This study compared adherence and persistence with SGLT-2 inhibitors and GLP-1 receptor agonists in type 2 diabetes. It used pharmacy claims from Castilla y León, Spain, on 14,998 propensity-matched new users aged 40 or over, 2019–2024. One-year adherence by medication possession ratio was 86.66% with SGLT-2 inhibitors and 76.53% with GLP-1 receptor agonists (OR 2.02). Persistence at 12 months was 71.48% versus 66.52% (HR for discontinuation 0.83). In matched patients with cardiovascular disease, the gap widened: OR 2.44 for adherence and HR 0.66 for discontinuation. Patients with fewer than two refills were excluded, and deaths, side effects and clinical outcomes were not recorded.
Why it is interesting: Both classes are recommended for people with diabetes and cardiovascular disease, yet direct comparisons of medication-taking are few. The gap was widest in that group, and oral semaglutide made up about half of GLP-1 receptor agonist use.
Abstract — the authors' own words, CC BY
Background/Objectives : Poor adherence and persistence to sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a critical issue in the treatment of type 2 diabetes mellitus (T2DM), especially in patients with cardiovascular disease (CVD). We aimed to compare adherence and persistence to these drugs in routine care. Methods : A retrospective propensity score-matched (PSM) cohort study was conducted using pharmacy claims data. Patients aged 40 years or older with T2DM initiating SGLT-2is or GLP-1 RAs from 1 January 2019 to 31 December 2024 were included. Adherence was measured using the Medication Possession Ratio (MPR), and persistence was defined as the time to discontinuation (gap ≥ 60 days between refills). Results : At the 1-year follow-up, the SGLT-2i cohort showed significantly higher adherence compared to the GLP-1 RA cohort (86.66% vs. 76.53%; OR = 2.02) and higher persistence (71.48% vs. 66.52% at 12 months; HR = 0.83). The main factors associated with lack of persistency were newly diagnosed T2DM (HR = 1.25) and insulin use (HR = 1.32). In the CVD subgroup, the differences in favor of the SGLT-2i cohort were more pronounced for adherence (89.57% vs. 78.12%; OR = 2.44) and persistence (73.9% vs. 63.59%; HR = 0.66). Conclusions : In real-world clinical practice, adherence and persistence rates were higher in patients on SGLT-2is compared to those on GLP-1 RAs, particularly in the CVD subgroup. Our findings suggest that the new strategies are necessary to improve adherence and persistence to these medications, particularly in patients with CVD.
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