Physician perspectives on de-intensifying diabetes medications

Genere, Natalia; Sargis, Robert M.; Masi, Christopher M.; Nathan, Aviva G.; Quinn, Michael T.; Huang, Elbert S.; Laiteerapong, Neda

doi:10.1097/md.0000000000005388

Cited by 12 publications

(25 citation statements)

References 32 publications

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“…Physicians' agreement with the concept of individualising HbA1c goals did not significantly differ between physicians from different demographics. Unlike a previous study, which showed that female physicians had a higher possibility of initiating such conversations with their patients, 23 we found that male physicians showed a higher possibility of initiating conversations about antidiabetic therapy de‐intensification compared with females. Previous studies showed that male physicians usually have shorter durations of consultations with their patients than female physicians, ask them less questions, and do not discuss physical activities and lifestyle with them 36‐40 .…”

Section: Discussioncontrasting

confidence: 99%

“…Genere and colleagues' questionnaire, which was developed to understand physicians' awareness of, agreement with and their practices of individualising HbA1c goals and antidiabetic treatment de‐intensification. In addition, it has been used to identify HbA1c level at which physicians start treatment de‐intensification and what important patient factors that motivate them to consider such practice 23 . In addition, Grant and colleagues' questionnaire, which was used to assess factors affecting physicians' treatment choice when prescribing antidiabetic treatment for patients with type 2 DM has been used 24…”

Section: Methodsmentioning

confidence: 99%

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The perspectives of physicians regarding antidiabetic therapy de‐intensification and factors affecting their treatment choices—A cross‐sectional study

et al. 2020

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Background: Comprehensive diabetes management includes an appropriate dietary plan, exercise, and antidiabetic medications. Nevertheless, the target glycaemic control is not always achieved using single antidiabetic, patients may need to start treatment intensi cation by increasing the dose of the single antidiabetic agent or by the administration of antidiabetic combination therapy. However, it has been shown that intensive antidiabetic therapy should be used carefully as it is associated with an increased risk of adverse events and death. The aim of this study is to understand physicians' perspectives regarding treatment de-intensi cation and factors affecting their treatment choice for patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted in governmental specialised primary and secondary care units in Saudi Arabia using online questionnaire. Two previously validated questionnaires were used to understand physicians' awareness of, agreement with, and their practices of individualising HbA1c goals and antidiabetic treatment de-intensi cation, and to assess factors affecting physicians' treatment choice when prescribing antidiabetic treatment for patients with type 2 diabetes mellitus. Study population were physicians who are treating patients with diabetes mellitus during the period between October 2018 and May 2019. Results: A total of 205 physicians have participated in the study. Approximately 50% of physicians had family medicine speciality (n = 98, 47.8%). The majority of physicians (n = 183, 89.3%) were familiar with the concept of HbA1c goals individualisation. However, only 66.3% of them (n = 136) reported that they apply it either always or most of the time. 58.5% (n = 120) of physicians reported that they would not initiate conversations about de-intensifying antidiabetic therapy even if their patients had a stable HbA1c values for one year. Physicians showed higher consideration to objective patient clinical data and their assessment of patient's health status, with minor consideration to patient-related factors. Conclusions: Healthcare professionals should focus more on implementing contemporary practices and applying any necessary treatment de-intensi cation. Subjective patient factors should be taken into account, as these factors are associated with better disease management.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The perspectives of physicians regarding antidiabetic therapy de‐intensification and factors affecting their treatment choices—A cross‐sectional study

et al. 2020

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“…A physician survey by Genere et al. found that targeting adherence is both impactful for treatment success and difficult to implement [ 28 ]. 2 European studies observed higher adherence rates for monitoring adherence than for screening adherence parameters [ 9 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

In guidelines physicians trust? Physician perspective on adherence to medical guidelines for type 2 diabetes mellitus

Brenner

Oberaigner

Stummer

2020

Heliyon

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Aims Adherence to treatment guidelines and treatment success are low in Type 2 diabetes mellitus (T2DM). This study aims to capture the physician perspective on T2DM guideline adherence and identify levers for increasing adherence. Methods A survey among German physicians captured the perceived value of 4 areas in the national treatment guideline (NVL), 13 possible barriers, and 9 possible enablers for guideline adherence. Perceived value was assessed by ranking 4 NVL areas by implementation difficulty and impact on treatment success. Barriers and enablers were assessed by rating their influence on guideline deviation and adherence. The consistency of results across subgroups was assessed using Fisher's exact test. Results Responses from 46 physicians showed a strong consensus about the value of each NVL area. Physicians perceived patient inability and demotivation to be the strongest adherence barriers (93%, 78%). All queried enablers were approved by ≥ 50% of participants. Physicians considered cross-provider collaboration and electronic therapy decision support as strongest enablers (85%, 80%). Consistency was high between subgroups. Conclusion This study suggests that physicians consider patient-related factors to be stronger barriers for guideline adherence than physician-related factors. Finding opportunities to increase physician buy-in is important for better guideline adherence. In this study, physicians voiced appreciation for adherence enablers based on digital solutions to support the care process and to reduce the complexity of therapy decisions.

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“…The reason could be the familiarity and awareness about the individualized HbA1C goals in patients with T2D among older physicians. In a recent study, physicians widely used the concept of individualizing glycemic goals 24 .…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the discontinuation of dipeptidyl peptidase-4 inhibitors (DPP-4is) after initiation of insulin

Fernandes

Matos

Jaffe³

et al. 2019

Current Medical Research and Opinion

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Objective: Type 2 diabetes (T2D) is a prevalent health problem. Oral agents, with the exception of metformin, are often discontinued with the initiation of insulin. The objective was to understand the proportion of patients discontinuing dipeptidyl peptidase-4 inhibitors (DPP-4is) and the reasons for the decision to discontinue. Methods: A retrospective study using a health claims database investigated discontinuation of DPP-4i in adult patients on a dual therapy of metformin and DPP-4i who initiated insulin (n ¼ 3391). An online survey administered to 406 physicians in the US examined reasons for discontinuation. Physicians surveyed included endocrinologists (34.5%), general practitioners (32.5%), internal medicine specialists (30.5%), and diabetologists (2.5%), treating a monthly average of 154 patients. Results: Among patients treated with metformin and DPP-4is who were newly prescribed insulin, 33.3 and 57.3% discontinued DPP-4i therapy within 3 and 12 months, respectively. Patients who discontinued DPP-4i therapy had higher out-of-pocket costs and a greater proportion of renal and liver disease. Top 3 responses for discontinuation included adverse events/tolerability issues (58.9%), lack of efficacy/treatment goals not being met (55.4%) and additional cost of DPP-4i with insulin (48.5%). Top 3 responses for continuing DPP-4i included meeting treatment goals (70.7%), using a lower dose of insulin (65.3%) and good tolerability (48.0%). Physician characteristics, such as physician specialty, age, gender and location impacted to some extent the reasons for treatment decisions. Conclusions: A large proportion of patients discontinue DPP-4is in the real world when initiating insulin. The impact of physician characteristics in treatment decisions highlights the need for enhanced physician training and support as new clinical data emerges and therapy options are available.

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Physician perspectives on de-intensifying diabetes medications

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 32 publications

The perspectives of physicians regarding antidiabetic therapy de‐intensification and factors affecting their treatment choices—A cross‐sectional study

The perspectives of physicians regarding antidiabetic therapy de‐intensification and factors affecting their treatment choices—A cross‐sectional study

In guidelines physicians trust? Physician perspective on adherence to medical guidelines for type 2 diabetes mellitus

Factors associated with the discontinuation of dipeptidyl peptidase-4 inhibitors (DPP-4is) after initiation of insulin

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