Abstract：
OBJECTIVE: The management of type 2 diabetes mellitus has advanced in the last two decades since the introduction of glucagon-like peptide-1 receptor agonists (GLP-1RAs). However, multiple factors may interfere with achieving better glycaemic control. This study evaluated the differences between various GLP-1RAs in efficacy, adherence and persistence.
METHODS: We conducted a retrospective cohort study using the electronic medical database from Clalit Health Services. Adults with type 2 diabetes mellitus who purchased any GLP-1RA between 2009 and 2021 were included. The Index Date was defined as the date of the first purchase of any GLP-1RA. We evaluated the adherence, persistence and glycaemic control after GLP-1RAs initiation. Baseline glycaemic and post-treatment glycaemic controls were analysed.
RESULTS: In total, 70 654 patients were included. The mean age was 11.7 ± 60.4, and 51% were females. A significant reduction in glycated haemoglobin (HbA1c) was observed in all patients who received GLP-1RAs. However, the percentage of changes in the HbA1c was higher among weekly GLP-1RA than daily initiators (14.6% vs. 10.2%, p < 0.001). The proportion of subjects with any decrease in HbA1c was higher among the once-weekly compared with the daily dose (82.4% vs. 74.7%) and mainly patients initiated semaglutide or dulaglutide, with 16.0% and 14.7% reduction. The frequency of good adherence (the proportion of days covered ≥80%) was significantly higher among the weekly group odds ratio = 1.25 (95% confidence interval 1.21-1.28). Good adherence was reported in older age, female gender, Jewish ethnicity and high socio-economic status (p < 0.001).
CONCLUSIONS: Weekly GLP-1RAs initiators were more adherent, persistent to therapy and achieved better glycaemic control. Epidemiological variables might play a role in achieving this goal.
METHODS: We conducted a retrospective cohort study using the electronic medical database from Clalit Health Services. Adults with type 2 diabetes mellitus who purchased any GLP-1RA between 2009 and 2021 were included. The Index Date was defined as the date of the first purchase of any GLP-1RA. We evaluated the adherence, persistence and glycaemic control after GLP-1RAs initiation. Baseline glycaemic and post-treatment glycaemic controls were analysed.
RESULTS: In total, 70 654 patients were included. The mean age was 11.7 ± 60.4, and 51% were females. A significant reduction in glycated haemoglobin (HbA1c) was observed in all patients who received GLP-1RAs. However, the percentage of changes in the HbA1c was higher among weekly GLP-1RA than daily initiators (14.6% vs. 10.2%, p < 0.001). The proportion of subjects with any decrease in HbA1c was higher among the once-weekly compared with the daily dose (82.4% vs. 74.7%) and mainly patients initiated semaglutide or dulaglutide, with 16.0% and 14.7% reduction. The frequency of good adherence (the proportion of days covered ≥80%) was significantly higher among the weekly group odds ratio = 1.25 (95% confidence interval 1.21-1.28). Good adherence was reported in older age, female gender, Jewish ethnicity and high socio-economic status (p < 0.001).
CONCLUSIONS: Weekly GLP-1RAs initiators were more adherent, persistent to therapy and achieved better glycaemic control. Epidemiological variables might play a role in achieving this goal.
摘要：
目的：自胰高血糖素样肽-1受体激动剂（GLP-1RAs）的引入以来，2型糖尿病的治疗在过去的二十年中取得了进展。然而,多种因素可能会干扰实现更好的血糖控制。本研究评估了各种GLP-1RA在疗效上的差异，坚持和坚持。
方法：我们使用ClalitHealthServices的电子医学数据库进行了一项回顾性队列研究。包括在2009年至2021年之间购买任何GLP-1RA的2型糖尿病成年人。索引日期定义为首次购买任何GLP-1RA的日期。我们评估了依从性，GLP-1RAs启动后的持久性和血糖控制。分析基线血糖和治疗后血糖对照。
结果：总计，包括70654名患者。平均年龄为11.7±60.4，女性占51％。在所有接受GLP-1RA的患者中观察到糖化血红蛋白(HbA1c)显著降低。然而,每周GLP-1RA的HbA1c变化百分比高于每日起始者(14.6%vs.10.2%,p<0.001)。与每日剂量相比，每周一次HbA1c下降的受试者比例较高（82.4％vs.74.7％），主要是患者开始使用司马鲁肽或杜拉鲁肽，分别减少16.0%和14.7%。在每周组比值比=1.25（95％置信区间1.21-1.28）中，良好依从性的频率（覆盖天数的比例≥80％）明显更高。据报道，老年人的依从性良好，女性性别,犹太种族和较高的社会经济地位(p<0.001)。
结论：每周的GLP-1RAs起始剂更有依附性，坚持治疗，并获得更好的血糖控制。流行病学变量可能在实现这一目标方面发挥作用。
方法：我们使用ClalitHealthServices的电子医学数据库进行了一项回顾性队列研究。包括在2009年至2021年之间购买任何GLP-1RA的2型糖尿病成年人。索引日期定义为首次购买任何GLP-1RA的日期。我们评估了依从性，GLP-1RAs启动后的持久性和血糖控制。分析基线血糖和治疗后血糖对照。
结果：总计，包括70654名患者。平均年龄为11.7±60.4，女性占51％。在所有接受GLP-1RA的患者中观察到糖化血红蛋白(HbA1c)显著降低。然而,每周GLP-1RA的HbA1c变化百分比高于每日起始者(14.6%vs.10.2%,p<0.001)。与每日剂量相比，每周一次HbA1c下降的受试者比例较高（82.4％vs.74.7％），主要是患者开始使用司马鲁肽或杜拉鲁肽，分别减少16.0%和14.7%。在每周组比值比=1.25（95％置信区间1.21-1.28）中，良好依从性的频率（覆盖天数的比例≥80％）明显更高。据报道，老年人的依从性良好，女性性别,犹太种族和较高的社会经济地位(p<0.001)。
结论：每周的GLP-1RAs起始剂更有依附性，坚持治疗，并获得更好的血糖控制。流行病学变量可能在实现这一目标方面发挥作用。
