ADHERENCE AND PERSISTENCE WITH NOVEL GLUCOSE-LOWERING MEDICATIONS IN SWEDEN
Daniel O’Hara1,2, Roemer J Janse3,4, Edouard L Fu3,4,5, Meg J Jardine1,6, Juan-Jesus Carrero3,7 1NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia2Renal Department, Royal North Shore Hospital, Sydney, NSW, Australia3Karolinska Institutet, Stockholm, Sweden4Leiden University Medical Center, Leiden, The Netherlands5Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America6Concord Repatriation General Hospital, Sydney, NSW, Australia7Division of Renal Medicine, Danderyd Hospital, Stockholm, Sweden
Abstract
Aim: To assess adherence and persistence with sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), and dipeptidyl peptidase-4 inhibitors (DPP4i) in real-world care.
Background: The full benefits of new glucose-lowering agents can only be achieved through consistent medication use.
Methods: We used routinely collected healthcare data from the region of Stockholm, Sweden, to examine treatment patterns for new-users of SGLT2i, GPL1-RA, and DPP4i among people with type 2 diabetes from 2015 to 2020. We investigated rates of adherence (proportion of days covered by active medication supply ≥80%) and persistence (no treatment gap >60 days) and assessed prognostic factors for non-adherence and non-persistence.
Results: We identified 24,470 new-users, including 10,743 for SGLT2i, 10,315 for GLP1-RA and 9,488 for DPP4i, with 5,397 patients included in more than one group. Mean age was 63 years and 38% were women. Over a median follow-up of 2.8 years, the proportion of patients demonstrating adherence was 57% for SGLT2i, 54% for GLP1-RA, and 53% for DPP4i, and the proportion demonstrating persistence was 50% for SGLT2i, 51% for GLP1-RA and 56% for DPP4i. Better adherence and persistence were seen among new-users who were older, had a history of high blood pressure, who dispensed a greater number of non-diabetic medications, and had completed secondary schooling or university. Worse adherence was seen with higher HbA1c and worse kidney function for all agents, and female sex for SGLT2i and GLP1-RA.
Interpretation: We show adherence and persistence to SGLT2i, GLP1-RA and DPP4i substantially lower than the exposure in large phase 3 clinical trials, and identify prognostic factors for non-adherence and non-persistence that could inform interventions to optimise adherence and persistence and hence improve patient outcomes.
Biography
Dr Daniel O’Hara is a nephrologist and clinical researcher undertaking a PhD with the University of Sydney and the NHMRC Clinical Trials Centre. Daniel’s research interests include improving patient education and support to enhance adherence, implementation of evidence-based guidelines into real-world care, improving outcomes in the care of Aboriginal and Torres Strait Islander peoples, and the development of robust clinical trials to generate new evidence to guide patient care.