This retrospective cohort study used MarketScan claims from 2018 to 2021 on US adults with diabetes or obesity. All started injectable semaglutide with no prior incretin therapy, and were followed for 12 months. Initiating dose was low (0.5 mg/week or less) or high (1.0 mg/week or more); 14.5% started high. High-dose initiation carried a 25% higher early discontinuation risk (HR 1.25, 95% CI 1.17-1.34). One-year persistence was lower, independent of age, obesity status, co-morbidity and cost; high-dose starts were commoner among men and endocrinologists. Claims data cannot confirm whether dispensed medication was taken, or why treatment stopped.
Why it is interesting: Persistence on GLP-1 therapy is low in routine care, and this identifies prescriber dosing as a modifiable contributor. It separates initiation behaviour from patient characteristics and cost.
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