Discontinuation of SGLT-2i and GLP-1RA among persons with Type 2 diabetes and atherosclerotic cardiovascular disease treated in US cardiology clinics.

BACKGROUND: SGLT-2i and GLP-1RA are recommended for persons with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD); for those prescribed, little is known about reasons for discontinuation. METHODS: From the COORDINATE-Diabetes randomized trial database, the frequency and reasons for discontinuation of SGLT2i or GLP-1RA were analyzed. RESULTS: 1045 participants were enrolled 7/2019 to 5/2022; 290 (27.8%) were prescribed SGLT-2i of whom 67 (23.1%) discontinued; and 118 (11.3%) were prescribed GLP-1RA of whom 38 (32.2%) discontinued. Race, age and sex did not differ among those discontinuing either class. Medicare was more common among those discontinuing vs persisting with SGLT-2i (71.4 vs. 58.1%; p=0.058) and GLP-1RA (71.1 vs. 49.4%); p=0.027). Cost, side effects, and patient choice were common reasons for discontinuation. CONCLUSION: Up to one-third of participants discontinued either an SGLT-2i or GLP-1RA within 12 months of initiating. Efforts to address modifiable contributors to discontinuation are required.

Duke Scholars

Author Christopher Bull Granger Medicine, Cardiology

Author Jennifer Brigitte Green Medicine, Endocrinology, Metabolism, and Nutrition

Author Renato Delascio Lopes Medicine, Cardiology

Author Hussein Rashid Al-Khalidi Biostatistics & Bioinformatics, Division of Biostatistics

Author Lisa Kaltenbach  

Author Neha Pagidipati Medicine, Cardiology