SEARCHCOHORTendocrinology, internal medicine

cohort·endocrinology, internal medicine, epidemiology, observational study·PMC10064368

Real-World Evaluation of GLP-1 Receptor Agonist Therapy Persistence, Adherence and Therapeutic Inertia Among Obese Adults with Type 2 Diabetes

Diabetes Therapy · 8 authors, 5 centres

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TL;DR

This retrospective cohort study found that among obese adults with type 2 diabetes, those using GLP-1 receptor agonists showed better medication adherence but lower persistence after two years compared to users of other glucose-lowering agents. Persistent GLP-1RA users had significantly better glycemic control, but therapeutic inertia was widespread.

Full summary

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A retrospective cohort study analyzed electronic medical records from 2014 to 2019 for adults with type 2 diabetes in Valencia, Spain. At two years, GLP-1RA users had lower persistence (48.4% vs. Persistent GLP-1RA users had a greater proportion with reduced HbA1c (40.5% vs. Therapeutic inertia was observed in 38.0% of the population, with a higher rate of treatment intensification among GLP-1RA users than non-users. Limitations include its retrospective design, potential data inaccuracies, and the generalizability of findings from a specific region. The study suggests that while GLP-1RA persistence is low, it is associated with improved glycemic control, and therapeutic inertia is a significant barrier, especially in non-GLP-1RA users.

STUDY TYPE

cohort

SPECIALTY

endocrinology

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ORIGINAL PAPER

PMC10064368

Real-World Evaluation of GLP-1 Receptor Agonist Therapy Persistence, Adherence and Therapeutic Inertia Among Obese Adults with Type 2 Diabetes

Diabetes Therapy

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ABSTRACT

Introduction In type 2 diabetes (T2D), key barriers to optimal glycaemic control include lack of persistence with treatment, reduced medication adherence and therapeutic inertia. This study aimed to assess the impact of these barriers in obese adults with type 2 diabetes treated with a GLP-1 receptor agonist (GLP-1RA) and compare them against other glucose-lowering agents in a real-world setting. Methods A retrospective study was conducted using electronic medical records from 2014 to 2019 for adults with T2D at the Valencia Clínico-Malvarrosa Department of Health (Valencia, Spain). Four study groups were established: all GLP-1RA users, SGLT2i users, insulin users and other glucose-lowering agent users (miscellany group). To account for imbalance between groups, propensity score matching (PSM) including age, gender and pre-existing cardiovascular disease was performed. Chi-square tests were used for comparisons between groups. Time to first intensification was calculated using competing risk analysis. Results Among the 26,944 adults with T2D, 7392 individuals were selected following PSM, with 1848 patients in each group. At 2 years, GLP-1RA users were less persistent than non-users (48.4% versus 72.7%, p < 0.0001) but more adherent (73.8% versus 68.9%, respectively, p < 0.0001). A greater proportion of persistent GLP-1RA users than non-persistent users exhibited reduced HbA1c (40.5% versus 18.6%, respectively, p < 0.0001), but no differences in cardiovascular outcomes and death were found. Overall, therapeutic inertia was observed in 38.0% of the study population. The large majority of GLP-1RA users received treatment intensification, whereas only 50.0% of GLP-1RA non-users were intensified. Conclusion Under real-life conditions, obese adults with T2D persistently treated with GLP-1RA showed improved glycaemic control. Despite benefits, persistence with GLP-1RA was limited after 2 years. Additionally, therapeutic inertia occurred in two out of three study participants. Strategies to facilitate medication adherence, persistence and treatment intensification in people with T2D should be made a priority in order to achieve and maintain glycaemic targets and improve outcomes in this population. Trail registration Study registered in clinicaltrials.org with the identifier NCT05535322 .

CITATION EXPORT

Ana Palanca, F. Javier Ampudia-Blasco, José Miguel Calderón et al.. Real-World Evaluation of GLP-1 Receptor Agonist Therapy Persistence, Adherence and Therapeutic Inertia Among Obese Adults with Type 2 Diabetes. Diabetes Therapy. (2023). https://doi.org/10.1007/s13300-023-01382-9

AUTHORS

8 · 5 CENTRES

Ana Palanca, F. Javier Ampudia-Blasco, José Miguel Calderón, Inmaculada Sauri, Sergio Martinez-Hervás, José Luis Trillo, Josep Redón, José T. Real

1grid.411308.fDepartment of Endocrinology and Nutrition, Clinic University Hospital of Valencia, Avda. Blasco Ibáñez nº 17, 46010 Valencia, Spain
2grid.429003.c0000 0004 7413 8491INCLIVA Biomedical Research Institute, Valencia, Spain
3grid.430579.c0000 0004 5930 4623CIBERDEM, CIBER of Diabetes and Associated Metabolic Diseases, Madrid, Spain
4grid.5338.d0000 0001 2173 938XDepartment of Medicine, Medicine Faculty, University of Valencia (UV), Valencia, Spain
5Department of Health of Valencia Clínico-Malvarrosa, Valencia, Spain