Living With Type 2 Diabetes

Abstract


 We conducted a custom technology review to narratively describe treatment outcomes and considerations important to people living with type 2 diabetes mellitus (T2DM) in Canada, as detailed in patient input provided to CADTH in the past. Patient groups submitted the input described in this review to inform CADTH Reimbursement Reviews, which advise reimbursement decisions made by public drug programs in Canada. CADTH staff produced this report through close engagement with representatives from patient groups that had contributed these inputs, including Diabetes Canada, Type 2 Diabetes Experience Exchange (T2DXX), and Patient Commando. This learning project provided an opportunity for CADTH to explore patient input in a new but rigorous way outside of the time constraints of Reimbursement Reviews for specific drugs.
 In past patient input, people living with T2DM emphasized that the condition demands intensive, perpetual self-management and has a profound and usually negative impact on their physical, psychosocial, and economic well-being.
 People living with T2DM want a cure for the condition. In the meantime, to improve their quality of life, they desire treatments that reduce the risk of hyperglycemia and its short- and long-term complications; facilitate weight loss; and improve their mental state, focus, and energy levels. They also desire treatments that can lessen the burden of medication administration, specifically by decreasing polypharmacy and dose frequency and allowing for easy storage, preparation, and administration. They would like medications to reduce the need for blood glucose checks, injections, and insulin, and they hope that new treatments can promote a return to normalcy by providing the freedom to eat and do what they want, when they want.
 In addition to these desired treatment outcomes, people living with T2DM want medications that cause few or no adverse effects, especially hypoglycemia, weight gain, and gastrointestinal and urogenital side effects.
 All patient input emphasized the need to increase access to and affordability of T2DM treatments in Canada. When discussing the contexts in which people living with T2DM access and use medications, patient groups also stressed the importance of respect and effective communication in therapeutic and interprofessional relationships; the need to provide and enhance knowledge to support informed decisions about and safe use of medications; and the importance of offering people with T2DM individualized treatment plans and a variety of choices.
 Patient groups reported limited demographic information on the people they surveyed and interviewed to inform their inputs. Inputs providing demographic information, however, showed that the voices of those belonging to equity-deserving groups in Canada were missing or underrepresented. The treatment outcomes and considerations emphasized in past patient input may differ from those important to members of these groups or may carry additional meaning or significance to them. Future avenues of inquiry and active engagement could focus on gaining insight into the perspectives and preferences of equity-deserving groups that include but are not limited to Black people, Indigenous people, and other people of colour; people living in poverty or with low income; people living in rural and remote communities; adolescents and adults aged 25 years or younger; and members of the LGBTQ2S+ community.