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Abstract
Objective:
Understanding patients’ preferences for attributes of injectable antihyperglycemic regimens may improve patient satisfaction and medication adherence. Our objective was to quantify the preferences of patients with type 2 diabetes mellitus (T2DM) for reducing the frequency of glucagon-like peptide-1 receptor agonist injections from once daily to once weekly.
Methods:
A total of 643 respondents with a self-reported physician diagnosis of type 2 diabetes completed a web-based discrete-choice experiment survey. The sample included four prespecified subgroups: currently using exenatide once weekly (n = 150), liraglutide once daily (n = 153), insulin (but not exenatide once weekly or liraglutide) (n = 156), and no injectable treatment (n = 184). Device attributes included type of injection device, needle size and pain, injection frequency, refrigeration, and injection-site reactions. Random-parameters logit was used to estimate the relative impact of device attributes on treatment choice for each subgroup.
Results:
In all subgroups, changing injection frequency from daily to weekly (independent of the effect of injection frequency on preferences for other attributes) was the most important predictor of treatment choice. Switching from a longer and thicker needle to a shorter and thinner needle and eliminating injection-site reactions were also statistically significant predictors of device choice (P < 0.05). Exenatide once weekly users and those not currently using injections were more likely to choose a treatment with characteristics similar to exenatide once weekly.
Conclusions:
The treatment attribute most important to patients choosing among hypothetical injectable treatments for T2DM was injection frequency: patients preferred weekly over daily injections.
Limitations:
The primary limitations of this study are that it included only a limited number of attributes that may not reflect the full complexity of patient choices, diagnosis was self-reported, and patients were recruited from an Internet panel and may not be representative of the T2DM patient population.
Transparency
Declaration of funding
This study was funded by Bristol-Myers Squibb and AstraZeneca.
Author contributions
Employees of AstraZeneca helped to author the manuscript. All authors meet the criteria for authorship as recommended by the International Committee for Medical Journal Editors, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
Declaration of financial/other relationships
H.N. and J.R. have disclosed that they are employees of AstraZeneca. A.B.H. and J.P. have disclosed that they are employees of RTI Health Solutions, which received research funding from Bristol-Myers Squibb and AstraZeneca. J.R. has disclosed that he owns stock in AstraZeneca. I.K. has disclosed that he was an employee of AstraZeneca during the time this study was conducted.
CMRO peer reviewer 1 has received consultancy fees, research grants, speaker fees and travel support from Insuline Medical. Peer reviewer 2 has disclosed that he is a recipient of research/grant funding from sanofi-aventis, Eli Lilly, Novo Nordisk, Merck, Sharpe & Dohme, Takeda, Pfizer and Servier; is a consultant/advisor to sanofi-aventis, Eli Lilly, Novo Nordisk, MSD, Novartis, BMS-AstraZeneca, Takeda, Boehringer Ingelheim and Servier; and is a member of the speaker’s bureaus for sanofi-aventis, Eli Lilly, Novo Nordisk, Merck, Sharpe & Dohme, Novartis, BMS-AstraZeneca, Takeda and Boehringer Ingelheim. Peer reviewer 3 has disclosed that he is the recipient of sponsorship funding to attend meetings on behalf of Merck and Sharpe & Dohme; is a consultant for Merck and Sharpe & Dohme; and is a member of the speaker’s bureaus for Merck, Sharpe & Dohme and Genzyme. Peer Reviewer 4 has disclosed that he is the recipient of research/grant funding from GlaxoSmithKline, Novartis, Novo Nordisk, Takeda, AstraZeneca, NIH, sanofi-aventis, Eli Lilly and Daiichi-Sankyo; is a consultant to, and lecturer for, GlaxoSmithKline, Novartis, Takeda, sanofi-aventis, Eli Lilly and Daiichi Sankyo; and is on the speaker’s bureau for Novo Nordisk and sanofi-aventis.
Acknowledgments
The authors gratefully acknowledge the contributions of Emily Haydysch of RTI Health Solutions for assisting with the qualitative interviews, Claire Ervin of RTI Health Solutions for leading the qualitative interviews and assisting with the pretest interviews, Susan LaRue of AstraZeneca for assistance in survey development, and Kate Lothman and Catherine Copley-Merriman of RTI Health Solutions and Mark Riotto of AstraZeneca for assistance in the preparation of this manuscript.