Efficacy and adherence of glucagon-like peptide-1 receptor agonist treatment in patients with type 2 diabetes mellitus in real-life settings
Open accessAbstract
Despite the availability of a large number of therapeutic options throughout the world, rates of optimal glycaemic control in adult patients with type 2 diabetes mellitus remain low. Delays in treatment intensification to insulin and low adherence to insulin regimes, which are well-documented contributors to poor glycaemic control, are in many cases driven by fear of hypoglycaemic events, weight gain and injections. Over the last 10 years, injectable glucagon-like peptide-1 receptor agonists (GLP1-RAs) have emerged as alternatives to basal insulin for treatment intensification in patients inadequately controlled with oral antidiabetic drugs. As a class, GLP1-RAs are associated with weight loss and fewer hypoglycaemic events than insulin. In addition, some of them are available in once-a-week formulations and therefore require fewer injections. However, as randomized controlled trials are not representative of everyday practice, physicians should consider the results of real-life studies to guide their treatment decisions. In this review, while significant variations in efficacy, tolerability and adherence data were noted from one study to another, rates of glycaemic control overall were low. Indeed, our present analysis has suggested that regular re-evaluations of treatment, including response, tolerability, adherence, cost and quality of life, are necessary.
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The few studies that have evaluated real-world effectiveness of GLP-1 RAs have yielded inconsistent results.
“The few studies that have evaluated real-world effectiveness of GLP-1 RAs have yielded inconsistent results.”
From Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK (2022) · cites this paper as [8]
The Introduction (page unavailable) reports a gap between randomized-trial and real-world results, and Effectiveness and tolerability (page unavailable) reviews several real-world effectiveness studies. Neither passage establishes that the real-world studies themselves yielded inconsistent results; the reported discrepancy is between trial and real-world findings. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAdherence to GLP-1 RAs specifically has been shown to vary widely across studies.
“Adherence to GLP-1 RAs specifically has also been shown to vary widely across studies.”
The results of this study are overall consistent with previous reports on adherence to GLP-1 RAs.
“Thus, the results of this study are overall consistent with previous reports.”
Participants in clinical trials tend to be more motivated and have resources and support to comply with treatment regimens.
“Participants in clinical trials tend to be more motivated and have resources and support to comply with the treatment regimens under investigation.”
The finding that patients on weekly dosing regimens are more adherent than those on daily dosing regimens is consistent with other studies.
“The finding that patients on weekly dosing regimens are more adherent than those on daily dosing regimens is also consistent with other studies using administrative and electronic medical records datasets across Europe and the USA.”
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“These disparities potentially contribute to poor drug effectiveness observed in real-world settings (22-24).”
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“12 Furthermore, these drugs are characterised by a higher cost than previous drug therapies for the management of diabetes, thus making the impact on the National Health Service (NHS) uncertain.”
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“However, as observed with many T2DM medications, adherence is a major problem with GLP-1 RAs with reported discontinuation in real-world scenarios to be approximately 45% at 1 year [28,29] due to unwanted side effects [30], high cost [31], and unwillingness to follow the physician’s treatment advice [32].”
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“62 Similarly, liraglutide is considered a more reasonable option over other GLP1RAs.”
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“Finally, the model outcomes assumed a consistent treatment effect over the whole 1 year time horizon; however, in real-world settings, this consistent effect might not hold due to persistence and adherence issues [35, 36].”
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“Treatment effect observed in RCTs often exceeds the real-world effectiveness due in part to insufficient representativeness of clinical trial participants [46] or greater accessibility to resources and support systems that help comply with treatment regimen during RCTs [28].”
BackgroundInfluentialDulaglutide: Clinical Benefits and Contribution to the Treatment of Type 2 Diabetes
Biryukova, E. V., & Solovyova, I. V. S. (2020) · Effective Pharmacotherapy · doi:10.33978/2307-3586-2020-16-12-30-40
Halimi, S. (2020) · Médecine des Maladies Métaboliques · doi:10.1016/j.mmm.2019.12.019
GLP-1 Obesity and Diabetes Gerald H Tomkin and Daphne Owens
TOMKIN, G. H. (2019) · Interventions in Obesity & Diabetes · doi:10.31031/iod.2019.03.000553
“A review recently [27] ended by suggesting that regular re-evaluations of treatment including response, tolerability, adherence, cost and quality of life, are necessary.”
Background
- Authors
- Guerci, B., Charbonnel, B., Gourdy, P., Hadjadj, S., Hanaire, H., Marre, M., & Vergès, B.
- Affiliations
- Université de Lorraine (FR)
- Université de Nantes (FR)
- Centre Hospitalier Universitaire de Toulouse (FR)
- Centre Hospitalier Universitaire de Poitiers (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- CHU Dijon Bourgogne (FR)
- Corresponding author
- Guerci, B.
- Venue
- Diabetes & Metabolism
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 45
- Issue
- 6
- Pages
- 528-535
- ISSN
- 1262-3636 (ISSN-L)
- OpenAlex
- W2912404136
- Cited by
- 40
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 3 · 2020: 5 · 2019: 6
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes & Metabolism (acceptedVersion, other-oa)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- AstraZeneca
- Sanofi
- Intarcia Therapeutics
- Novo Nordisk
- Servier
- Roche Diabetes Care
- Novartis Pharma
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- GLP-1 receptor agonists, type 2 diabetes, medication adherence, glycemic control, insulin intensification, hypoglycemia, weight gain, real-world evidence, tolerability, quality of life, cost
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Assessment of Medication Adherence, Adult, Blood Glucose, Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Primary Health Care, Quality of Life, Treatment Outcome, Drug Monitoring, Medication Adherence, Drug-Related Side Effects and Adverse Reactions
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