OBJECTIVE We aimed to understand the factors associated with sodium–glucose cotransporter 2 inhibitor (SGLT2i) adherence and longitudinal adherence trajectories in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS Using Medicare claims data (April 2013–December 2017), we identified 83,675 new SGLT2i users ≥66 years old with type 2 diabetes. We measured SGLT2i adherence as the proportion of days covered (PDC) during the first year of SGLT2i therapy. We used linear regression to assess the association between baseline covariates and PDC. Then we used group-based trajectory modeling to identify distinct longitudinal SGLT2i adherence groups and used a multivariable logistic regression model to examine the association between baseline covariates and membership in these adherence groups. RESULTS Unadjusted mean PDC was 63%. Previous adherence to statins had the strongest positive association with PDC (regression coefficient 6.00% [95% CI 5.50, 6.50]), whereas female sex (−5.51% [−6.02, −5.00]), and Black race/ethnicity (−5.06% [−6.03, −4.09]) had the strongest negative association. We identified three adherence trajectory groups: low (23% of patients, mean PDC 17%), moderate (32%, mean PDC 50%), and high (45%, mean PDC 96%) adherence. More patients in the high adherence group were previously adherent to statins (odds ratio 1.43 [95% CI 1.39, 1.48]), and more women (1.28 [1.23, 1.32]) and Black patients (1.31 [1.23, 1.40]) were in the low adherence group. CONCLUSIONS In a large population of older patients with type 2 diabetes, 45% were highly adherent during the first year of SGLT2i treatment. Female sex and Black race/ethnicity were most strongly associated with low adherence.

中文翻译：

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故事的三个方面：医疗保险受益人 SGLT2 抑制剂治疗第一年的依从性轨迹

目的 我们旨在了解与 2 型糖尿病老年人的钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 依从性和纵向依从性轨迹相关的因素。研究设计和方法 使用 Medicare 索赔数据（2013 年 4 月至 2017 年 12 月），我们确定了 83,675 名年龄≥66 岁的 2 型糖尿病新 SGLT2i 用户。我们将 SGLT2i 依从性衡量为 SGLT2i 治疗第一年期间覆盖天数 (PDC) 的比例。我们使用线性回归来评估基线协变量和 PDC 之间的关联。然后我们使用基于组的轨迹建模来识别不同的纵向 SGLT2i 依从组，并使用多变量逻辑回归模型来检查基线协变量与这些依从组中的成员之间的关联。结果 未经调整的平均 PDC 为 63%。先前对他汀类药物的依从性与 PDC 具有最强的正相关性（回归系数 6.00% [95% CI 5.50, 6.50]），而女性（-5.51% [-6.02, -5.00]）和黑人种族/民族（-5.06 % [−6.03, −4.09]) 具有最强的负相关性。我们确定了三个依从性轨迹组：低（23% 的患者，平均 PDC 17%）、中度（32%，平均 PDC 50%）和高（45%，平均 PDC 96%）依从性。高依从性组中更多的患者以前坚持使用他汀类药物（比值比 1.43 [95% CI 1.39, 1.48]），并且更多的女性（1.28 [1.23, 1.32]）和黑人患者（1.31 [1.23, 1.40]）在低依从性组。结论 在大量老年 2 型糖尿病患者中，45% 的患者在 SGLT2i 治疗的第一年期间依从性很高。