Adherence to antihyperglycemic medications and glucagon-like peptide 1-receptor agonists in type 2 diabetes: clinical consequences and strategies for improvement

Abstract

Adherence to antihyperglycemic medications is often suboptimal in patients with type 2 diabetes, and this can contribute to poor glycemic control, increased hospitalization, and the development of diabetic complications. Reported adherence rates to antihyperglycemics vary widely among studies, and this may be related to differences in methodology for measuring adherence, patient populations, and other factors. Poor adherence may occur regardless of the specific regimen used and whether therapy is oral or injectable, and can be especially common in chronic, asymptomatic conditions, such as type 2 diabetes. More convenient drug-administration regimens and advances in formulations and delivery devices are among strategies shown to improve adherence to antihyperglycemic therapy, especially for injectable therapy. This is exemplified by technological developments made in the drug class of glucagon-like peptide 1-receptor agonists, which are a focus of this narrative review. Dulaglutide, albiglutide, and prolonged-release exenatide have an extended duration of action and can be administered once weekly, whereas such agents as liraglutide require once-daily administration. The convenience of once-weekly versus once-daily administration is associated with better adherence in real-world studies involving this class of agent. Moreover, provision of a user-friendly delivery device has been shown to overcome initial resistance to injectable therapy among patients with type 2 diabetes. This suggests that recent innovations in drug formulation (eg, ready-to-use formulations) and delivery systems (eg, single-dose prefilled pens and hidden, ready-attached needles) may be instrumental in encouraging patient acceptance. For physicians who aim to improve their patients’ adherence to antihyperglycemic medications, it is thus important to consider the patient’s therapeutic experience (treatment frequency, drug formulation, delivery device). Better adherence, powered by recent technological advances in the delivery of glucagon-like peptide 1-receptor agonists, may thus lead to improved clinical outcomes in type 2 diabetes.

Real-world impact on monthly glucose-lowering medication cost, HbA1c, weight, and polytherapy after initiating a GLP-1 receptor agonist

“…6,7 Literature suggests patients are more likely to adhere to injectable medications administered weekly rather than daily. [8][9][10][11] Clinical outcomes of HbA 1c reduction and weight loss seen in the present study were similar or better than those demonstrated in clinical trials that led to the approval of GLP-1 receptor agonists. The LEAD trials for liraglutide found 1.0%-1.5% reductions in HbA 1c and weight loss varied from 0.2-3.2 kg.…”

Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes: Their Use and Differential Features

“…Unless otherwise indicated, results presented are for both dosages of dulaglutide and semaglutide. Active comparators were administered at a daily dosage of 1. options, leading to improvements in clinical outcomes [34]. Over a 6-month period in retrospective studies in the realworld setting, treatment adherence was significantly better with once-weekly exenatide ER than with twice-daily exenatide IR [35,36] and/or once-daily liraglutide [35][36][37], and treatment adherence and persistence rates were significantly higher, and discontinuation rates were significantly lower, with once-weekly dulaglutide than with once-daily liraglutide and once-weekly exenatide [38].…”

GLP-1 receptor agonists in the treatment of type 2 diabetes: role and clinical experience to date

“…Although GLP-1RAs have demonstrated effective glycemic control with a low risk of hypoglycemia and a reduction in body weight [3,8], reported adherence and persistence rates with injectable GLP-1RAs are suboptimal [95][96][97]. This has been partly addressed by the advent of once-weekly injectable GLP-1RAs, which are typically associated with improved adherence and persistence compared with once-or twice-daily agents [96,98,99,100]. Nevertheless, in a US claims-based analysis, approximately 40% of patients were not fully adherent to the once-weekly GLP-1RA dulaglutide after 6 months [96], and suboptimal adherence therefore remains a concern with these therapies.…”