{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:36:41Z","timestamp":1793144201312,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      Real\u2010world medication use varies across clinical trial and healthcare settings; therefore, we evaluated\n                      <jats:styled-content style=\"fixed-case\">GLP<\/jats:styled-content>\n                      \u20101 receptor agonist (\n                      <jats:styled-content style=\"fixed-case\">GLP<\/jats:styled-content>\n                      \u2010\n                      <jats:styled-content style=\"fixed-case\">1RA<\/jats:styled-content>\n                      ) persistence and dose titration among adults with type 2 diabetes in\n                      <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                      primary care, stratified by agent, obesity status, cardiovascular disease (\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      ) history, and sex assigned at birth.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Adults with type 2 diabetes initiating GLP\u20101RAs between 1 March 2018 and 30 June 2023, with follow\u2010up \u22651\u2010year, were identified using the IQVIA Medical Research Data (IMRD) incorporating data from THIN, A Cegedim Database. The absolute 1\u2010year risk\u00a0of discontinuation was\u00a0estimated using the Aalen\u2010Johansen estimator, while multivariable cause\u2010specific Cox models assessed associations with patient characteristics. Dosing trajectories were characterised across individual prescriptions during the first therapy year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 8200 GLP\u20101RA initiators (46.5% dulaglutide, 38.7% semaglutide), the 1\u2010year discontinuation risk was 41.1% (95% CI 40.1\u201342.2), higher among those without obesity (BMI\u2009&lt;30\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : 49.2%, 46.5\u201352.0) versus with BMI\u2009\u226530\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      (BMI 30\u2013&lt;35\/\u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      : 40.4%\/37.2%, 38.4\u201342.4\/35.4\u201339.1). Discontinuation was lower with dulaglutide (36.9%, 35.4\u201338.4) than with subcutaneous\/oral semaglutide (46.4%\/55.8%, 44.4\u201348.4\/52.3\u201359.4). Only 58% of subcutaneous\/oral semaglutide initiators reached recommended maintenance doses after 4\u2009weeks, while 21% remained on starting doses. At prescription 10, most common doses were 0.5\/1\u2009mg subcutaneous semaglutide (44.0%\/48.6%), 7\/14\u2009mg oral semaglutide (50.2%\/36.6%), and 0.75\/1.5\/3\u2009mg dulaglutide (20.4%\/71.5%\/6.7%). Faster dose escalation occurred with higher BMI and subcutaneous semaglutide (1\u2009mg at prescription 5: 20.8%\/25.9%\/33.2% with BMI\u2009&lt;30\/30\u2013&lt;35\/\u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Additional analyses (e.g., by CVD history) revealed no further heterogeneity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In UK primary care, GLP\u20101RA persistence was suboptimal and dose escalation was frequently delayed across all patient stratifications, including individuals with established CVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70535","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:41:17Z","timestamp":1771393277000},"page":"3386-3395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Real\u2010world persistence and dose titration of\n                    <scp>GLP<\/scp>\n                    \u20101 receptor agonists in type 2 diabetes: A\n                    <scp>UK<\/scp>\n                    population\u2010based cohort study by obesity and cardiovascular disease status"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2278-7400","authenticated-orcid":false,"given":"Franziska S.","family":"Ulrich","sequence":"first","affiliation":[{"name":"Institute of Pharmaceutical Sciences ETH Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-8205","authenticated-orcid":false,"given":"Nicola","family":"Napoli","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology and Diabetes, Campus Bio\u2010Medico University of Rome  Rome Italy"},{"name":"Unit of Metabolic Bone and Thyroid Disorders, Fondazione Policlinico Universitario Campus Bio\u2010Medico University of Rome  Rome Italy"},{"name":"Division of Bone and Mineral Diseases Washington University  St Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5608-1589","authenticated-orcid":false,"given":"Morten Frost","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Odense University Hospital  Odense Denmark"},{"name":"Steno Diabetes Centre Odense Odense University Hospital  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7082-8530","authenticated-orcid":false,"given":"Andrea M.","family":"Burden","sequence":"additional","affiliation":[{"name":"Institute of Pharmaceutical Sciences ETH Zurich  Zurich Switzerland"},{"name":"Division of Clinical Immunology and Rheumatology, Heersink School of Medicine University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,17]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"IDF Diabetes Atlas, 11th Edition","author":"International Diabetes Federation","year":"2025"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0706245"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01655-5"},{"issue":"1","key":"e_1_2_10_5_1","first-page":"S181","article-title":"Pharmacologic approaches to glycemic treatment: standards of care in diabetes\u20142025","volume":"48","author":"Committee ADAPP","year":"2025","journal-title":"Diabetes Care"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05787-2"},{"key":"e_1_2_10_7_1","unstructured":"National Institute for Health and Care Excellence.Type 2 Diabetes in Adults: Management|NIC; 2022[cited 2025 July 15]. 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