Poor adherence and persistence to sodium glucose co‐transporter 2 inhibitors in real‐world settings: Evidence from a systematic review and meta‐analysis
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Aims: Despite increasing prescription of sodium glucose co‐transporter 2 (SGLT2) inhibitors, there is limited insight of the patterns of use among patients with diabetes prescribed these drugs. This study aimed to summarize available real‐world data on the adherence and persistence to SGLT2 inhibitors. Materials and Methods: A systematic review for observational studies reporting the adherence and persistence to SGLT2 inhibitors was performed in Medline, Embase, and Web of Science from their inception to October 2019. Data were analysed via random‐effects meta‐analysis. Results: A total of 22 studies (31 cohorts) comprising 123 854 individuals prescribed SGLT2 inhibitors from eight countries were included. The pooled mean proportions of days covered [PDC] at six months and one year were 0.77 (95% confidence interval [CI] 0.72‐0.82) and 0.72 (95% CI 0.66‐0.77), respectively. The pooled proportions adherent (PDC ≥0.80) at six months and one year were 59.5% (95% CI 52.9‐65.9) and 49.0% (95% CI 42.3‐55.8), respectively. The pooled proportions of people persistent at six months, one year, and two years were 80.1% (95% CI 75.8‐84.0), 61.8% (95% CI 57.8‐65.7), and 45.9% (95% CI 35.5‐56.5), respectively. When persistence was defined as the absence of ≥90‐days gap, the equivalent pooled proportions persistent were 81.5% (95% CI 73.1‐88.6), 58.9% (95% CI 53.1‐64.6), and 34.7% (95% CI 33.6‐35.8). Adherence and persistence appeared to vary across different SGLT2 inhibitors. Conclusions: Real‐world adherence and persistence to SGLT2 inhibitors is poor. Hence, targets for improving treatment adherence and persistence need to be identified and appropriate interventions implemented.
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A random-effects model using a generalized linear mixed model was employed for pooling studies.
“Given the anticipated statistical heterogeneity, consistent with previous adherence studies,23, 24, 25 we employed a random-effects model using a generalized linear mixed model for pooling studies.”
From Adherence to PCSK9 Inhibitors in Clinical Practice (2026) · cites this paper as [25]
Section 2.3 (page not provided) says the paper pooled studies with a random-effects model because of anticipated between-study heterogeneity. It describes using Freeman–Tukey double-arcsine transformed proportions, not a generalized linear mixed model, so that methodological detail is unsupported. (LLM, conf=0.88)
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- Authors
- Ofori‐Asenso, R., Sahle, B. W., Chin, K. L., Mazidi, M., Ademi, Z., De Bruin, M. L., & Liew, D.
- Affiliations
- University of Copenhagen (DK)
- The University of Melbourne (AU)
- King's College London (GB)
- Monash University (AU)
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Corresponding author
- Ofori‐Asenso, Richard
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2020-06-23
- Volume
- 37
- Issue
- 1
- Pages
- e3350-e3350
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W3026408162
- Cited by
- 44
- References
- 77
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 8 · 2023: 9 · 2022: 2 · 2021: 2 · 2020: 1
- FWCI
- 0.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Minerva Access (University of Melbourne) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Funders
- Bristol-Myers Squibb
- Pfizer
- AstraZeneca
- Sanofi
- Novo Nordisk
- Astellas Pharma
- H. Lundbeck A/S
- LEO Pharma
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- SGLT2 inhibitors, medication adherence, treatment persistence, diabetes mellitus, real-world data, proportion of days covered, drug discontinuation, antidiabetic drugs
- MeSH terms
- Sodium-Glucose Transporter 2 Inhibitors, Assessment of Medication Adherence, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Drug Monitoring, Medication Adherence, Observational Studies as Topic
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