SGLT2 Inhibitor Adherence and Diabetes Hospitalization Risk in Type 2 Diabetes.
Abstract
Objectives
Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations. STUDY
Design
SGLT2 inhibitor new-user retrospective cohort study using a 25% random sample of IQVIA PharMetrics Plus for Academics US health plan claims, 2014 to 2022.
Methods
We included new users of SGLT2 inhibitors who had type 2 diabetes with prior cardiovascular disease or risk factors. Group-based trajectory modeling identified SGLT2 inhibitor adherence subgroups using monthly proportions of days covered over the 12 months post SGLT2 inhibitor initiation. Cox proportional hazards models, adjusted for baseline covariates, estimated the HRs for diabetes-related hospitalizations/emergency department (ED) visits in the year following 12-month treatment with SGLT2 inhibitors.
Results
We classified 5051 new SGLT2 inhibitor users into 5 SGLT2 inhibitor adherence trajectory groups: nonadherent (14.7%), early decline (13.5%), late decline (10.5%), dynamic adherence (13.0%), and adherent (48.3%). A diabetes-related hospitalization/ED visit occurred in 2.3% of the overall cohort, with a median (IQR) time to event of 151.5 (76-263) days. In the adjusted Cox proportional hazards model, the late decline group (HR, 2.52; 95% CI, 1.38-4.60) and the dynamic adherence group (HR, 2.42; 95% CI, 1.52-3.86) had a statistically significantly greater risk of diabetes-related hospitalizations/ED visits than the adherent group.
Conclusions
These findings suggest that variable adherence to SGLT2 inhibitors can negatively impact diabetes-related outcomes.
Objectives
Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations.