Doctors Weigh Cardiovascular Risk Reduction Over Side Effects for Antihyperglycemic Agents

Abhinav Sharma, MD, PhD

It is not well understood what the attributes health care providers should consider when prescribing oral antihyperglycemic agents to treat diabetes.

However, in data presented during the annual American Heart Association 2021 conference, investigators have identified through an online survey the attributes prescribers generally prefer when doling out these medications.

A team, led by Abhinav Sharma, MD, PhD, McGill University Health Center, evaluated the drug attributes preferred by health care providers of empagliflozin 25 mg (SGLT2i), oral semaglutide 14 mg (GLP-1 RA) and sitagliptin 100 mg (DPP-4 inhibitor).

Online Surveys

In the PREFER-DM trial, the investigators used conjoint analysis to evaluate the 3 oral antihyperglycemic treatments by sending an online survey via email to health care providers who regularly treat patients with type 2 diabetes.

Each participant was asked to select from 6 hypothetical, blinded pair-wise drug profile comparisons of different drug benefits and side effects and risk attributes.

The attributes were derived from published trials and US Food and Drug Administration (FDA) labeling data. The investigators calculated the relative importance of 1 attribute relative to others.

Respondents

Overall, 12,806 health care providers received the survey, with 1052 individuals completing the questionnaires. Of this, 35% (n = 365) were primary care physicians, 33% (n = 350) were endocrinologists, and 32% (n = 337) were cardiologists.

The most important perceived attribute was the risk reduction of cardiovascular death (z-test P <0.05), with attributes of reductions in heart failure, risk of nausea or vomiting, decreasing progression of renal disease, and weight reduction considered to have similar importance.

The least selected attributes were food and medication restrictions and A1c lowering followed by risk of diabetic ketoacidosis, risk of genital infection, and the avoidance of severe hypoglycemia.

In addition, the relative ordering of attributes remained consistent across the different specialists.

“HCPs across specialties prefer oral antihyperglycemic drug attributes associated with [cardiovascular] risk reduction over side effect profile, tolerability, and adverse outcomes,” the authors wrote. “Whether these preferences translate to prescription patterns and patient acceptance of oral antihyperglycemic drugs in clinical settings remains to be investigated.”

The study, “Provider Evaluation for Selection of Evidence-Based Therapies to Reduce Cardiovascular Complications in Patients With Type 2 Diabetes Mellitus Study - Primary Results of the PREFER-DM Study,” was published online by AHA.