Real-world treatment patterns and adherence among privately insured patients with type 2 diabetes in Saudi Arabia: a retrospective cohort study using national claims data
Shabab Alghamdi, Ibrahim Abdulrahman Aljuffali, Ahmed M AlDammas, Nebras Abu Alhamayel, Muhammed Jumaah, Mirna Matni, Joelle Barhoun, Saeed Mastour Alshahrani, Nada AlagilObjectives
Type 2 diabetes mellitus (T2DM) imposes clinical and economic burdens worldwide, with the Kingdom of Saudi Arabia (KSA) reporting among the highest prevalence rates in the Middle East and North Africa (MENA) region. Despite national diabetes initiatives under Vision 2030 and recent guideline implementation, evidence on T2DM management among privately insured beneficiaries remains limited. This study aimed to provide one of the first real-world assessments of antidiabetic treatment patterns, therapy modifications, medication adherence and guideline-recommended glycaemic monitoring among privately insured patients with T2DM in KSA.
Design
Longitudinal retrospective cohort study.
Setting
A national claims-based analysis was conducted using the National Platform for Health Information Exchange Services (NPHIES), covering privately insured beneficiaries across KSA. The study period spanned from 1 September 2022 to 31 December 2024.
Participants
Eligible participants were privately insured individuals aged ≥15 years with a diagnosis of T2DM, defined as having at least one medical claim of T2DM (International Classification of Diseases, 10th Revision, Australian Modification code E11) and continuous insurance enrolment for a minimum of 12 months (including ≥180 days pre-index and ≥180 days post-index). The index date was defined as the earliest observed antidiabetic prescription within the study window. A total of 187 797 patients met the inclusion criteria and were included in the final analysis.
Primary and secondary outcome measures
The primary outcomes were antidiabetic real-world treatment patterns and therapy modifications, including treatment escalation, switching, early discontinuation and medication adherence. Secondary outcomes included guideline-recommended laboratory testing of glycaemic control for haemoglobin A1c (HbA1c), plasma glucose tests and oral glucose tolerance test. Claims were linked to the Council of Health Insurance’s internal product dictionary using the NPHIES product/service code to retrieve the standardised product name and activity type. Data extraction used Structured Query Language-based queries and Python transformation.
Results
Patients had a mean age of 53.7 years, while T2DM rates reached 47.4 per 1000 insured men and 43.8 per 1000 insured women. Combination therapy accounted for 29.4% of initial treatment regimens among eligible patients with T2DM. Biguanide monotherapy users exhibited switching and escalation rates of 9% and 7%, respectively, while 35% of sulfonylurea users exhibited escalation. Treatment discontinuation was observed in 22% of users of combination therapies, 22% of SGLT2 inhibitor users and 19% of sulfonylurea users. The medication possession ratio was 0.87 for insulin users. Regarding laboratory monitoring, 61% of patients had at least one glycaemic test 6 months prior to therapy initiation. Laboratory testing reached 73% following therapy initiation.
Conclusion
The Saudi experience suggests that integrated national claims platforms, supported by standardised coding and e-prescribing, can play a critical role in advancing real-world evidence generation and informing diabetes management strategies in KSA and across MENA health systems.