Patient preferences for treatment in type 2 diabetes: the Italian discrete-choice experiment analysis
- 27 Downloads
Several drug classes are now available to achieve a satisfactory metabolic control in patients with type 2 diabetes (T2DM), but patients’ preferences may differ.
In a discrete-choice experiment, we tested T2DM patients’ preferences for recent antidiabetic drugs, in the event that their treatment might require intensification. The following attributes were considered: (a) route of administration; (b) type of delivery; (c) timing; (d) risk of adverse events; (e) effects on body weight. Twenty-two possible scenarios were built, transferred into 192 paired choices and proposed to 491 cases naïve to injectable treatments and 171 treated by GLP-1 receptor agonists (GLP-1RAs). Analyses were performed by descriptive statistics and random effects logit regression model.
Preferences according to dosing frequency, risk of nausea and urinary tract infections (UTls) were similar across groups, age, sex and BMI. Administration route and delivery type accounted for 1/3 of relative importance; the risk of UTIs, nausea and dosing frequency for ≈ 20% each, and weight loss for only 6%. Two significant interactions emerged (p < 0.01): type of delivery × group, and weight change × BMI class. Irrespective of previous treatment, the three preferred choices were injectable, coupled with weekly dosing and a ready-to-use device (first two choices). In a regression model, being naïve or non-naïve changed the ranking of preferences (p < 0.001), and the order was systematically shifted towards injectable medications in non-naïve subjects.
Easy-to-deliver, injectable treatment is preferred in T2DM, independently of treatment history, and previous experience with GLP-1RAs strengthens patients’ willingness to accept injectable drugs.
KeywordsAdverse events Dose frequency Glucagon-like peptide-1 receptor agonists Injectable drugs Nausea Oral treatment Route of delivery Sodium–glucose co-transporter 2 inhibitors Urogenital-tract infections Weight loss
The authors are indebted to Carlo Donato and Andrea Pulazzini, ThinkTank, Milan, Italy, for their support in implementing the DCE methodology.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Research involving human and/or animal rights
All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Montilla S, Marchesini G, Sammarco A et al (2014) Drug utilization, safety, and effectiveness of exenatide, sitagliptin, and vildagliptin for type 2 diabetes in the real world: data from the Italian AIFA Anti-diabetics Monitoring Registry. Nutr Metab Cardiovasc Dis 24:1346–1353. https://doi.org/10.1016/j.numecd.2014.07.014 CrossRefPubMedGoogle Scholar
- 14.Reaney M, Mathieu C, Ostenson CG et al (2013) Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study. Health Qual Life Outcomes 11:217. https://doi.org/10.1186/1477-7525-11-217 CrossRefPubMedPubMedCentralGoogle Scholar
- 18.Hauber AB, Nguyen H, Posner J et al (2016) A discrete-choice experiment to quantify patient preferences for frequency of glucagon-like peptide-1 receptor agonist injections in the treatment of type 2 diabetes. Curr Med Res Opin 32:251–262. https://doi.org/10.1185/03007995.2015.1117433 CrossRefPubMedGoogle Scholar
- 22.Marshall D, Bridges JF, Hauber B et al (2010) Conjoint analysis applications in health—How are studies being designed and reported? An update on current practice in the published literature between 2005 and 2008. Patient 3:249–256. https://doi.org/10.2165/11539650-000000000-00000 CrossRefPubMedGoogle Scholar
- 23.Qin L, Chen S, Flood E et al (2017) Glucagon-like peptide-1 receptor agonist treatment attributes important to injection-experienced patients with type 2 diabetes mellitus: a preference study in Germany and the United Kingdom. Diabetes Ther 8:335–353. https://doi.org/10.1007/s13300-017-0237-8 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Qin L, Chen S, Flood E et al (2017) Glucagon-like peptide-1 receptor agonist treatment attributes important to injection-naive patients with type 2 diabetes mellitus: a multinational preference study. Diabetes Ther 8:321–334. https://doi.org/10.1007/s13300-017-0230-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Zheng SL, Roddick AJ, Aghar-Jaffar R et al (2018) Association between use of sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 agonists, and dipeptidyl peptidase 4 inhibitors with all-cause mortality in patients with type 2 diabetes: a systematic review and meta-analysis. JAMA 319:1580–1591. https://doi.org/10.1001/jama.2018.3024 CrossRefPubMedGoogle Scholar
- 31.Janssen EM, Hauber AB, Bridges JFP (2018) Conducting a discrete-choice experiment study following recommendations for good research practices: an application for eliciting patient preferences for diabetes treatments. Value Health 21:59–68. https://doi.org/10.1016/j.jval.2017.07.001 CrossRefPubMedGoogle Scholar