Persistence and adherence to sodium-glucose co-transporter 2 inhibitor monotherapy among patients with type 2 diabetes mellitus: a retrospective study based on a Japanese claims database

Junichi Mukai; Manabu Akazawa; Yuji Yoshiyama; Rie Kubota

doi:10.1007/s13340-025-00821-1

Persistence and adherence to sodium-glucose co-transporter 2 inhibitor monotherapy among patients with type 2 diabetes mellitus: a retrospective study based on a Japanese claims database

Diabetol Int. 2025 May 29;16(3):559-567. doi: 10.1007/s13340-025-00821-1. eCollection 2025 Jul.

Authors

Junichi Mukai¹, Manabu Akazawa², Yuji Yoshiyama³, Rie Kubota¹

Affiliations

¹ Division of Clinical Pharmacy (Laboratory of Clinical Pharmacy Education) and Research and Education Centre for Clinical Pharmacy, School of Pharmacy, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641 Japan.
² Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo 204-8588 Japan.
³ Division of Clinical Pharmacy (Laboratory of Pharmaceutical Health Care and Sciences in Community Pharmacy Practice) and Research and Education Centre for Clinical Pharmacy, School of Pharmacy, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo, 108-8641 Japan.

Abstract

The aims of this retrospective study were to examine persistence/adherence rates to sodium-glucose co-transporter 2 inhibitors (SGLT2i) monotherapy in patients with type 2 diabetes (T2DM) and identify factor(s) affecting persistence/adherence. Claims data on patients with T2DM newly using SGLT2i monotherapy from the JMDC database between October 2017 and September 2020 were analyzed. Persistence without a 90-day gap was calculated from the index date until the time of discontinuation of SGLT2i in a 1-year follow-up. Adherence was calculated using the proportion of days covered (PDC). Baseline characteristics were examined as potential factors affecting persistence/adherence using a multivariate logistic method. The present study identified 2172 new users of SGLT2i monotherapy. The persistence rate to SGLT2i after 365 days was 61.0%. Mean PDC was 71.2%, and 58.3% of patients adhered to treatment. A multivariate logistic regression analysis showed that an older age, hypertension, dyslipidemia, and hyperuricemia were associated with a lower risk of the discontinuation of SGLT2i monotherapy, while an older age, hypertension, dyslipidemia, and hyperuricemia were associated with a lower risk of poor adherence. The present study identified several factors that reduced the risk of discontinuation/poor adherence to SGLT2i monotherapy in patients with T2DM. An older age, hypertension, dyslipidemia, and hyperuricemia were common factors for a lower risk of discontinuation/poor adherence.

Keywords: Adherence; Observational study; Persistence; Retrospective study; Sodium-glucose co-transporter 2 inhibitor; Type 2 diabetes.