2D-08 - Longitudinal Adherence Trajectories of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2I) And the Risk of Diabetes-Related Hospitalization

Background: Sodium-glucose Cotransporter 2 Inhibitors' (SGLT2I) high cost and adverse effects may contribute to poor adherence and ultimately poor clinical outcomes, among individuals with type-2 diabetes mellitus(T2DM). Real-world evidence is lacking on the impact of SGLT2I adherence after treatment initiation on diabetes-related outcomes.

Objectives: To examine longitudinal trajectories of SGLT2I adherence and the association with the risk of diabetes-related hospitalizations and emergency department visits (ED).

Methods: This retrospective cohort study used a 25% random sample of IQVIA PharMetrics® Plus for Academics US health plan claims, 2013 to 2022. We identified individuals 18-64 years with T2DM who newly initiated oral SGLT2I. The date of the first SGLT2I pharmacy dispensing claim was the index date. Group-based trajectory modeling was used to estimate latent subgroups of SGLT2I adherence using monthly proportions of days covered (PDC) from months 1 to 12 after the index date. A monthly PDC of ≥80% was defined as being adherent and < 80% non-adherent. The primary exposure was SGLT2I adherence trajectory group membership. Diabetes-related hospitalization/ED visits were defined as inpatient admission or ED visits for diabetes complications operationalized using the medical diagnosis code as primary discharge. Cox proportional hazard models, adjusted for baseline covariates, estimated the risk of diabetes-related hospitalization/ED visits in months 13 to 25 after the SGLT2I index date, by adherence trajectory group.

Results: We identified 7121 new SGLT2I initiators; mean age of 54.0 (SD= 7.6). Five distinct antihypertensive adherence trajectories were identified. The first group labeled dynamic adherence accounted for 12.8% of the cohort. Three groups were defined based on the timing of treatment discontinuation: 14.3% of participants discontinued treatment within five months (rapid decline group), 13.2% exhibited an early decrease in adherence (early decline group), and 11.0% showed a late decrease in adherence (late decline group). The fifth group demonstrated near-perfect adherence. In the adjusted model, compared to the near-perfect adherence trajectory group, the rapid decline adherence trajectory group [HR = 1.46, 95 % CI (1.15-1.85)] and dynamic adherence trajectory group [HR = 1.35, 95 % CI (1.09-1.66)] had a greater risk of diabetes-related hospitalizations/ED visits.

Conclusions: Our results highlight the importance of promoting SGLT2I adherence in T2DM patients to mitigate adverse health outcomes. These findings emphasize the need to optimize adherence for T2DM patients at risk of diabetes-related complications.