One-year usage patterns of SGLT-2 inhibitors and GLP-1 receptor agonists in individuals with type 2 diabetes in a real-world population.

AIMS: Real-world studies of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) typically assess adherence and discontinuation as separate outcomes. We applied a novel approach that integrates these measures to categorize patterns of drug usage. We describe patterns across individual subclasses, and in overall class-level models, we examined clinical characteristics associated with each category with particular interest in poor adherence and intolerance. MATERIALS AND METHODS: We conducted an observational cohort study using electronic health records from the Scottish Care Information Diabetes Collaboration database, including individuals with type 2 diabetes who initiated a SGLT2i or GLP-1RA. Each initiation was followed for 1 year and classified into five mutually exclusive groups: adherent, poor adherence and three discontinuation categories including a proxy for intolerance. RESULTS: Among SGLT2is, poor adherence was more common in younger individuals, with greater socioeconomic deprivation, and higher HbA, while intolerance was more frequent in older, leaner females and in those with prior genital thrush. For GLP-1RAs, newer agents were associated with more favourable usage patterns. Poor adherence was more frequent with liraglutide, lixisenatide, and exenatide compared to semaglutide, and intolerance was more common with lixisenatide. In addition, poor adherence was associated with younger age and prior GLP-1RA use, while intolerance was linked to lower BMI, female sex, and more advanced CKD. CONCLUSIONS: Distinct clinical and biochemical characteristics are associated with poor adherence versus discontinuation. Understanding these patterns is crucial for developing targeted strategies to improve sustained use, ultimately enhancing treatment outcomes for people with type 2 diabetes.