How Long-Term Continuity of Care Drives GLP-1 Pharmacotherapy Adherence

GLP-1 RAs are reshaping the treatment landscape for obesity, diabetes, and cardiometabolic disease, yet real-world outcomes often fall short of clinical trial data. Discontinuation rates remain high, adherence is inconsistent, and many patients cycle on and off therapy without sustained benefit ¹. Evidence shows long-term continuity of care is strongly associated with improved medication adherence, reduced healthcare utilization, and lower mortality across chronic disease populations ²-⁴.

“Without structured, timely follow-up, patients are often left to manage predictable challenges independently, therefore increasing likelihood of early discontinuation and risk of weight cycling, which may contribute to worsening metabolic health long-term”.

Pharmacotherapy Adherence is Highly Influenced by Care Continuity

Real-world data suggest that more than half to two-thirds of patients discontinue GLP-1 RAs within the first year of treatment, with the highest drop-off occurring within the first 3 to 6 months ¹,⁵. Patients without a type 2 diabetes diagnosis are more likely to discontinue pharmacotherapy ⁵. Outside of cost and access barriers, common reasons for patient discontinuation of medication use include GI side effects, unmet expectations, and lack of ongoing clinical support during dose titration.

These findings mirror adherence trends seen across chronic cardiometabolic conditions, where treatment persistence declines rapidly when care is episodic rather than longitudinal. GLP-1 therapy requires sustained engagement across medication titration, side effect management, medical nutrition therapy, and behavioral adaptation. Without structured, timely follow-up, patients are often left to manage predictable challenges independently, therefore increasing likelihood of early discontinuation and risk of weight cycling, which may contribute to worsening metabolic health long-term.

Continuity of Care is Associated with Improved Medication Adherence

Multiple systematic reviews demonstrate a strong association between continuity of care and improved medication adherence across chronic disease states. A landmark systematic review by Pereira Gray et al. found that higher continuity of care was consistently associated with improved adherence, reduced hospitalizations, and lower mortality ². These associations persisted across healthcare systems, provider types, and patient populations.

In diabetes care specifically, higher continuity with the same clinician or care team has been associated with better glycemic regulation, greater medication persistence, and fewer acute complications ³,⁶. Continuity enables clinicians to identify early barriers to adherence, adjust treatment plans over time, and intervene before patients disengage from care.

For GLP-1 therapy, where early side effects and uncertainty are common, continuity allows providers to normalize expected experiences, provide anticipatory guidance, and individualize treatment decisions rather than responding reactively after discontinuation has already occurred.

Therapeutic Alliance Is a Key Mechanism of Action

Continuity of care strengthens the therapeutic alliance, which has been shown to directly influence medication adherence and patient engagement. Patients who report higher trust in their care team are more likely to disclose side effects, adhere to treatment recommendations, and persist with long-term therapies despite challenges ⁷.

Patients living with obesity and diabetes often have a history of weight stigma and fragmented care. Repeated handoffs and short-term encounters can reinforce disengagement. Continuity reduces this burden by allowing care to become contextual and relational, rather than transactional. This is particularly relevant for GLP-1 therapy, as many patients discontinue medications without notifying their prescriber. Longitudinal relationships increase the likelihood that concerns are addressed early, when course correction is still possible.

“Patients who report higher trust in their care team are more likely to disclose side effects, adhere to treatment recommendations, and persist with long-term therapies despite challenges ⁷”.

Continuity Reduces Utilization and Improves System-Level Outcomes

From a health system perspective, continuity of care is associated with meaningful reductions in utilization and cost. Higher continuity has been linked to fewer emergency department visits, lower hospitalization rates, and reduced total healthcare spending ³,⁴.

In patients with diabetes, greater continuity is associated with fewer preventable hospitalizations and lower rates of complications related to poor glycemic control ⁶. These findings are increasingly relevant as GLP-1 therapies are incorporated into value-based care arrangements, where persistence and metabolic durability directly influence financial performance. High-cost therapies with poor persistence generate waste. Continuity improves the likelihood that patients remain on therapy to achieve durable and continuous benefit, protecting both clinical outcomes and system investment.

Team-Based Continuity and the Role of Dietitians

Continuity does not require that all care be delivered by a single physician. Evidence supports team-based continuity models in which patients engage consistently with a defined multidisciplinary care team operating under a shared longitudinal plan.

“Multidisciplinary approaches that include registered dietitians have been shown to improve adherence, metabolic outcomes, and patient satisfaction in obesity and diabetes care ⁸”.

Nutrition-related challenges are among the most common contributors to GLP-1 discontinuation, including inadequate protein intake, intolerable GI side effects, and fatigue related to inadequate nutrient intake. Dietitians embedded longitudinally can proactively address these issues, support lean mass preservation, and help patients navigate appetite changes and plateaus. This ongoing support reduces avoidable discontinuation and reinforces sustainable behaviors throughout treatment.

Implications for Healthcare Leaders

For healthcare administrators, continuity of care represents a strategic investment rather than a cost center. Longitudinal care models improve clinical outcomes, stabilize high-cost medication utilization, and support patient retention. Fragmented models that prioritize initiation over persistence are misaligned with both patient needs and value-based performance metrics. Health systems that invest in continuity infrastructure, including consistent care teams, proactive follow-up, and integrated nutrition support, are better positioned to realize the full clinical and economic value of GLP-1 therapies.

Conclusion

Ultimately, continuity of care is essential as it improves medication adherence, clinical outcomes, and healthcare efficiency across chronic disease management. GLP-1 therapy is no exception. For patients living with obesity, diabetes, and cardiometabolic disease, long-term success with GLP-1s depends not only on access to medication but on sustained relationships with a care team that adapts alongside them.

Key Takeaways

• GLP-1 pharmacotherapy requires sustained clinical engagement for dose titration, side-effect management, and behavioral adaptation.
• Therapeutic alliance and patient trust are key mechanisms supporting persistent medication adherence.
• Team-based continuity models outperform initiation-focused approaches, especially with inclusion of longitudinal dietitian and psychologist involvement.
• Investing in continuity infrastructure aligns clinical outcomes with value-based care goals and reduces system-level waste.