Medication adherence to injectable glucagon‐like peptide‐1 (GLP‐1) receptor agonists dosed once weekly vs once daily in patients with type 2 diabetes: A meta‐analysis

Abstract

Background Suboptimal medication adherence has been associated with increased resource utilisation and mortality among patients with type 2 diabetes (T2D). Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) are becoming increasingly important in the treatment of T2D. However, medications in this class differ considerably in their dosing frequency, which may impact adherence. We sought to perform a meta‐analysis to compare adherence to injectable GLP‐1RAs dosed once weekly vs once daily in patients with T2D. Methods Medline and Scopus were searched from 1/2005 to 7/2020 using keywords and MeSH terms pertaining to adherence and GLP‐1RAs. Studies of adults with T2D were included if they compared adherence (as measured by proportion of days covered [PDC]) to injectable GLP‐1RAs dosed once weekly vs once daily. A meta‐analysis of non‐overlapping studies was performed to evaluate the primary outcome of non‐adherence, defined as the proportion of patients with a PDC < 80. Results A total of 7 studies evaluating 75 159 patients (range: 2886‐30 097) with T2D were included. The follow‐up periods of included studies ranged from 6 to 12 months. Injectable GLP‐1RAs dosed once weekly were either dulaglutide, albiglutide or exenatide extended release; while liraglutide was the injectable once daily agent evaluated in all included studies. Upon meta‐analysis, once weekly GLP‐1RA dosing was associated with an 11% lower risk of non‐adherence compared to once daily dosing (risk ratio = 0.89; 95% confidence interval = 0.83‐0.95; I2 = 89%). Conclusion Once weekly dosing of injectable GLP‐1RAs was associated with better adherence vs once daily dosing among patients with T2D. These findings coupled with the known detrimental consequences of non‐adherence suggest that dosing frequency is an important factor to consider when selecting a GLP‐1RA.

Distinct associations of self‐monitoring of blood glucose with glycemic control and hypoglycemia between groups of recently diagnosed and long‐term follow‐up type 2 diabetes: The Taiwan Diabetes Registry

“…We suppose that decline in SMBG adherence over time might be one reason, while the possibility of reverse causality cannot be excluded. Our results, in conjunction with previous findings, 28‐30,32‐38 highlight the importance of maintaining SMBG adherence in patients with prolonged diabetes duration.…”

“…We suppose that decline in SMBG adherence over time might be one reason, while the possibility of reverse causality cannot be excluded. Our results, in conjunction with previous findings, [28][29][30][32][33][34][35][36][37][38] highlight the importance of maintaining SMBG adherence in patients with prolonged diabetes duration. Interestingly, we observed that SMBG was independently associated with hypoglycemia in both study populations.…”

Structured self-monitoring of blood glucose is associated with more appropriate therapeutic interventions than unstructured self-monitoring: A novel analysis of data from the PRISMA trial

“…Of note, GLP-1 RA and DPP-4 inhibitors including exenatide, liraglutide, sitagliptin, vildagliptin, and saxagliptin, were only licensed in Italy sometime after the study start and were not included in the diabetes medication algorithm. As a result, it cannot be excluded that, if investigators were provided with additional new-generation drugs with high efficacy [15], low hypoglycemia risk, lower frequency of administration [16,17], and/or cardiovascular/renal benefits [18][19][20], this could affect their attitude to review patients' therapy and, in turn, short-term glycemic outcomes. Moreover, different patient characteristics or different SMBG testing schemes may lead to different results.…”

Basal weekly insulins: the way of the future!

“…For example, a population-based analysis in the UK estimated a median delay to insulin initiation of 4.9 years and 4.2 years for patients with HbA 1c levels of ≥8.0% and ≥9.0%, respectively [33]. Clinical inertia on the part of either clinicians or their patients has been attributed to concerns related to hypoglycemia and weight gain, fear of injections, and anticipation of problems with treatment adherence and a reduced quality of life [31,32,[34][35][36][37][38][39][40][41]. Technological advances (e.g., in formulations and devices) have addressed some of these concerns, and many can be managed through education and support [32,42]; as such, these concerns may often be unwarranted.…”

“…If a basal insulin could be injected just once weekly, it is reasonable to predict that this would reduce clinical inertia, increase treatment adherence, and improve patients' quality of life, provided that the risk of hypoglycemia remains low. It is reasonable to extrapolate such assumption from the comparisons of once-weekly GLP-1 RAs with once-daily GLP-1 RAs that are encouraging in this regard [38][39][40][41].…”