Introduction:
Adherence and persistence to oral hypoglycemic agents (OHAs) are critical for optimal glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly those with chronic kidney disease (CKD). The comparative adherence between dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter-2 (SGLT2) inhibitors in this population is not well studied, especially in the Indian context. This study aimed to evaluate and compare the adherence and persistence to DPP-4 inhibitors versus SGLT2 inhibitors among T2DM patients with non-dialysis CKD stages 3 and 4.
Methods:
We conducted a prospective analysis of patients with T2DM and non-dialysis CKD who initiated therapy with either a DPP-4 inhibitor or an SGLT2 inhibitor between 2020 and 2023, at two centers in North India. Adherence was assessed over one year using an indirect method of pill counts. We analyzed demographic, clinical, and treatment-related factors influencing adherence and persistence. The final cohort included 918 patients, with 513 on DPP-4 inhibitors and 405 on SGLT2 inhibitors.
Results:
: Of the 918 patients, 74% were in CKD stage 3 and 23% in stage 4. Diabetic kidney disease (DKD) was present in 63.18% of the cohort, while non-diabetic kidney disease (NDKD) was seen in the remaining patients, with renal stone disease being the most common cause of NDKD. Only 31.4% of patients were on monotherapy, with the majority on dual therapy; metformin (63.5%) and glimepiride (24%) were the most frequently prescribed additional OHAs. Adequate glycemic control was achieved in only 41.8% of patients. The main barriers to adherence were financial constraints (45%) and perceived drug side effects (38%). Furthermore, the knowledge and practice of critical diabetes self-management behaviours were generally low among the patients studied.
Conclusions:
Adherence and persistence to DPP-4 inhibitors and SGLT2 inhibitors in T2DM patients with CKD are influenced by several factors, including financial barriers and concerns about side effects. Despite the known benefits of these therapies, a significant proportion of patients did not achieve adequate glycemic control, underscoring the need for improved patient education on diabetes self-management and better support systems to enhance adherence. These findings highlight the importance of addressing external barriers and enhancing patient engagement to improve treatment outcomes in this high-risk population
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.