https://orcid.org/0000-0002-3144-8938
Abstract
Purpose
Hemoglobin A1c (HbA1c) is the accepted measure of effectiveness for type 1 diabetes therapies. We investigated preferences for measures of diabetes control in addition to HbA1c among adults with type 1 diabetes and caregivers of children with type 1 diabetes.
Methods
Using discrete-choice experiment methodology, surveys for adults with type 1 diabetes and caregivers presented choices between hypothetical treatments described by six attributes with varying levels: HbA1c, time in optimal glucose range, weekly number and severity of hypoglycemic and hyperglycemic events, additional disease management time, and additional treatment cost. Choice data were analyzed using random-parameters logit.
Results
A total of 300 adults with type 1 diabetes and 400 caregivers completed the survey. Adults and caregivers placed the most importance on reducing hypoglycemic and hyperglycemic events. For adults, avoiding 1–5 mild-to-moderate hypoglycemic events (glucose 54–69 mg/dL)/week was five times more important than being a half-point above target HbA1c. Avoiding 1–5 hyperglycemic events (glucose >180 mg/dL)/week was seven times more important than being a half-point above target HbA1c. Additional time in optimal glucose range was as important as a reduction greater than a half-point in HbA1c. Avoiding hyperglycemic and hypoglycemic events was more important than all other outcomes for caregivers of younger children. Caregivers of children >12 years placed relatively more weight on avoiding hypoglycemic events <54 mg/dL than those with younger children and preferred avoiding additional costs.
Conclusion
Adults with type 1 diabetes and caregivers prioritize controlling hypoglycemic and hyperglycemic events, including mild-to-moderate events. These preferences should be considered in drug development and regulatory decisions.
Graphical Abstract
Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use:
Ethics
The study was reviewed and granted an exemption from full review by the RTI International Institutional Review Board (submission no. 14231). All participants provided informed consent electronically. The study followed the guidelines outlined in the Declaration of Helsinki.
Acknowledgments
Kimberly Moon of RTI Health Solutions provided overall project management for this study. Kate Lothman provided medical writing services, which were funded by JDRF and the Leona M. and Harry B. Helmsley Charitable Trust. This study was conducted under a research contract between RTI Health Solutions and JDRF and was funded by JDRF and the Leona M. and Harry B. Helmsley Charitable Trust.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
KK, CM, and JS are salaried employees of RTI Health Solutions, which received research funding from JDRF and Leona M. and Harry B. Helmsley Charitable Trust for this study. CH and MM are salaried employees of JDRF. SS is a salaried employee of the Leona M. and Harry B. Helmsley Charitable Trust. The authors report no other conflicts of interest in this work.