Patient and physician preferences for type 2 diabetes medications: a systematic review

Toroski, Mahdi; Kebriaeezadeh, Abbas; Esteghamati, Alireza; Karyani, Ali Kazemi; Abbasian, Hadi; Nikfar, Shekoufeh

doi:10.1007/s40200-019-00449-4

Cited by 27 publications

(16 citation statements)

References 49 publications

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“…When given information on their weight on all three therapies only 45% of participants chose the drug resulting in the lowest weight for them. This is in contrast to other studies which have indicated that weight is an important attribute in treatment choice 6,7 , with 84% of patients rating weight as important in a recent meta-analysis 7 . However, these studies are based on evaluating options in hypothetical scenarios, rather than the patients comparing their own lived experience on the three drugs.…”

Section: Discussioncontrasting

confidence: 91%

Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study

Shields

Angwin

Shepherd

et al. 2022

Nat Med

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Patient preference is key for medication selection in chronic medical conditions, like type 2 diabetes, where there are many different drugs available. Patient preference balances potential efficacy with potential side effects. As both aspects of drug response can vary markedly between individuals this decision could be informed by the patient personally experiencing the alternative medications, as occurs in a crossover trial. In the TriMaster (NCT02653209, ISRCTN12039221), randomised doubleblind, three-way crossover trial. patients received three different second or third line once-daily type 2 diabetes glucose-lowering drugs (pioglitazone 30mg, sitagliptin 100mg, and canagliflozin 100mg). As part of a prespecified secondary analysis we examined patients' drug preference after they had tried all 3 drugs. 448 participants were treated with all three drugs which overall showed similar glycaemic control (HbA1c on pioglitazone 59.5 sitagliptin 59.9, canagliflozin 60.5mmol/mol, p=0.19). 115 patients (25%) preferred pioglitazone, 158 (35%) sitagliptin, 175 (38%) canagliflozin. The drug preferred by individual patients was associated with a lower HbA1c (mean 4.6 [95%CI 3.9, 5.3]mmol/mol lower vs. non-preferred) and fewer side effects (mean 0.50[0.35, 0.64] fewer side effects vs. non-preferred). Allocating therapy based on individually preferred drugs, rather than allocating all patients the overall most preferred drug (canagliflozin), would result in more patients achieving the lowest HbA1c for them (70% v 30%) and the fewest side effects (67% v 50%). When precision approaches do not predict a clear optimal therapy for an individual, allowing patients to try potential suitable medications before they choose long term therapy could be a practical alternative to optimising treatment for type 2 diabetes.

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Section: Discussioncontrasting

confidence: 91%

Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study

Shields

Angwin

Shepherd

et al. 2022

Nat Med

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“…Weight Control For some patients with T2DM, weight control was ranked as very important, as measured in willingness-to-pay or discrete-choice exercises [ 105 , 129 ], and was a concern when starting insulin therapy [ 131 , 133 ]. Weight self-monitoring in obesity was considered as fostering ownership and self-knowledge, increasing the ability to understand and self-control weight loss and maintenance success [ 134 ].…”

Section: Resultsmentioning

confidence: 99%

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews

Guzmán

García

Orrego

et al. 2021

Patient

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Background Self-management (SM) interventions are supportive interventions systematically provided by healthcare professionals, peers, or laypersons to increase the skills and confidence of patients in their ability to manage chronic diseases. We had two objectives: (1) to summarise the preferences and experiences of patients and their caregivers (informal caregivers and healthcare professionals) with SM in four chronic diseases and (2) to identify and describe the relevant outcomes for SM interventions from these perspectives. Methods We conducted a mixed-methods scoping review of reviews. We searched three databases until December 2020 for quantitative, qualitative, or mixed-methods reviews exploring patients' and caregivers' preferences or experiences with SM in type 2 diabetes mellitus (T2DM), obesity, chronic obstructive pulmonary disease (COPD), and heart failure (HF). Quantitative data were narratively synthesised, and qualitative data followed a three-step descriptive thematic synthesis. Identified themes were categorised into outcomes or modifiable factors of SM interventions. Results We included 148 reviews covering T2DM (n = 53 [35.8%]), obesity (n = 20 [13.5%]), COPD (n = 32 [21.6%]), HF (n = 38 [25.7%]), and those with more than one disease (n = 5 [3.4%]). We identified 12 main themes. Eight described the process of SM (disease progression, SM behaviours, social support, interaction with healthcare professionals, access to healthcare, costs for patients, culturally defined roles and perceptions, and health knowledge), and four described their experiences with SM interventions (the perceived benefit of the intervention, individualised care, sense of community with peers, and usability of equipment). Most themes and subthemes were categorised as outcomes of SM interventions. Conclusion The process of SM shaped the perspectives of patients and their caregivers on SM interventions. Their perspectives were influenced by the perceived benefit of the intervention, the sense of community with peers, the intervention's usability, and the level of individualised care. Our findings can inform the selection of patient-important outcomes, decisionmaking processes, including the formulation of recommendations, and the design and implementation of SM interventions.

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“…Although previous reports from the EMPA‐REG OUTCOME trial have reported consistent CV and HF benefits, regardless of the magnitude of reduction in HbA1c with empagliflozin, 24 a better understanding of the clinical efficacy of glucose‐lowering drugs across the spectrum of cardio‐metabolic characteristics may help to better individualize therapy 12,13 . These are therefore important data to consider when choosing add‐on therapy to metformin for patients with specific glycaemic or weight considerations.…”

Section: Discussionmentioning

confidence: 98%

“…A better understanding of the clinical efficacy of specific glucose‐lowering drugs across phenotypical characteristics of key cardio‐metabolic factors will help clinicians to better tailor therapy, while potentially helping patients achieve their treatment goals. This is particularly important when discussing the efficacy of different glucose‐lowering drugs as second‐line therapy to metformin, also in the context of the need to take patient preferences into account when selecting therapy 12,13 and the treatment inertia that often occurs during T2D management 14 …”

Section: Introductionmentioning

confidence: 99%

Empagliflozin treatment effects across categories of baseline HbA1c, body weight and blood pressure as an add‐on to metformin in patients with type 2 diabetes

Inzucchi

Davies

Khunti

et al. 2020

Diabetes Obesity Metabolism

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Aim To investigate the association of different categories of baseline cardio‐metabolic risk factors on the treatment effects of empagliflozin 10 and 25 mg when added as second‐line therapy to metformin in patients with type 2 diabetes (T2D). Materials and Methods Patients aged 18 years or older with HbA1c 7.0%‐10.0% were included. Analysis of covariance compared change from baseline to weeks 24 and 76 in HbA1c, body weight (BW) and systolic blood pressure (SBP) by respective baseline categories (HbA1c <8.5/≥8.5%; BW <80/80‐90/>90 kg, SBP <130/130‐140/>140 mmHg). Analyses were also conducted with a model using continuous covariates of cardio‐metabolic factors. Results In total, 637 patients (56.7% males; mean [SD] age 55.7 [9.9] years, HbA1c 7.9% [0.9%], BW 81.2 [18.8] kg, SBP 129.4 [14.6] mmHg) received one or more dose of either empagliflozin 10 mg (n = 217) or 25 mg (n = 213), or placebo (n = 207). At both time points, empagliflozin 10/25 mg versus placebo significantly ( P < .0001) reduced HbA1c and BW, with greater reductions in HbA1c at higher baseline HbA1c ( P interaction week 24/76 categorical and continuous models: .0290/.1431 and .0004/.0042, respectively) and in BW ( P interaction .1340/.0012 and .0202/<.0001, respectively). Both empagliflozin doses also significantly lowered SBP versus placebo at both time points, with similar efficacy by subgroups of baseline SBP. Adverse events were consistent with the established empagliflozin safety profile across treatment groups. Conclusions Empagliflozin, as add‐on to metformin, decreases HbA1c and BW, particularly in patients with higher HbA1c and BW baseline values, and effectively lowers SBP.

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Patient and physician preferences for type 2 diabetes medications: a systematic review

Cited by 27 publications

References 49 publications

Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study

Patient preference for second- and third-line therapies in type 2 diabetes: a prespecified secondary endpoint of the TriMaster study

The Perspectives of Patients with Chronic Diseases and Their Caregivers on Self-Management Interventions: A Scoping Review of Reviews

Empagliflozin treatment effects across categories of baseline HbA1c, body weight and blood pressure as an add‐on to metformin in patients with type 2 diabetes

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