1093-P: Incidence of Primary Nonadherence to Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) and Glucagon-Like Peptide-1 Agonists (GLP-1A) in an Integrated Health Care System

Abstract

Background: The incidence and predictors of primary nonadherence (when a medication is prescribed but not dispensed) for newer glucose lowering medications including SGLT2i and GLP-1a is not known. Methods: Using a database that links electronic health records with commercial claims from an integrated health system in PA (UPMC), we identified patients with T2D newly prescribed an SGLT2i or GLP-1a from 2011-2019. We measured the incidence of 30-day primary nonadherence to both overall and by individual drug. We used multivariable logistic regression to examine patient and provider factors associated with primary nonadherence. Results: Our cohort included 5,505 commercially insured adults (mean age 50[SD11]) with T2D newly prescribed an SGLT2i (n=2,844) or GLP-1a (n=2,661). Overall, 1,867(34%) patients did not fill their first prescription. Among the most commonly prescribed drugs, the incidence of primary nonadherence was lowest for dulaglutide(30%) and highest for canagliflozin(44%). In a multivariable model, age>65 (OR 1.3, 95%CI:1.06-1.61), hypertension (OR 1.18, 95%CI:1.02-1.35), and number of hospitalizations (OR 1.39, 95%CI:1.16-1.65) was associated with an increased odds of primary nonadherence. Female sex (OR 0.88, 95%CI:0.77-0.99), PAD (OR 0.73, 95%CI:0.57-0.93), having a HbA1c value (OR 0.76, 95%CI:0.64-0.89), having a creatinine value (OR 0.82, 95%CI:0.71-0.94), and having an endocrinologist vs. PCP prescribe the index drug (OR 0.77, 95% CI:0.65-0.91) were associated with decreased odds of primary nonadherence. Conclusions: In this integrated health system, 1 out of 3 patients prescribed a SGLT2i and GLP-1 agonist did not fill their prescription within 30 days. Older age and increasing morbidity predicted higher odds while more active engagement with providers, including diabetes specialists, was associated with reduced odds of primary nonadherence. Disclosure J. Luo: Consultant; Self; Alosa Health, Research Support; Self; Health Action International. R. Feldman: None. S. D. Rothenberger: None. M. Fischer: None. M. T. Korytkowski: None. W. F. Gellad: None. Funding National Center for Advancing Translational Sciences (KL2TR001856)