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Cited by 2Medication Adherence and ComplianceDiabetes Treatment and ManagementDiabetes Management and Education

Medication Adherence to Semaglutide versus Empagliflozin in Adults with Type 2 Diabetes: A Retrospective Observational Study in Saudi Arabia

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Ali, Mostafa, Amirthalingam, Palanisamy, Alshareef, Hanan, Alqifari, Saleh, Elsaid Hamdan, Ahmed, Alatawi, Olayan, Hakami, Faris, Albalawi, Nader +1 more·2025·Patient Preference and Adherence
DOI 10.2147/ppa.s569096PMC PMC12724230
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Abstract

Purpose: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are widely prescribed, yet medication adherence varies. This study evaluated real-world adherence and persistence to semaglutide and empagliflozin among adults with T2D and assessed the associations between adherence and clinical outcomes. Patients and Methods: A retrospective observational study was performed using electronic health records and pharmacy dispensing data from a military hospital in Tabuk, Saudi Arabia, between July 1, 2023 and June 30, 2024. Adults with T2D (≥18 years old) prescribed semaglutide or empagliflozin were included. Medication adherence was quantified using proportion of days covered (PDC). Persistence was defined by absence of treatment gap ≥60 days. Associations between adherence and patient characteristics, and clinical out-comes, were examined. Results: Among 5087 patients (mean age 57.9 ± 12.3 years, mean T2D duration 10.3 ± 7.6 years), 4020 received empagliflozin and 1067 initiated semaglutide. Adherence (PDC ≥ 80%) was observed in 57.7% of semaglutide and 60% of empagliflozin users. Persistence was lower 40% (semaglutide) and 45% (empagliflozin) met the criteria. Sociodemographic variables were not significant predictors of medication adherence. Conclusion: Medication adherence and persistence to both semaglutide once-weekly injection and oral empagliflozin were suboptimal among T2D patients. Adherent patients to both medications experienced a significant improvement in glycemic control. Targeted strategies are needed to enhance patient motivation for consistent medication use and timely refills.

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  • In Saudi Arabia, persistence with GLP-1 RAs was 40% at 1 year in a tertiary-care T2DM cohort.

    “| Saudi Arabia (tertiary-care cohort) [50] | T2DM | Not reported | 40% persistence at 1 year | Injection burden; patient preference for oral agents |”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [50]

    The Results section (Adherence to Semaglutide and Empagliflozin Among T2D Patients; page unavailable) reports 40% persistence among semaglutide users over 12 months, using a 60-day treatment-gap definition. Materials and Methods identifies the Saudi study site as a tertiary-care hospital. The 40% figure applies specifically to semaglutide, not GLP-1 receptor agonists as a class; the paper also did not measure whether injection burden or preference for oral agents explained persistence. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Injection burden and cost may drive patients toward oral alternatives in Saudi Arabia.

    “suggesting that injection burden and cost may drive patients toward oral alternatives [50]”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [50]

    The Discussion says patients may favor oral medications over injections and reports greater persistence with oral empagliflozin than injectable semaglutide. It does not establish that injection burden drove treatment choice in Saudi Arabia. The Discussion also says medications were free at the study site and cost was not expected to affect adherence there; its co-payment evidence concerns adherence in another analysis, not a shift toward oral alternatives. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In a Saudi tertiary-care cohort, 12-month persistence with injectable semaglutide was approximately 40%, lower than with the oral SGLT2 inhibitor empagliflozin.

    “Evidence from a Saudi tertiary-care cohort indicates that, although GLP-1 RAs are widely prescribed, 12-month persistence with injectable semaglutide is lower than with the oral sodium–glucose cotransporter 2 inhibitor empagliflozin (approximately 40% vs. a higher rate with sodium–glucose cotransporter 2 inhibitors)”

    From Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review (2026) · cites this paper as [50]

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Cited by

Sorted by citations

Authors
Ali, M., Amirthalingam, P., Alshareef, H., Alqifari, S., Elsaid Hamdan, A., Alatawi, O., Hakami, F., Albalawi, N., & Aljabri, A.
Affiliations
  • University of Tabuk (SA)
  • King Abdulaziz University (SA)
Corresponding author
Ali, Mostafa
ORCID
Venue
Patient Preference and Adherence
Publisher
Informa UK Limited
Published
2025-12
Volume
Volume 19
Pages
4179-4190
ISSN
1177-889X (ISSN-L)
DOI
10.2147/ppa.s569096
PMC
PMC12724230
OpenAlex
W4417465723
Cited by
2
References
4
Citations by year
2026: 2
FWCI
2.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Patient Preference and Adherence (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
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, semaglutide, empagliflozin, type 2 diabetes, SGLT2 inhibitors, GLP-1 receptor agonists, treatment persistence, proportion of days covered, glycemic control, military hospital patients

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