Older age and better kidney function predicted higher adherence to dulaglutide, while obesity and baseline use of sulfonylureas or insulin predicted earlier discontinuation.
236 patients, 1 yearRetrospective analysis identified clinical characteristics that predicted whether type 2 diabetes patients continued or stopped dulaglutide over one year
What the researchers found
Among 236 dulaglutide users followed for one year, increasing age and higher estimated glomerular filtration rate (eGFR) significantly increased both adherence and treatment continuation. Baseline obesity and baseline use of sulfonylurea or insulin significantly reduced the likelihood of continuing dulaglutide.
Switching dulaglutide dose during treatment and baseline neuropathy were associated with higher proportion of days covered (PDC) and longer treatment duration. In patients at high cardiovascular risk, baseline hypertension and higher LDL-C levels increased the likelihood of adherence. Cardiovascular risk status itself did not significantly affect any adherence or persistence outcome.
Why it matters
GLP-1 receptor agonists like dulaglutide only work if patients keep taking them. Understanding which patients are likely to stop — and why — helps clinicians provide targeted support. The finding that obese patients and those on insulin or sulfonylureas are more likely to discontinue suggests these groups may need closer monitoring and encouragement, potentially preventing the metabolic consequences of stopping GLP-1 therapy.
How the study worked
This was a retrospective observational cohort study using the Common Data Model at Seoul National University Hospital. The 236 eligible patients with type 2 diabetes treated with dulaglutide were followed for one year. Researchers used multivariate logistic regression for categorical outcomes (adherence status, continuation status) and linear regression for continuous outcomes (proportion of days covered, treatment duration). A subgroup analysis examined patients at high cardiovascular risk, defined as having two or more identifiable risk factors.
What this study cannot tell us
This was a single-center retrospective study at one Korean hospital, limiting generalizability to other populations. The sample size of 236 is relatively small. Reasons for discontinuation (e.g., side effects, cost, patient preference) were not captured. The study used a one-year follow-up period, which may not capture longer-term adherence patterns. The Common Data Model approach relies on pharmacy records, which may not perfectly reflect actual medication use.
How to read the evidence
This is a single-center retrospective observational study with a modest sample size of 236 patients. While it uses appropriate multivariate statistical methods, the retrospective design, single institution, and lack of randomization limit causal inference.
When this study was published
Published in 2023, this study is recent and relevant as GLP-1 receptor agonist prescriptions continue to surge worldwide. The adherence patterns identified may become increasingly important as more patients initiate these therapies.
The bigger picture
As GLP-1 receptor agonists become first-line treatments for type 2 diabetes, real-world adherence data is critical. Clinical trials show these drugs work, but outcomes depend on patients actually staying on therapy. This study from a Korean hospital adds to the growing body of evidence identifying at-risk populations for discontinuation, helping healthcare systems design interventions to improve long-term treatment success.
Questions still open
- Why are obese patients and those on sulfonylureas or insulin more likely to discontinue dulaglutide — is it side effects, perceived lack of benefit, or other factors?
- Would targeted adherence interventions for high-risk groups improve long-term dulaglutide persistence?
- Do these adherence predictors differ across GLP-1 receptor agonists, or are they class-wide patterns?
Common questions
What made patients more likely to keep taking dulaglutide?
Why might obese patients stop dulaglutide sooner?
Read the original research
Clinical Characteristics Associated with Adherence and Persistence in Patients with Type 2 Diabetes Mellitus Treated with Dulaglutide.
Journal of diabetes research, 2023, 7917641
Citation
Lee, David Seung U; Lee, Howard. (2023). Clinical Characteristics Associated with Adherence and Persistence in Patients with Type 2 Diabetes Mellitus Treated with Dulaglutide.. Journal of diabetes research, 2023, 7917641. https://doi.org/10.1155/2023/7917641