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

Abstract

AbstractAimThe 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 MethodsWe 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.ResultsIn 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).ConclusionsWeekly GLP‐1RAs initiators were more adherent, persistent to therapy and achieved better glycaemic control. Epidemiological variables might play a role in achieving this goal.