What Do Patients Want in a Diabetes Medication?

Interviews with people with type 2 diabetes (T2DM) revealed that dosing frequency and type of delivery system are two important attributes when it comes to selecting a treatment, according to the results of a study comparing two specific glucagon-like peptide (GLP)-1 agonists.

According to study researchers Heather L. Gelhorn, of Outcomes Research, Evidera, Bethesda, MD, and colleagues, these results differ from similar studies that found that “frequency of hypoglycemia, efficacy (ie, HbA1c change), weight change, and frequency of nausea are generally of greatest importance.”

“In contrast, the current study, with a very specific medication comparison dictating the design, suggests that dosing frequency and type of delivery system are of greatest importance to patients in this context,” Gelhorn and colleagues wrote.

For the study, in-person interviews were given to 243 participants with self-reported T2DM who were not currently taking injectable or oral medications for their diabetes. As part of the interview, participants were administered a discrete choice experiment that examined six attributes of T2DM treatment: dosing frequency, HbA1c change, weight change, type of delivery system, frequency of nausea, and frequency of hypoglycemia. The researchers calculated relative importance (RI) values for each attribute examined.

Results showed that participants ranked dosing frequency (RI=41.6%) and type of delivery system (RI=35.5%) as the most important attributes. The other attributes were all ranked as less important: frequency of nausea (RI=10.4%), weight change (RI=5.9%), HbA1c change (RI=3.6%), and frequency of hypoglycemia (RI=3.0%).

The researchers also looked at the medication preferences by participant sex. They found that dosing frequency and type of delivery system were ranked highest among both men and women, however, the most important attribute was significantly different between the groups with men ranking dosing frequency as more important and women ranking type of delivery system as more important (P<0.0001).

As part of the discrete choice experiment, the researchers included a question with a choice between two medication profiles representing the GLP-1 agonists dulaglutide and liraglutide. According to the researchers, the attributes of each medication represented the safety and efficacy of the drugs observed in the head-to-head clinical trial AWARD-6. Results indicated that 83.1% of patients preferred the profile for dulaglutide and 16.9% preferred liraglutide (P<0.0001).

“Also consistent with the findings of the DCE, a much larger proportion of the participants (77.0%) were willing to take the medication represented by the dulaglutide profile, while less than one-third of the participants (30.5%) were willing to take the medication represented by the liraglutide profile,” the researchers wrote.

“The study highlights the potential importance of nonclinical factors such as dosing frequency and type of delivery system as important drivers of patient preference,” the researchers wrote. “This information may help guide patient–clinician treatment discussions, and facilitate a shared decision-making process focusing on each patient’s specific needs and preferences.”

Gelhorn HL, et al. Evaluating preferences for profiles of GLP-1 receptor agonists among injection-naïve type 2 diabetes patients in the UK. Patient Prefer Adherence. 2015;9:1611-1622.