WEIGHT CHANGE AND DIABETES MEDICATIONS: IS THERE AN ASSOCIATION WITH ADHERENCE AND DISCONTINUATION?

To conduct a systematic literature review exploring if weight change during treatment of type 2 diabetes (T2D) is associated with medication adherence and/or discontinuation. A literature search of MEDLINE, EMBASE, and recent congress abstracts was conducted to identify studies (January 2005 to September 2020) reporting objective data on weight change and adherence and/or discontinuation in people with T2D (PwD) treated with diabetes medications. Nine studies were identified from 9188 records. Studies evaluated the association between weight change and adherence (n=6), discontinuation (n=2), and adherence and discontinuation (n=1). Four reported absolute weight change (kg) by adherence: three found the direction of change followed known weight profiles (loss or gain) of the evaluated drug; one demonstrated greater weight loss in adherent versus non-adherent PwD even when data from drugs with different weight profiles were pooled. Two studies reported the proportion of PwD achieving categorical weight loss (≥3%) by adherence: one showed that more adherent versus non-adherent PwD lost ≥3% weight within 3–6 months of glucagon-like peptide-1 agonist initiation; the second demonstrated that ≥3% weight loss occurred more commonly in adherent PwD regardless of weight profile of the evaluated drug. One study reported adherence according to categorical weight change: adherence improved with increasing weight loss regardless of the drug received (loss/gain profile). All three discontinuation studies reported that PwD who lost weight versus gained weight were less likely to discontinue therapy. Our findings suggest weight gain is associated with discontinuation, but the relationship between on-treatment adherence and weight change is more complex. Further evidence from longitudinal studies is needed to evaluate causality between weight change on T2D medication and adherence/discontinuation. Supporting better diabetes medication adherence and persistence is key in improving outcomes; therefore, further exploration of weight as an important influencer in this regard is warranted.