Abstract: SA-OR012
Sex Differences in SGLT2 Inhibitor and GLP-1 Receptor Agonist Discontinuation in Patients with and Without CKD
Session Information
- CKD: Advancing Epidemiology, Risk Factors, and Prevention
November 08, 2025 | Location: Room 362A, Convention Center
Abstract Time: 04:50 PM - 05:00 PM
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Hartsell, Sydney Elizabeth, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Singh, Ravinder, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Nevers, Mckenna R., Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Derington, Catherine G., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Throolin, Michael J, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Akramimoghadam, Farideh, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Ence, Thomas Steven, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Sarwal, Amara, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Drakos, Stavros, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
Background
Adherence barriers to SGLT2i and GLP-1RA are poorly understood and limit their benefit. Women are underrepresented in the literature on SGLT2i and GLP-1RA. Understanding sex differences in discontinuation is critical to improving implementation of these therapies.
Methods
We examined adherence in a national Veterans cohort of 5,544 women and 100,869 men with T2D who initiated SGLT2i or GLP-1RA (2018-2021) while on metformin. Adherence was defined by quantity and fill dates of prescriptions within the index drug class at 90-day intervals, expressed as N adherent / N at risk. Patients were followed for adherence, death, loss to follow up or censorship until 3/31/23. Patients were stratified by sex and baseline CKD status (eGFR <60).
Results
3,577 women started SGLT2i and 1,967 started GLP-1RA. 81,048 men started SGLT2i and 19,828 started GLP-1RA. As is evident from Figure, across all sub-groups, adherence to both SGLT2i and GLP-1RA precipitously declined in year 1 with continued decline over the next two-years. Women had notably lower SGLT2i adherence than men in both non-CKD and CKD subgroups. At 3 years, 48.2% (541/1,123 at risk) of women without CKD remained on SGLT2i compared to 66.9% (17,767/26,560 at risk) of men. Corresponding adherence rates in those with CKD were 48.2% (55/114 at risk) in women and 63.2% (2,473/3,910 at risk) in men. Women also had lower GLP-1RA adherence than men in those without CKD (58.6% (533/909 at risk) vs. 64.3% (5,964/9,279 at risk) at 3 years) but equal or greater adherence than men in those with CKD (67.3% (74/110 at risk) vs. 63.5% (1,161/1,828 at risk) at 3 years) .
Conclusion
Decline in adherence to SGLT2i and GLP-1RA is the steepest in year 1. Less than 50% of women initiated on SGLT2i stay on the therapy by year 3. As VA provides these medications at no/minimal cost, the cost of these medications is less likely to explain the lower adherence. Interventions to promote adherence to SGLT2i and GLP-1RA, particularly in women are warranted.
Funding
- NIDDK Support – Bayer, National Kidney Foundation and Women in Nephrology's REACH Award