Poor adherence and persistence to sodium glucose co‐transporter 2 inhibitors in real‐world settings: Evidence from a systematic review and meta‐analysis

Abstract

AimsDespite increasing prescription of sodium glucose co‐transporter 2 (SGLT2) inhibitors, there is limited insight of the patterns of use among patients with diabetes prescribed these drugs. This study aimed to summarize available real‐world data on the adherence and persistence to SGLT2 inhibitors.Materials and MethodsA systematic review for observational studies reporting the adherence and persistence to SGLT2 inhibitors was performed in Medline, Embase, and Web of Science from their inception to October 2019. Data were analysed via random‐effects meta‐analysis.ResultsA total of 22 studies (31 cohorts) comprising 123 854 individuals prescribed SGLT2 inhibitors from eight countries were included. The pooled mean proportions of days covered [PDC] at six months and one year were 0.77 (95% confidence interval [CI] 0.72‐0.82) and 0.72 (95% CI 0.66‐0.77), respectively. The pooled proportions adherent (PDC ≥0.80) at six months and one year were 59.5% (95% CI 52.9‐65.9) and 49.0% (95% CI 42.3‐55.8), respectively. The pooled proportions of people persistent at six months, one year, and two years were 80.1% (95% CI 75.8‐84.0), 61.8% (95% CI 57.8‐65.7), and 45.9% (95% CI 35.5‐56.5), respectively. When persistence was defined as the absence of ≥90‐days gap, the equivalent pooled proportions persistent were 81.5% (95% CI 73.1‐88.6), 58.9% (95% CI 53.1‐64.6), and 34.7% (95% CI 33.6‐35.8). Adherence and persistence appeared to vary across different SGLT2 inhibitors.ConclusionsReal‐world adherence and persistence to SGLT2 inhibitors is poor. Hence, targets for improving treatment adherence and persistence need to be identified and appropriate interventions implemented.

Comparing medication persistence among patients with type 2 diabetes using sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists in real-world setting

“…The present study, based on almost 7,000 patients newly treated with GLP1-RA and SGLT2-I, confirms previous observations that the discontinuation rate of antidiabetic drug treatment is high in 'real-life' practice [24][25][26]. In addition, evidence that a substantial number of patients discontinued therapy initially employed [27] was confirmed from our study, being 13% those who did not renew the initial prescription within one year after treatment starting.…”

New Strategies to Improve Patient Adherence to Medications for Noncommunicable Diseases During and After the COVID-19 Era Identified via a Literature Review

“…Unfortunately, adherence, persistence or concordance to medications used to treat chronic NCDs is frequently poor. [35][36][37][38][39][40][41] Indeed, the WHO has estimated that adherence with long-term therapy for chronic illnesses averages 50% in developed countries and is even lower in developing countries. 35 Furthermore, it has been estimated that 20% of new prescriptions are never filled, and even among those filled, approximately 50% are taken incorrectly (errors regarding dosage and timing or frequency administration).…”

Diabetes and erectile dysfunction: The relationships with health literacy, treatment adherence, unrealistic optimism, and glycaemic control

“…One possible explanation is that physicians are generally careful to provide information about the potential side effects of SGLT2‐i (e.g., increased risk of genitourinary tract infections), so patients are more careful to take it correctly and therefore more likely to adhere to treatment 12 . Conversely, a recent meta‐analysis found that despite increasing prescription of SGLT2‐i, adherence and persistence to treatments in the general population is low 33 . However, the authors emphasised the need to identify goals to improve adherence and to take appropriate action.…”