Glucagon‐like peptide‐1 receptor agonist versus sodium‐glucose cotransporter‐2 inhibitor persistence in Medicare Advantage beneficiaries with type 2 diabetes, cardiovascular risk, and obesity

AIMS: To compare treatment persistence and augmentation in adults with type 2 diabetes initiating glucagon-like peptide-1 receptor agonist versus sodium-glucose cotransporter-2 inhibitor therapy, including subgroups with cardiovascular disease and obesity. MATERIALS AND METHODS: Using Humana Healthcare Research claims data, we identified adults with type 2 diabetes newly initiating GLP-1 RA or SGLT2i therapy between 1 January, 2018, and 30 June 2022. Eligible patients had >12 months of continuous enrollment before and after the index date (first GLP-1 RA or SGLT2i claim). Persistence was measured over 12 months post-index, defined by a therapy gap <45 days, with additional 30- and 90-day gap assessments. Days on therapy until discontinuation were calculated. Augmentation was defined as the initiation of a new glucose-lowering class not used pre- or at-index. RESULTS: The 1:1 matched cohort included 22 167 GLP-1 RA and 22 267 SGLT2i initiators (mean age 68.2 years; 52.2% female; 73.4% White; 18.6% Black). At 1 year, persistence was 37.6% for GLP-1 RA versus 47.0% for SGLT2i (p <0.001). Augmentation occurred in 23.4% versus 27.4%, respectively (p <0.001). GLP-1 RA users were more likely to discontinue (HR = 1.39, p <0.001) therapy. Cardiovascular and obesity subgroup findings were consistent with overall study findings. A higher percentage of patients were persistent with increasing allowable gap (30-day: 31.4% vs. 41.1%; 90-day: 50.1% vs. 59.1%, GLP-1 RA vs. SGLT2i, respectively). CONCLUSIONS: At 1 year, SGLT2i users showed higher persistence and augmentation than GLP-1 RA users. This may reflect better tolerance, fewer side effects, improved glucose control, preferences for oral medications, lower patient costs, and easier access to SGLT2i medications. Providers may support improved persistence by addressing patient-specific factors influencing therapy choices.