Impact of Medication Adherence and Persistence on Clinical and Economic Outcomes in Patients with Type 2 Diabetes Treated with Liraglutide: A Retrospective Cohort Study
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INTRODUCTION: Adherence to diabetes medication has been linked to improved glycemic levels and lower costs, but previous research on adherence has typically involved oral antidiabetic medication or insulin. This study examines how adherence and persistence to once-daily liraglutide impact glycemic control and economic outcomes in a real-world population of adult type 2 diabetes (T2D) patients. METHODS: A retrospective cohort study using administrative claims data from July 2009 through September 2013. Patients aged ≥18 years with T2D treated with liraglutide were identified (index date = first liraglutide prescription). Adherence was based on the proportion of days covered (PDC); with PDC ≥0.80 classified as adherent. Non-persistent patients were those with a gap in therapy of >90 days. Lab results for glycated hemoglobin (A1C) were used to identify whether patients achieved target levels of <7.0% and ≤ 6.5%, or experienced a reduction of ≥1.0% in A1C from pre-index (baseline) to post-index (follow-up). Logistic regression was used to estimate the likelihood of achieving the A1C goals, adjusted for baseline characteristics. Diabetes-related medical, pharmacy, and total costs were modeled and estimated for the adherence and persistence cohorts. RESULTS: A total of 1321 patients were identified. The mean PDC was 0.59 and 34% of patients were classified as adherent, while 60% were persistent over 12 months of follow-up. Adherent and persistent patients were more likely to achieve each of the A1C goals than their non-adherent and non-persistent counterparts after adjusting for patient characteristics. Adherence and persistence were associated with higher adjusted diabetes-related pharmacy and total healthcare costs during follow-up; whereas persistent patients had significantly lower diabetes-related medical costs than non-persistent patients. CONCLUSIONS: Adherence and persistence to liraglutide are associated with improved A1C outcomes. Persistent patients showed significantly lower medical costs versus those discontinuing liraglutide. Total healthcare costs were higher for adherent and persistent cohorts driven by higher pharmacy costs.
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Suboptimal adherence and low rates of continued medication use have been linked to poorer glycaemic control, increased healthcare utilization, and higher costs.
“Suboptimal adherence and low rates of continued medication use have been linked to poorer glycaemic control, increased healthcare utilization, and higher costs. 11 , 12 , 13”
From Real‐world persistence and dose titration of <scp>GLP</scp> ‐1 receptor agonists in type 2 diabetes: A <scp>UK</scp> population‐based cohort study by obesity and cardiovascular disease status (2026) · cites this paper as [12]
The Discussion and Conclusion report better A1C outcomes with adherence and persistence, while the Results report more emergency and inpatient use among non-adherent patients. The costs claim needs qualification: non-adherent patients had higher diabetes-related medical costs, but adherent and persistent patients had higher total diabetes-related costs, largely because of pharmacy costs. (LLM, conf=0.90)
Experimental — accuracy not yet measuredReal-world adherence to GLP-1RA therapy remains suboptimal in patients with type 2 diabetes.
“Despite evidence from clinical trials demonstrating benefits in glycaemic control, weight loss, and cardiorenal outcomes, 7 , 8 , 9 , 10 real‐world adherence to GLP‐1RA therapy remains suboptimal in patients with type 2 diabetes. 11 , 12 , 13”
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“A retrospective study of 1,321 patients with T2D treated with liraglutide (Novo Nordisk A/S, Bagsværd, Denmark) reported that 60% were persistent with therapy (no 90-day gap) over a 12-month period, but only 34% were adherent (MPR 80%).(22) Among 40,000 patients with T2D, persistence (no 30-day gap) over a 12-month…”
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- Authors
- Buysman, E. K., Liu, F., Hammer, M., & Langer, J.
- Affiliations
- Optum (United States) (US)
- Novo Nordisk (Denmark) (DK)
- Corresponding author
- Buysman, Erin K.
- Venue
- Advances in Therapy
- Published
- 2015-04
- Volume
- 32
- Issue
- 4
- Pages
- 341-355
- ISSN
- 0741-238X (ISSN-L)
- 1865-8652
- PMC
- PMC4415988
- OpenAlex
- W2047187313
- Cited by
- 101
- References
- 5
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 11 · 2020: 7 · 2019: 9 · 2018: 14 · 2017: 18 · 2016: 15 · 2015: 2
- FWCI
- 19.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Advances in Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- medication adherence, treatment persistence, liraglutide, type 2 diabetes, glycemic control, HbA1c, health care costs, pharmacy costs, GLP-1 receptor agonists, treatment discontinuation
- MeSH terms
- Liraglutide, Assessment of Medication Adherence, Adolescent, Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Health Expenditures, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Retrospective Studies, Cohort Studies, Logistic Models, Drug Monitoring, Medication Adherence, Young Adult
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