Evidence map›Paper›PMID 40667705›Full record

ArticleDiabetes, obesity & metabolism2025

Adherence to GLP-1 receptor agonists and SGLT2 inhibitors by out-of-pocket spending among Medicare beneficiaries with diabetes.

Nicklas S Klepser, Ellerie S Weber, Lihua Li, Kirsten E Fleischmann, Umesh Masharani, Meyeon Park, Wendy B Max, Joseph Yeboah, M G Myriam Hunink, Bart S Ferket

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Diabetes, obesity & metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Nicklas S KlepserInstitute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Ellerie S WeberDepartment of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Lihua LiInstitute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Kirsten E FleischmannDepartment of Medicine, University of California, San Francisco, California, USA.
Umesh MasharaniDepartment of Medicine, University of California, San Francisco, California, USA.
Meyeon ParkDepartment of Medicine, University of California, San Francisco, California, USA.
Wendy B MaxInstitute for Health & Aging and Department of Social and Behavioral Sciences, University of California, San Francisco, California, USA.
Joseph YeboahHeart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, North Carolina, USA.
M G Myriam HuninkDepartment of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
Bart S FerketInstitute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.ORCID https://orcid.org/0000-0003-2754-545X

Funding

NHLBI NIH HHS R01 HL153456NHLBI NIH HHS R01HL153456
6 · The paper itself

Abstract

aimsTo assess associations between out-of-pocket (OOP) expenditures and adherence to glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) among low-income Medicare beneficiaries with diabetes. MATERIALS AND

methodsWe analysed Medicare Current Beneficiary Survey two-year longitudinal data (2016-2021) on beneficiaries with diabetes using GLP-1RAs (N = 168; weighted = 2 187 500) or SGLT2i (N = 139; weighted = 1 741 910) in year one (baseline). Among these, N = 97 (weighted = 1 117 637) GLP-1RA and N = 73 (weighted = 785 301) SGLT2i users had an income below 200% of the Federal Poverty Level (low-income). Survey-weighted generalized Poisson regression assessed the association between baseline cumulative OOP drug expenses and year two adherence, defined as proportion of days covered (PDC). We repeated analyses in participants with higher income and using dual (Medicare/Medicaid) enrolment as a proxy for full coverage in low income.

resultsYear-two PDC was 65.2% (95% CI: 57.9%-72.6%) for low-income GLP-1RA users and 65.4% (95% CI: 58.3%-72.5%) for low-income SGLT2i users. We did not observe a significant association between OOP costs (mean: $253; range: $0-$4699) and adherence in low-income GLP-1RA users. For low-income SGLT2i users, higher OOP costs (mean: $204; $0-$2649) were associated with lower adherence: adjusted adherence ratio 0.959 (95% CI: 0.932-0.987) per $100 increase. Dual Medicare-Medicaid coverage was associated with increased adherence: adjusted adherence ratio 1.580 (95% CI: 1.061-2.352). For high-income GLP-1RA users, higher OOP expenditures were associated with increased adherence in the highest income range.

conclusionsOOP costs for GLP-1RAs and SGLT2i are substantial, potentially posing a particular burden for low-income Medicare beneficiaries. Policy changes may reduce this burden, although adherence improvements appear limited to beneficiaries using SGLT2i.

Indexed as

Diabetes MellitusDiabetes Mellitus, Type 2Glucagon-Like Peptide-1 Receptor AgonistsHealth ExpendituresHypoglycemic AgentsMedicareSodium-Glucose Transporter 2 InhibitorsAgedAged, 80 and overFemaleHumansLongitudinal StudiesMalePovertyUnited StatesGlucagon-Like Peptide-1 Receptor AgonistsHypoglycemic AgentsSodium-Glucose Transporter 2 InhibitorsGLP‐1 analoguehealth economicsreal‐world evidenceSGLT2 inhibitortype 2 diabetes

Identifiers

PMID40667705
PMCPMC12313199

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.