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

Am Heart J. 2025 Apr:282:51-57. doi: 10.1016/j.ahj.2024.12.006. Epub 2024 Dec 21.

Abstract

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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Atherosclerosis* / complications
  • Atherosclerosis* / drug therapy
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / drug therapy
  • Female
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Sodium-Glucose Transporter 2 Inhibitors* / therapeutic use
  • United States / epidemiology

Substances

  • Sodium-Glucose Transporter 2 Inhibitors
  • Hypoglycemic Agents