Abstract Aims Real‐world medication use varies across clinical trial and healthcare settings; therefore, we evaluated GLP ‐1 receptor agonist ( GLP ‐ 1RA ) persistence and dose titration among adults with type 2 diabetes in UK primary care, stratified by agent, obesity status, cardiovascular disease ( CVD ) history, and sex assigned at birth. Materials and methods Adults with type 2 diabetes initiating GLP‐1RAs between 1 March 2018 and 30 June 2023, with follow‐up ≥1‐year, were identified using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, A Cegedim Database. The absolute 1‐year risk of discontinuation was estimated using the Aalen‐Johansen estimator, while multivariable cause‐specific Cox models assessed associations with patient characteristics. Dosing trajectories were characterised across individual prescriptions during the first therapy year. Results Among 8200 GLP‐1RA initiators (46.5% dulaglutide, 38.7% semaglutide), the 1‐year discontinuation risk was 41.1% (95% CI 40.1–42.2), higher among those without obesity (BMI <30 kg/m 2 : 49.2%, 46.5–52.0) versus with BMI ≥30 kg/m 2 (BMI 30–<35/≥35 kg/m 2 : 40.4%/37.2%, 38.4–42.4/35.4–39.1). Discontinuation was lower with dulaglutide (36.9%, 35.4–38.4) than with subcutaneous/oral semaglutide (46.4%/55.8%, 44.4–48.4/52.3–59.4). Only 58% of subcutaneous/oral semaglutide initiators reached recommended maintenance doses after 4 weeks, while 21% remained on starting doses. At prescription 10, most common doses were 0.5/1 mg subcutaneous semaglutide (44.0%/48.6%), 7/14 mg oral semaglutide (50.2%/36.6%), and 0.75/1.5/3 mg dulaglutide (20.4%/71.5%/6.7%). Faster dose escalation occurred with higher BMI and subcutaneous semaglutide (1 mg at prescription 5: 20.8%/25.9%/33.2% with BMI <30/30–<35/≥35 kg/m 2 ). Additional analyses (e.g., by CVD history) revealed no further heterogeneity. Conclusions In UK primary care, GLP‐1RA persistence was suboptimal and dose escalation was frequently delayed across all patient stratifications, including individuals with established CVD.
Ulrich et al. (Tue,) studied this question.