Key result
Late-decline SGLT2 inhibitor adherence linked to ~2.5-fold higher risk of diabetes-related hospitalizations or ED visits.
Why the study?
Evidence of SGLT2 inhibitor adherence and its association with diabetes-related clinical outcomes in real-world settings was lacking.
Does suboptimal adherence to SGLT2 inhibitors increase the risk of diabetes-related hospitalizations or ED visits in patients with type 2 diabetes and prior cardiovascular disease or risk factors?
Cohort (n=5,051)
Does suboptimal adherence to SGLT2 inhibitors increase the risk of diabetes-related hospitalizations or ED visits in patients with type 2 diabetes and prior cardiovascular disease or risk factors?
Hazard Ratio: 2.52 (95% CI 1.38–4.6)
Suboptimal adherence to SGLT2 inhibitors is associated with an over two-fold increase in the risk of diabetes-related hospitalizations and emergency department visits.
Suboptimal SGLT2i adherence may raise diabetes-related events; supports monitoring in high-risk T2D but leaves causality and practice change for prospective trials.
OBJECTIVES: Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations. STUDY DESIGN: SGLT2 inhibitor new-user retrospective cohort study using a 25% random sample of IQVIA PharMetrics Plus for Academics US health plan claims, 2014 to 2022. METHODS: We included new users of SGLT2 inhibitors who had type 2 diabetes with prior cardiovascular disease or risk factors. Group-based trajectory modeling identified SGLT2 inhibitor adherence subgroups using monthly proportions of days covered over the 12 months post SGLT2 inhibitor initiation. Cox proportional hazards models, adjusted for baseline covariates, estimated the HRs for diabetes-related hospitalizations/emergency department (ED) visits in the year following 12-month treatment with SGLT2 inhibitors. RESULTS: We classified 5051 new SGLT2 inhibitor users into 5 SGLT2 inhibitor adherence trajectory groups: nonadherent (14.7%), early decline (13.5%), late decline (10.5%), dynamic adherence (13.0%), and adherent (48.3%). A diabetes-related hospitalization/ED visit occurred in 2.3% of the overall cohort, with a median (IQR) time to event of 151.5 (76-263) days. In the adjusted Cox proportional hazards model, the late decline group (HR, 2.52; 95% CI, 1.38-4.60) and the dynamic adherence group (HR, 2.42; 95% CI, 1.52-3.86) had a statistically significantly greater risk of diabetes-related hospitalizations/ED visits than the adherent group. CONCLUSIONS: These findings suggest that variable adherence to SGLT2 inhibitors can negatively impact diabetes-related outcomes. OBJECTIVES: Emerging evidence shows that sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control and reduce the risk of cardiovascular-related mortality. This is contingent on adherence, yet evidence of SGLT2 inhibitor adherence and associated diabetes-related clinical outcomes in real-world settings is lacking. Therefore, we examined SGLT2 inhibitor longitudinal adherence trajectories and their association with the risk of diabetes-related hospitalizations.
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Udim Damachi (2026) conducted a cohort in Type 2 diabetes with prior cardiovascular disease or risk factors (n=5,051). Late decline or dynamic adherence to SGLT2 inhibitors vs. Adherent group was evaluated on Diabetes-related hospitalizations/emergency department (ED) visits (HR 2.52, 95% CI 1.38-4.60). Late decline adherence to SGLT2 inhibitors significantly increased the risk of diabetes-related hospitalizations or ED visits compared to the adherent group (HR 2.52; 95% CI 1.38-4.60).
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