About 40% of patients with type 2 diabetes discontinue second-line medication

Key takeaways:

• Discontinuation was higher among patients who were prescribed GLP-1 receptor agonists.
• Physicians need better prescribing approaches and greater communication, an expert said.

Almost 40% of patients with type 2 diabetes stopped taking their second-line medication within 1 year, putting them at risk for future hospitalization related to diabetes, according to researchers.

Previous research has found alarming antidiabetic medication (ADM) usage trends because most adults with type 2 diabetes are eligible for GLP-1 receptor agonists and SGLT2 inhibitors but few use them.

David T. Liss, PhD, a professor of medicine at Northwestern Feinberg School of Medicine, told Healio that although they did not have data on why patients discontinued medications, there are several suspicions.

“I suspect that patients were not fully prepared for the potential challenges of taking some of these new medications,” he said. “There are certainly benefits to these medications, and some of them can be delayed or deferred ... While patients wait for these benefits, there are challenges. There are costs of the medications in the form of copays, there can be symptoms of hypoglycemia and there are side effects.”

In the study, published in the American Journal of Managed Care, Liss and colleagues analyzed the private health plan claims of 82,624 adults with type 2 diabetes who initiated one of five ADMs.

These medication classes included:

• sulfonylureas;
• dipeptidyl peptidase 4 (DPP4) inhibitors;
• SGLT2 inhibitors;
• GLP-1 receptor agonists; and
• thiazolidinediones.

Treatment modifications, which included either discontinuation, intensification or a medication switch, were then evaluated over a 12-month period.

Overall, 63.6% of adults experienced one of the three treatment modifications.

Medication discontinuation, regardless of class, was the most frequent outcome at 38.6%. The discontinuation rate was higher — 50.3% — for patients taking GLP-1 receptor agonists, which “was likely due to previously observed factors such as gastrointestinal adverse effects,” the researchers wrote.

The researchers also found that, compared with patients prescribed sulfonylureas, discontinuation risk was:

• 7% higher among patients prescribed DPP4 inhibitors (HR = 1.07; 95% CI, 1.04-1.1); and
• 28% higher among patients prescribed GLP-1 receptor agonists (HR = 1.28; 95% CI, 1.23-1.33).

Additionally, all other medication classes had higher risks for switching and lower risks for intensification compared with sulfonylureas, and prescriptions by an endocrinologist were linked to a lower risk for discontinuation and a higher risk for intensification vs. prescriptions by an internal medicine or family medicine physician.

“We suspect that these discontinuation decisions were made by patients without thorough discussions with their doctors or providers,” Liss said. “It’s reasonable to assume their prescribing clinician was not telling them, ‘It’s fine for you to discontinue your medications if you just stop.’”

Thus, “at the time of prescribing, it seems there’s potential for longer or more effective discussions with patients about the benefits and drawbacks of these medicines,” he said.

Liss also pointed to possible improvements in shared decision-making, which “has been shown to be really effective.”

“It doesn’t always have to be a conversation with their doctor,” he said. “It can be high-quality brochures, videos and other materials. You can have patients and their providers make highly informed decisions that ... have been shown to result in high patient satisfaction and presumably higher rates of adherence as well.”

References:

• Liss D, et al. Am J Manag Care. 2023;doi:10.37765/ajmc.2023.89466.
• Nearly 40% of type 2 diabetes patients stop taking their second-line medication. https://www.eurekalert.org/news-releases/1010651. Published Dec. 12, 2023. Accessed Dec. 12, 2023.