Efficacy, adherence and persistence of various glucagon‐like peptide‐1 agonists: nationwide real‐life data

Aug 7, 2024Diabetes, obesity & metabolism

Effectiveness and long-term use of different diabetes medications in real-life across the country

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Abstract

A total of 70,654 patients with type 2 diabetes mellitus were evaluated for their response to glucagon-like peptide-1 receptor agonists (GLP-1RAs).

All patients experienced a significant reduction in glycated hemoglobin (HbA1c) levels after starting GLP-1RAs.
Weekly GLP-1RA initiators had a greater reduction in HbA1c compared to daily initiators (14.6% vs. 10.2%, p < 0.001).
The percentage of patients experiencing a decrease in HbA1c was higher in the weekly group (82.4%) than in the daily group (74.7%).
Semaglutide and dulaglutide were associated with the most significant reductions in HbA1c at 16.0% and 14.7%, respectively.
Good adherence to therapy (≥80% of days covered) was significantly higher among weekly GLP-1RA users with an odds ratio of 1.25 (95% confidence interval 1.21-1.28).
Epidemiological factors such as older age, female gender, Jewish ethnicity, and high socio-economic status were linked to better adherence.

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AIM: The management of type 2 diabetes mellitus has advanced in the last two decades since the introduction of glucagon-like peptide-1 receptor agonists (GLP-1RAs). However, multiple factors may interfere with achieving better glycaemic control. This study evaluated the differences between various GLP-1RAs in efficacy, adherence and persistence.

MATERIALS AND METHODS: We conducted a retrospective cohort study using the electronic medical database from Clalit Health Services. Adults with type 2 diabetes mellitus who purchased any GLP-1RA between 2009 and 2021 were included. The Index Date was defined as the date of the first purchase of any GLP-1RA. We evaluated the adherence, persistence and glycaemic control after GLP-1RAs initiation. Baseline glycaemic and post-treatment glycaemic controls were analysed.

RESULTS: In total, 70 654 patients were included. The mean age was 11.7 ± 60.4, and 51% were females. A significant reduction in glycated haemoglobin (HbA1c) was observed in all patients who received GLP-1RAs. However, the percentage of changes in the HbA1c was higher among weekly GLP-1RA than daily initiators (14.6% vs. 10.2%, p < 0.001). The proportion of subjects with any decrease in HbA1c was higher among the once-weekly compared with the daily dose (82.4% vs. 74.7%) and mainly patients initiated semaglutide or dulaglutide, with 16.0% and 14.7% reduction. The frequency of good adherence (the proportion of days covered ≥80%) was significantly higher among the weekly group odds ratio = 1.25 (95% confidence interval 1.21-1.28). Good adherence was reported in older age, female gender, Jewish ethnicity and high socio-economic status (p < 0.001).

CONCLUSIONS: Weekly GLP-1RAs initiators were more adherent, persistent to therapy and achieved better glycaemic control. Epidemiological variables might play a role in achieving this goal.

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Efficacy, adherence and persistence of various glucagon‐like peptide‐1 agonists: nationwide real‐life data

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