What does this research mean for the field?

Real-world persistence and adherence to GLP-1 therapies among US adults with type 2 diabetes are consistently low, with only 49% of patients remaining persistent and 42% adherent at 12 months. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This analysis aims to synthesize evidence on the persistence and adherence to GLP-1 therapies in adults with T2D.

June 7, 2026

1691-P: A Meta-Analysis of Persistence and Adherence to Glucagon-Like Peptide 1-Based Treatments among Patients with Type 2 Diabetes in the United States

Key Points

This analysis aims to synthesize evidence on the persistence and adherence to GLP-1 therapies in adults with T2D.
Conducted a systematic literature review following PRISMA guidelines.
Included observational studies from 2014-2025 reporting persistence and adherence rates.
Utilized restricted maximum likelihood random effects modeling to estimate pooled proportions.
69% of patients were persistent at 6 months (95% CI: 65%-73%) and 49% at 12 months (95% CI: 43%-55%).
Dulaglutide had the highest persistence at 12 months (56%, 95% CI: 55%-56%).
50% of patients were adherent at 6 months (95% CI: 45%-55%) and 42% at 12 months (95% CI: 37%-47%).

Abstract

Introduction and Objective: Glucagon-like peptide-1-based treatments (GLP-1s) are increasingly prescribed for type 2 diabetes (T2D), and their clinical benefits depend on sustained treatment. While individual studies report low persistence and adherence, a comprehensive synthesis of evidence is lacking. This systematic literature review aimed to synthesize real-world persistence and adherence among adults with T2D initiating GLP-1 therapy. Methods: Following PRISMA guidelines, observational studies (2014-2025) reporting persistence (treatment gap thresholds ranging from 30-90 days) and/or adherence (proportion of days covered ≥80%) among adults with T2D initiating a GLP-1(tirzepatide, semaglutide, dulaglutide, liraglutide) in the United States were identified. Meta-analyses using restricted maximum likelihood random effects modeling were used to estimate overall pooled proportions and 95% confidence intervals (CI). Results: Twenty-eight studies including 267,542 patients were included. Overall, 69% (95% CI: 65%-73%) of patients were persistent at 6 months and 49% (95% CI: 43%-55%) at 12 months. At 12 months, dulaglutide demonstrated the highest persistence (56%, 95% CI: 55%-56%), followed by semaglutide (53%, 95% CI: 44%-62%) and liraglutide (43%, 95% CI: 30%-55%). Overall, 50% (95% CI: 45%-55%) of patients were adherent at 6 months and 42% (95% CI: 37%-47%) at 12 months. At 12 months, dulaglutide showed highest adherence (50%, 95% CI: 43%-56%) followed by semaglutide (43%, 95% CI: 41%-44%) and liraglutide (34%, 95% CI: 29%-39%). Conclusion: Despite the introduction of new GLP-1 agents, real world GLP-1 persistence and adherence remain consistently low across studies, indicating continued real-world barriers to sustained use. These findings highlight a critical unmet need for strategies that address barriers to sustained GLP-1 use to improve real-world effectiveness and patient outcomes. Disclosure L. Perreault: Advisory Panel; Current; Novo Nordisk, Eli Lilly and Company, Boehringer Ingelheim International GmbH. Speaker's Bureau; Current; Novo Nordisk, Eli Lilly and Company, Boehringer Ingelheim International GmbH, Ascendis Pharma A/S. N. Rasouli: Advisory Panel; Current; Eli Lilly and Company. Research Support; Current; Eli Lilly and Company. Advisory Panel; Current; Novo Nordisk. Research Support; Current; Novo Nordisk. Advisory Panel; Current; Amgen Inc. Research Support; Current; SomaLogic, Inc. F. Sanogo: Employee; Current; Amgen Inc. N. Movva: Research Support; Current; Amgen Inc., Idorsia Pharmaceuticals Ltd. L. Bylsma: Research Support; Current; Amgen Inc. M. Suh: Research Support; Current; Amgen Inc., Idorsia Pharmaceuticals Ltd. H. Reichert: Research Support; Current; Amgen Inc., Idorsia Pharmaceuticals Ltd. M. Donsmark: Employee; Current; Amgen Inc. Stock/Shareholder; Current; Novo Nordisk A/S. M. Girguis: Employee; Current; Amgen Inc. C. Frankenfeld: Consultant; Current; Amgen Inc. Other - Editorial Board Member: Journal of Nutrition and Annals of Epidemiology; Current; Elsevier.

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Cite This Study

Perreault et al. (Fri,) studied this question.

synapsesocial.com/papers/6a250c7d7def13d035e1ca71 https://doi.org/https://doi.org/10.2337/db26-1691-p

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