Nearly one-third of patients were nonadherent to newly prescribed SGLT-2 inhibitors, GLP-1 receptor agonists
Factors associated with not filling a new prescription for a sodium-glucose cotransporter-2 (SGLT-2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist included older age, Black race, male sex, certain comorbid conditions, and having a primary care clinician prescribe the drug, a study found.
About one-third of patients did not fill their prescriptions for newer diabetes drugs within 30 days, a study found.
Researchers used a dataset that links electronic prescribing with health insurance claims to retrospectively assess adult patients from a large health system in Pennsylvania who had at least one prescription order for a sodium-glucose cotransporter-2 (SGLT-2) inhibitor (canagliflozin or empagliflozin) or a glucagon-like peptide-1 (GLP-1) receptor agonist (dulaglutide, liraglutide, or semaglutide) between 2012 and 2019. The primary outcome was the incidence of primary nonadherence to an SGLT-2 inhibitor or a GLP-1 receptor agonist, defined as no dispensed claim within 30 days of the first electronic prescription order for any drug within each respective medication class. Results were published Jan. 19 by the Journal of General Internal Medicine.
The cohort included 5,146 patients with a new prescription of an SGLT-2 inhibitor or a GLP-1 receptor agonist. Fifty-six percent of index prescriptions were written by a primary care clinician, and 24% were written by an endocrinologist. The incidence of 30-day primary nonadherence was 31.8% overall, 33.6% among those initiating an SGLT-2 inhibitor, and 29.8% among those initiating a GLP-1 receptor agonist. Factors associated with higher adjusted odds of primary nonadherence were age older than 65 years (odds ratio [OR], 1.37; 95% CI, 1.09 to 1.72), Black race versus White (OR, 1.29; 95% CI, 1.02 to 1.62), diabetic nephropathy (OR, 1.31; 95% CI, 1.02 to 1.68), and hyperlipidemia (OR, 1.18; 95% CI, 1.01 to 1.39). Factors associated with lower adjusted odds of primary nonadherence were female sex (OR, 0.86; 95% CI, 0.75 to 0.99), peripheral artery disease (OR, 0.73; 95% CI, 0.56 to 0.94), and having the index prescription ordered by an endocrinologist versus a primary care clinician (OR, 0.76; 95% CI, 0.61 to 0.95).
The researchers noted that they could not accurately measure payer type or patient socioeconomic status, level of education, or familial support using the available data. They added that the results may be limited by unmeasured confounding, among other factors.
“These findings highlight a key deficiency in the utilization of these newer diabetes drugs and an opportunity for improving the pharmacotherapy of patients with diabetes,” the authors concluded.