Factors associated with physicians’ decision to discontinue or down-titrate sulfonylureas for type 2 diabetes patients

ABSTRACT

Background: Sulfonylureas (SUs) can help manage type 2 diabetes mellitus, but often have side effects. The objective of this study was to identify factors impacting physicians’ decisions to discontinue (DC) or down-titrate (DT) SU therapy.

Methods: 1,026 physicians from the All Global panel were asked to rate level of concern regarding potential reasons for DC or DT on a 7-point Likert scale (1 = not concerned, 7 = extremely concerned). Physicians also provided information regarding treatment decisions from one DC patient, one DT patient, and two current SU users.

Results: When asked to report what factors might lead them to DC or DT an SU, physicians reported that hypoglycemic events requiring medical assistance (DC = 6.0, DT = 5.9), hypoglycemic events requiring nonmedical assistance (DC = 5.9, DT = 5.9), other hypoglycemic events not requiring assistance (DT = 5.7), and treatment goals not being met (DC = 5.6) were most concerning. DC and DT patients were more likely to have experienced ≥ 1 hypoglycemic events in the previous year vs. current users (DC = 41.0%, DT = 43.1%, current = 8.8%; p < .05).

Conclusions: Results highlight the strong influence  of hypoglycemia on physicians’ decisions to DC or DT SU therapy.

KEYWORDS:

• Hypoglycemia
• discontinuation
• down-titration
• physician attitudes
• sulfonylureas

Declaration of interest

K Iglay is a current employee and stockholder of Merck & Co., Inc., Kenilworth, NJ USA. K Kurtyka, P Laires, Y Qiu, and S Yu were employees of Merck & Co., Inc., Kenilworth, NJ USA at the time that the study was conducted. EA Witt was an employee of Kantar Health, Princeton, NJ USA and worked on this project as a paid consultant of Merck & Co., Inc., Kenilworth, NJ USA at the time this study was conducted. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Data previously presented at previously presented at the ISPOR 20th Annual International Meeting in Philadelphia, Pennsylvania, May 16-20, 2015.

Reviewer disclosures

A reviewer on this manuscript has disclosed employed at a pharmaceutical company (Merck & Co., Inc. in the US and Canada, known as MSD outside the US and Canada) that markets non-sulfonylurea antihyperglycemic agents for patients with type 2 diabetes.

Author contributions

PL, EW, YQ, and KI were involved in the conception and design of the study. EW performed the analysis and all-co-authors interpreted the data. EW drafted the initial manuscript and all co-authors critically revised the draft for intellectual content. All co-authors approve the final version of the manuscript and are accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

Funding for this research was provided by Merck & Co. Inc., Kenilworth, NJ, USA.