Long-term adherence to glucose-lowering therapy and cardiovascular risk in type 2 diabetes: a nationwide cohort study
In brief
Consistent glucose-lowering therapy adds about seven months event-free survival
In a Danish cohort of 79,500 newly diagnosed type 2 diabetics, those who maintained high medication adherence experienced 27% fewer cardiovascular events and lived roughly 220 days longer without heart disease, stroke, or heart failure over ten years compared with low-adherence patients. The benefit was driven mainly by reduced ischemic heart disease, highlighting adherence as a key preventive target.
- Journal
- The Lancet regional health. Europe (Q1)
- Published
- 31 July 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Lise B Nielsen, Andreas Bartholdy, Tri-Long Nguyen, Majken K Jensen, Simon Rasmussen, Marta Guasch-Ferré, et al.
- PMID
- 42571372
- DOI
- 10.1016/j.lanepe.2026.101795
Why clinicians should know about it
- Picked for Endocrinology, Diabetes and Metabolism (paper of the day, 10 August 2026).
- Picked for Internal Medicine (paper of the day, 10 August 2026): Long-term adherence to glucose‑lowering therapy linked to CV risk
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.