Pharmaceuticals (Basel, Switzerland)Oct 27, 2026

Comparing how well people with type 2 diabetes stick to and keep taking SGLT-2 inhibitors versus GLP-1 receptor agonists, especially in those with heart disease

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Oct 28, 2026

Abstract

At the 1-year follow-up, 86.66% of patients on sodium-glucose cotransporter-2 inhibitors (SGLT-2is) were adherent, compared to 76.53% of those on glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

SGLT-2is demonstrated significantly higher adherence than GLP-1 RAs, with an odds ratio of 2.02.
Persistence at 12 months was also greater for SGLT-2is (71.48%) compared to GLP-1 RAs (66.52%), with a hazard ratio of 0.83.
Newly diagnosed type 2 diabetes mellitus (T2DM) and insulin use were associated with a higher likelihood of discontinuation.
In patients with cardiovascular disease (CVD), adherence was even more pronounced for SGLT-2is (89.57%) versus GLP-1 RAs (78.12%), with an odds ratio of 2.44.
Similarly, persistence among the CVD subgroup favored SGLT-2is (73.9%) over GLP-1 RAs (63.59%), with a hazard ratio of 0.66.

Simplified

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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Comparing how well people with type 2 diabetes stick to and keep taking SGLT-2 inhibitors versus GLP-1 receptor agonists, especially in those with heart disease

Abstract

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