Comparing Medication Adherence and Persistence Among Patients with Type 2 Diabetes Using Sodium-Glucose Cotransporter 2 Inhibitors or Sulfonylureas.

BACKGROUND: Patients with type 2 diabetes treated with pharmacotherapy should be adherent to and persistent with their medications to experience glycemic control and prevent associated complications.

OBJECTIVE: To compare medication adherence and persistence among patients with type 2 diabetes who are newly initiating a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a sulfonylurea.

METHODS: This was a retrospective, observational cohort study using the MarketScan claims databases. The patients who were selected for the study had newly initiated treatment with an SGLT-2 inhibitor or a sulfonylurea between January 1, 2015, and December 31, 2015 (index date; class of earliest medication is defined as the index class); were aged ≥18 years on the index date; were continuously enrolled with health insurance for 12 months before and 6 months after (ie, follow-up) the index date; and had ≥1 baseline diagnoses of type 2 diabetes. Study exclusions were type 1 diabetes, pregnancy, and gestational diabetes. Medication adherence was measured by the proportion of days covered (PDC) with the index class during the follow-up period and dichotomized as adherent (PDC ≥80%) or nonadherent. Persistence was defined as the number of days from the index date until a >60-day continuous gap in days without the index drug class (ie, discontinuation) or the end of follow-up. A propensity score model was used to match patients receiving an SGLT-2 inhibitor to patients receiving a sulfonylurea in a 1:1 ratio based on patient characteristics. Logistic (ie, adherence) and Cox (ie, persistence) regression models were fit to the matched samples.

RESULTS: Initially, the study included 17,724 patients who received an SGLT-2 inhibitor and 25,490 patients who received a sulfonylurea. After propensity score matching, 13,657 patients remained in each cohort. Compared with patients receiving a sulfonylurea, a statistically significantly greater percentage of patients receiving an SGLT-2 inhibitor were adherent to therapy (61.4% vs 53.9%, respectively; odds ratio of adherence, 1.364; 95% confidence interval [CI], 1.30-1.43; P <.001) and persistent (76.1% vs 68.9%, respectively; hazard ratio of discontinuation, 0.746; 95% CI, 0.71-0.78; P <.001).

CONCLUSION: Maintaining adherence to and persistence with antidiabetes medication is vital to glycemic control among patients with type 2 diabetes. In this real-world study, patients who newly initiated treatment with SGLT-2 inhibitors were more likely to adhere to treatment and persist with the initiated therapy than similar patients who newly initiated treatment with sulfonylureas.