Comparison of medication adherence and persistence in type 2 diabetes: A systematic review and meta-analysis
Open accessAbstract
Limited medication adherence and persistence with treatment are barriers to successful management of type 2 diabetes (T2D). We searched MEDLINE, EMBASE, the Cochrane Library, the Register of Controlled Trials, PsychINFO and CINAHL for observational and interventional studies that compared the adherence or persistence associated with 2 or more glucose‐lowering medications in people with T2D. Where 5 or more studies provided the same comparison, a random‐effects meta‐analysis was performed, reporting mean difference (MD) or odds ratio (OR) for adherence or persistence, depending on the pooled study outcomes. We included a total of 48 studies. Compared with metformin, adherence (%) was better for sulphonylureas (5 studies; MD 10.6%, 95% confidence interval [CI] 6.5‐14.7) and thiazolidinediones (TZDs; 6 studies; MD 11.3%, 95% CI 2.7%‐20.0%). Adherence to TZDs was marginally better than adherence to sulphonylureas (5 studies; MD 1.5%, 95% CI 0.1‐2.9). Dipeptidyl peptidase‐4 inhibitors had better adherence than sulphonylureas and TZDs. Glucagon‐like peptide‐1 receptor agonists had higher rates of discontinuation than long‐acting analogue insulins (6 studies; OR 1.95; 95% CI 1.17‐3.27). Long‐acting insulin analogues had better persistence than human insulins (5 studies; MD 43.1 days; 95% CI 22.0‐64.2). The methods used to define adherence and persistence were highly variable.
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Suboptimal medication-taking behavior leads to suboptimal glycemic and CVD risk factor control, increased risks of diabetes complications, mortality, hospital admissions, and increased health care costs.
“Suboptimal medication-taking behavior and low rates of continued medication use, or what is termed ' persistence to therapy plans, ' affects almost half of people with type 2 diabetes, leading to suboptimal glycemic and CVD risk factor control as well as increased risks of diabetes complications, mortality, and hospital admissions and increased health care costs (58 -62).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [61]
The Introduction (page unavailable) associates non-adherence and non-persistence in type 2 diabetes with poorer glycaemic control, more complications, and higher overall costs. It does not state that they cause those outcomes or address CVD risk-factor control or hospital admissions; mortality appears only in a cited reference’s title. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSuboptimal medication-taking behavior and low rates of continued medication use affect almost half of people with type 2 diabetes.
“Suboptimal medication-taking behavior and low rates of continued medication use, or what is termed ' persistence to therapy plans, ' affects almost half of people with type 2 diabetes, leading to suboptimal glycemic and CVD risk factor control as well as increased risks of diabetes complications, mortality, and hospital admissions and increased health care costs (58 -62).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [61]
The Introduction (page not provided) says a substantial proportion of people with type 2 diabetes do not take medication as prescribed and distinguishes missed doses from stopping treatment or having a substantial medication gap. It does not quantify that proportion as almost half; the paper's results compare adherence and persistence across medication classes rather than establish that population-wide figure. (LLM, conf=0.84)
Experimental — accuracy not yet measuredObserved rates of medication adherence and persistence vary across medication classes and between agents; careful consideration of these differences may help improve outcomes.
“Observed rates of medication adherence and persistence vary across medication classes and between agents; careful consideration of these differences may help improve outcomes (61).”
From Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2022) · cites this paper as [61]
The Discussion reports substantial differences in adherence and persistence across medication classes and says that selecting classes with better rates may improve outcomes. It does not establish differences between individual agents within a class; the review's comparisons were between classes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredGLP-1 RAs are known to cause gastrointestinal disturbances that have been shown to negatively impact adherence and persistence.
“Furthermore, GLP-1 RAs are known to cause gastrointestinal disturbances, and while these effects may subside after initial use, they have been shown to negatively impact adherence and persistence.”
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 [12]
Section 3.2 (Injectable medications) reports that several studies attributed higher GLP-1 receptor agonist discontinuation to adverse effects, predominantly injection-site reactions and gastrointestinal disturbance. It also reports lower adherence than for some oral therapies, but does not establish that gastrointestinal disturbance specifically reduced adherence. The cited passages do not address whether these effects subside after initial use. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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- Authors
- McGovern, A., Tippu, Z., Hinton, W., Munro, N., Whyte, M., & de Lusignan, S.
- Affiliations
- University of Surrey (GB)
- Section of Clinical Medicine and Aging, Department of Clinical and Experimental Medicine University of Surrey Guildford UK
- Corresponding author
- McGovern, Andrew
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-12-12
- Volume
- 20
- Issue
- 4
- Pages
- 1040-1043
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- OpenAlex
- W2770940237
- Cited by
- 166
- References
- 11
- Citations by year
- 2026: 9 · 2025: 21 · 2024: 27 · 2023: 25 · 2022: 23 · 2021: 13 · 2020: 17 · 2019: 15 · 2018: 15
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Obesity and Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- 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, type 2 diabetes, glucose-lowering medications, metformin, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, long-acting insulin analogues, human insulin, drug discontinuation
- MeSH terms
- Assessment of Medication Adherence, Blood Glucose, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Drug Monitoring, Medication Adherence
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