Adherence to GLP1‐RA and SGLT2‐I affects clinical outcomes and costs in patients with type 2 diabetes

Abstract

AbstractAimsTo evaluate the impact of adherence to glucagon like peptide‐1 receptor agonists (GLP1‐RA) and sodium‐glucose transporter two inhibitors (SGLT2‐I) on clinical outcomes and costs in patients with type 2 diabetes mellitus (T2DM).Materials and MethodsThe 121,115 residents of the Lombardy Region (Italy) aged ≥40 years newly treated with metformin during 2007–2015 were followed to identify those who started therapy with GLP1‐RA or SGLT2‐I. Adherence to drug therapy over the first year was defined as the proportion of days covered >80%. Within each drug class, for each adherent patient, one non‐adherent patient was matched for age, sex, duration, adherence to metformin treatment and propensity score. The primary clinical outcome was a composite of insulin initiation, hospitalisation for micro‐ and macrovascular complications and all‐cause mortality after the first year of drug treatment. Costs were evaluated based on reimbursements from the national healthcare system.ResultsAfter matching, 1182 pairs of adherent and non‐adherent GLP1‐RA users and 1126 pairs of adherent and non‐adherent SGLT2‐I users were included. In both groups, adherent patients experienced a significantly lower incidence of the primary outcome (HR: 0.85, 95% CI 0.72–0.98 for GLP1‐RA and HR: 0.69, 95% CI 0.55–0.87 for SGLT2‐I). A significant reduction in hospitalizations was found for adherent patients in the GLP1‐RA group but not for the SGLT2‐I group. Results were consistent when analyses were stratified by age and sex. While higher drug‐related costs in the adherent group were counterbalanced by decreased hospitalisation costs in SGLT2‐I treated patients, this was not the case for GLP1‐RA.ConclusionsHigher adherence to drug treatment with GLP1‐RA and SGLT2‐I during the first year of the drug intake is associated with a lower incidence of adverse clinical outcomes in a real‐world setting.