ArticleThe Lancet regional health. Europe2026
Long-term adherence to glucose-lowering therapy and cardiovascular risk in type 2 diabetes: a nationwide cohort study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Type 2 diabetes is a major risk factor for cardiovascular disease, and reducing this excess risk is a central goal of clinical management. Sustained adherence to glucose-lowering medication is considered a key component of this strategy. However, long-term patterns of medication-taking behavior in real-world settings, and their relationship with cardiovascular outcomes, remain insufficiently characterized. Methods: We conducted a nationwide cohort study of Danish adults with newly diagnosed type 2 diabetes who initiated non-insulin glucose-lowering medication between 2005 and 2012. Medication adherence was estimated from pharmacy dispensing data, and group-based trajectory modeling was used to identify longitudinal adherence patterns. The primary outcome was a composite cardiovascular outcome including ischemic heart disease, stroke, or heart failure. Associations between adherence trajectories and cardiovascular outcomes over 10 years of follow-up were assessed with Cox proportional-hazards models. Findings: Among 79,510 individuals with newly diagnosed type 2 diabetes (median age, 61 (IQR: 52-69); 57% men), we identified three long-term adherence trajectories defined by high (n = 32,912; 41%), intermediate (n = 25,822; 33%), and low (n = 20,776; 26%) adherence. During follow-up, 15,276 cardiovascular events occurred. Compared with the high-adherence group, adjusted hazard ratios for the composite cardiovascular outcome were 1.07 (95% CI, 1.03-1.12) and 1.27 (95% CI, 1.21-1.33) in the intermediate- and low-adherence groups, respectively. Participants with high adherence remained free of cardiovascular events for an average of 220 more days (95% CI, 204-237) over 10 years. Associations were largely driven by ischemic heart disease, with no significant associations for heart failure. Interpretation: Long-term adherence to glucose-lowering medication was associated with lower cardiovascular rate and longer event-free survival time among individuals with newly diagnosed type 2 diabetes. Funding: Novo Nordisk Foundation and the European Innovation Council.
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