestingly, HbA1c levels did not correlate with the likelihood of therapy discontinuation.
The research highlights the importance of healthcare providers actively addressing barriers to treatment adherence. This includes educating patients about the benefits and potential side effects of GLP-1RAs and exploring financial assistance programs to reduce cost concerns. Tailoring treatment plans to individual patient needs, considering their lifestyle, preferences, and socioeconomic factors, can improve adherence and enhance health outcomes.
Overall, this study provides valuable insights into the real-world application of GLP-1RAs in managing T2D. It emphasizes the need for a comprehensive approach to patient care, where effective medication use is supported by education, accessibility, and ongoing follow-up. As the landscape of diabetes management continues to evolve, addressing adherence challenges will be essential for optimizing the benefits of GLP-1RAs and improving the health of individuals with diabetes.