Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review

Abstract

Purpose Type 2 diabetes (T2D) medication adherence is poor and is impacted by individual drug characteristics. Treatment-associated weight change can affect medication-taking behavior. This review aimed to explore weight change on T2D therapy and consider its impact on adherence and discontinuation. Methods Searches were conducted in MEDLINE and EMBASE (2005 to September 2020), and among recent congress abstract books for studies providing data on medication adherence or discontinuation and weight change in people with T2D (PwD). Results Nine studies meeting the inclusion criteria were identified from 9188 bibliographic records. All three studies exploring weight change and discontinuation reported weight loss to be associated with higher persistence. Seven studies of varying design explored weight change and adherence. Four reported absolute weight change (kg) and adherence: one pooled data from different diabetes medications and demonstrated that self-reported adherence was significantly associated with weight loss; however, three studies found that weight change in adherent PwD was in the direction of the known weight profile (loss/gain) of the evaluated drug. Categorical weight loss (≥3%) and adherence were reported in two studies: one reported that numerically more adherent versus non-adherent PwD lost ≥3% weight regardless of the drug’s weight profile, the other showed that early weight loss with a glucagon-like peptide-1 agonist was significantly associated with better adherence. One study reported adherence by categorical weight change; as weight loss increased, adherence scores improved, regardless of drug type. Conclusion Findings suggest that discontinuation rates may be lower in PwD who lose as compared to those who gain weight on T2D treatment. The evidence base on adherence and weight change is more challenging to interpret due to the range of study designs. Given the importance of weight control in T2D, further research exploring the individual’s treatment, weight journey, and behaviors over time should be undertaken.

Gait Analysis, Metabolic Parameters and Adherence to the Mediterranean Diet in Patients with Type 2 Diabetes Mellitus Compared with Healthy Controls: A Pilot Study

“…Furthermore, our results suggest an association between parallel T2DM risk and body weight gain, which is consistent with previous studies [34,35]. Weight management is essential for better glycemic control [36].…”

“…Adherence to the MedDiet was assessed with the MedDiet Score questionnaire, which recorded consumption of the 11 major components (unrefined grains, fruits, vegetables, potatoes, legumes, olive oil, fish, red meat, poultry, full-fat dairy products and alcohol) in a face-to-face interview with a qualified dietitian. The MedDiet score is categorized as no adherence (0-13), inadequate adherence (14-27), satisfactory adherence (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41), and very good adherence (42-55) [19].…”

Adherence to and Dropout from Liraglutide 3.0 mg Obesity Treatment in a Real-World Setting

“… 31 Patients with both conditions are likely to adhere to GLP-1 RA therapy better than diabetes patients without obesity, 32 and patients with diabetes mellitus who achieved substantial weight loss had significantly better adherence to medication and other treatment regimens than those with weight gain. 33 , 34 Therefore, it is not surprising that patients with both obesity and diabetes who achieved weight loss in our study displayed better than average adherence. For such patients, treatment using GLP-1 RAs such as liraglutide 3.0 mg are a viable option for achieving both weight loss and glycemic control.…”

Adherence to CPAP Treatment and the Risk of Recurrent Cardiovascular Events

“…Changes in BMI are likely to be informative of potential changes in apnea-hypopnea index, as decrease in BMI may be associated with decreased apnea-hypopnea index, that could affect adherence to the treatment. Moreover, previous studies suggested that BMI changes could affect adherence to therapies and a potential relationship between CPAP use and BMI changes has been reported . BMI has therefore been proposed to be a driver of CPAP adherence.…”