Real‐world weight change among patients treated with glucagon‐like peptide‐1 receptor agonist, dipeptidyl peptidase‐4 inhibitor and sulfonylureas for type 2 diabetes and the influence of medication adherence. (20th July 2017)

• Record Type: Journal Article
• Authors: Carls, G. S.; Tan, R.; Zhu, J. Y.; Tuttle, E.; Yee, J.; Edelman, S. V.; Polonsky, W. H.
• Is Part Of: Obesity science and practice. Volume 3:Number 3(2017)
• Page Start: 342
• Page End: 351
• Publication Date: 2017-07-20
• Subjects: Medication adherence -- real‐world -- type 2 diabetes -- weight change; Obesity -- Periodicals; 616.398005
• DOI: 10.1002/osp4.116
• Languages: English
• ISSNs: 2055-2238

Abstract

Summary: Aims: The study aims to examine real‐world weight change and the role of medication adherence among patients with type 2 diabetes who initiated one of three drug classes: glucagon‐like peptide‐1 receptor agonist (GLP‐1RA), dipeptidyl peptidase‐4 inhibitor (DPP4) and sulfonylureas (SUs). Materials and methods: A cohort of patients initiating one of the three drug classes was selected from a large US database of integrated electronic medical record and administrative claims. Adherence was defined as per cent of days covered ≥80% during the year following drug initiation. Weight change was calculated from drug initiation (−180, +30 d) to 1 year (±90 d) later. Multivariate regression controlled for baseline differences between adherent and poorly adherent patients and the addition of another drug class during follow‐up. Results: The study included 833 GLP‐1RA, 2, 272 DPP4 and 2, 713 SU patients who contributed 2, 279, 6, 602 and 7, 429 observations respectively. Patients initiating a GLP‐1RA achieved the largest weight change (−2.46 kg of GLP‐1RA, −1.26 kg of DPP4 and 0.18 kg of SU, P < 0.01). Adherent GLP‐1 patients lost 1.73 kg more than poorly adherent patients, and adherent SU patients gained 1.11 kg more than poorly adherent patients (all P < 0.01). Adherent and poorly adherent DPP4 patients experienced approximately the same amount of weight loss. Conclusions: Medication adherence can mediate observed weight loss in patients treated with a GLP1‐RA or weight gain in those treated with an SU. Medication adherence was low in a real‐world population, particularly for GLP‐1RA, which displayed the strongest weight loss benefit. Because recent American Diabetes Association guidelines recommend selecting drug therapies that have a weight loss or weight neutral effect for the management of type 2 diabetes patients, patients should be encouraged to enhance their adherence to benefit the most from therapies that have weight loss properties.