Evaluating preferences for profiles of glucagon-like peptide-1 receptor agonists among injection-naive type 2 diabetes patients in Japan

Figures & data

Table 1 Attributes and levels for the discrete choice experiment

Attributes	Levels
Dosing frequency	• Once a week (52 times per year).a • Once a day (365 times per year).b
Blood sugar (HbA1c) change	• 71.4% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.a • 69.1% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.b
Weight change	• On average, patients experience a very small amount of weight loss (−0.36 kg).b • On average, patients do not experience any change in their body weight.a
Type of delivery system	• Single-use prefilled pen ready for injection.a • Multidose prefilled pen, used with disposable injection needles, dosage selection required.b
Frequency of nausea	• 5.4% of patients experience nausea anytime in the first 6 months of treatment.a • 8.0% of patients experience nausea anytime in the first 6 months of treatment.b
Frequency of low blood sugar event (hypoglycemia)	• 1.5% of patients experience a low blood sugar (hypoglycemic) event in the first 6 months of treatment.b • 2.1% of patients experience a low blood sugar (hypoglycemic) event in the first 6 months of treatment.a

Notes:

a Level representing dulaglutide.

b Level representing liraglutide.

Abbreviation: HbA1c, hemoglobin A1c.

Table 2 Self-reported sociodemographic and clinical characteristics

	Overall sample (N=182)	Pilot sample (N=37)	Main sample (N=145)
Sex, n (%)
Male	117 (64.3)	27 (73.0)	90 (62.1)
Female	65 (35.7)	10 (27.0)	55 (37.9)
Age (years), mean (SD) [range]	58.9 (10.0) [32–81]	56.2 (9.4) [33–71]	59.5 (10.1) [32–81]
Age group (years), n (%)
30–39	4 (2.2)	1 (2.7)	3 (2.1)
40–49	27 (14.8)	7 (18.9)	20 (13.8)
50–59	64 (35.2)	15 (40.5)	49 (33.8)
60–69	61 (33.5)	11 (29.7)	50 (34.5)
70+	26 (14.3)	3 (8.1)	23 (15.9)
Education, n (%)
Middle school graduate	7 (3.9)	2 (5.4)	5 (3.5)
High school graduate	66 (36.5)	13 (35.1)	53 (36.8)
Vocational/work-based qualifications, partial college	35 (19.3)	7 (18.9)	28 (19.4)
University degree	72 (39.8)	14 (37.8)	58 (40.3)
Postgraduate degree	1 (0.6)	1 (2.7)	0 (0.0)
Household income, n (%)
<1 million yen	5 (2.8)	0 (0.0)	5 (3.5)
1 million yen to <2 million yen	14 (7.7)	2 (5.4)	12 (8.3)
2 million yen to <4 million yen	30 (16.5)	9 (24.3)	21 (14.5)
4 million yen to <6 million yen	28 (15.4)	2 (5.4)	26 (17.9)
6 million yen to <10 million yen	43 (23.6)	9 (24.3)	34 (23.5)
10 million yen to <15 million yen	4 (2.2)	1 (2.7)	3 (2.1)
Missing	58 (31.9)	14 (37.8)	44 (30.3)
Height (cm), mean (SD) [range]	164.3 (9.2) [143–185]	167.2 (8.0) [148–185]	163.5 (9.4) [143–185]
Weight (kg), mean (SD) [range]	70.5 (15.0) [37–150]	72.8 (13.1) [53–110]	70.0 (15.4) [37–150]
BMI (kg/m^2), mean (SD) [range]	26.1 (5.0) [16–58]	26.0 (3.8) [20–35]	26.1 (5.3) [16–58]
Duration of type 2 diabetes mellitus, n (%)
<1 year	7 (3.9)	3 (8.1)	4 (2.8)
>1 year and up to 5 years	59 (32.4)	14 (37.8)	45 (31.0)
>5 years and up to 10 years	53 (29.1)	9 (24.3)	44 (30.3)
>10 years	63 (34.6)	11 (29.7)	52 (35.9)
Current type 2 diabetes mellitus treatment, n (%)
One oral diabetes medication only	77 (42.3)	16 (43.2)	61 (42.1)
Two oral diabetes medication only	62 (34.1)	14 (37.8)	48 (33.1)
Three or more oral diabetes medication	43 (23.6)	7 (18.9)	36 (24.8)
Current HbA1c level, n (%)
Below 53 mmol/mol (<7%)	97 (53.3)	19 (51.4)	78 (53.8)
Between 54 mmol/mol and 64 mmol/mol (between 7.1% and 8%)	57 (31.3)	10 (27.0)	47 (32.4)
Between 65 mmol/mol and 75 mmol/mol (between 8.1% and 9%)	16 (8.8)	4 (10.8)	12 (8.3)
>75 mmol/mol (>9%)	12 (6.6)	4 (10.8)	8 (5.5)
I don’t know	0 (0.0)	0 (0.0)	0 (0.0)

Abbreviations: BMI, body mass index; HbA1c, hemoglobin A1c.

Table 3 Part-worth utilities, relative importance, and rankings of attributes in overall sample

Parameter	Attribute levels	Part-worth utility estimate (SE)a	P-valueb	Overall part-worth utility valuec	Relative importanced (%)	Rank
Dosing frequency	Once a day (365 times per year)	−1.236 (0.101)	<0.0001	2.47	44.1	1
	Once a week (52 times per year)	1.236 (0.101)	<0.0001
Type of delivery system	Multidose prefilled pen	−0.739 (0.091)	<0.0001	1.48	26.3	2
	Single-use prefilled pen	0.739 (0.091)	<0.0001
Frequency of nausea	8.0% experience nausea	−0.423 (0.062)	<0.0001	0.85	15.1	3
	5.4% experience nausea	0.423 (0.062)	<0.0001
Frequency of low blood sugar events (hypoglycemia)	Once every 2 years	−0.206 (0.049)	<0.0001	0.41	7.4	4
	Once every 3 years	0.206 (0.049)	<0.0001
Weight change	0 kg weight loss	−0.173 (0.049)	0.0004	0.35	6.2	5
	0.36 kg weight loss	0.173 (0.049)	0.0004
Blood sugar (HbA1c) change	69.1% at goal	−0.028 (0.046)	0.5502	0.06	1.0	6
	71.4% at goal	0.028 (0.046)	0.5502

Notes:

a Part-worth utility values provide information on the extent to which participants prefer each level of an attribute and are scaled within each attribute to have a mean of 0. A positive part-worth utility value indicates that the attribute level is preferred, while negative values indicate a preference for other levels of the attribute.

b The P-values indicate whether the part-worth utility value differs significantly from 0.

c The overall utility values represent the range of utility values within each attribute.

d $\text{Relative importance for each attribute}=\frac{\text{Overall utility value for each attribute}}{\text{Total utility value}}$, where total utility value = sum of overall utility values across all attributes.

Abbreviations: SE, standard error; HbA1c, hemoglobin A1c.

Figure 1 Relative importance of attributes in overall sample.

Abbreviations: RI, relative importance; HbA1c, hemoglobin A1c.

Figure 2 Relative importance of attributes by sex.

Notes: *Statistically significant difference between sexes in preference for levels of the attribute (P<0.05). ^†Statistically significant difference in the RI of each attribute across sex (P<0.0001).
Abbreviations: RI, relative importance; HbA1c, hemoglobin A1c.

Figure 3 Relative importance of attributes by age group (<60 years vs ≥60 years).

Note: *Statistically significant difference between age groups in preference for levels of the attribute (P<0.05).
Abbreviations: RI, relative importance; HbA1c, hemoglobin A1c.

Table 4 Patients’ poststudy willingness to take medications described by the dulaglutide and liraglutide medication profiles (N=182)

Willingness	Dulaglutide profile	Liraglutide profile
Not willing	21 (11.54%)	76 (41.76%)
Somewhat not willing	48 (26.37%)	78 (42.86%)
Neutral	35 (19.23%)	20 (10.99%)
Somewhat willing	64 (35.16%)	8 (4.40%)
Very willing	14 (7.69%)	0 (0.00%)

Table 5 Comparison of attributes and levels for the UK and Japanese discrete choice experiments

Attributes	Levels for Japanese Study	Levels for Prior UK Study
Dosing frequency	• Once a week (52 times per year).a • Once a day (365 times per year).b	• Once a week (52 times per year).a • Once a day (365 times per year).b
Blood sugar (HbA1c) change	• 71.4% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.a • 69.1% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.b	• 68.3% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.a • 67.9% of patients taking the medication reach their desired blood sugar (HbA1c) goals of <7%.b
Weight change	• On average, patients experience a very small amount of weight loss (−0.36 kg).b • On average, patients do not experience any change in their body weight.a	• Patients experience an average weight loss of 3.61 kg after the first 6 months of medication use.b • Patients experience an average weight loss of 2.90 kg after the first 6 months of medication use.a
Type of delivery system	• Single-use prefilled pen ready for injection.a • Multidose prefilled pen, used with disposable injection needles, dosage selection required.b	• Single-use prefilled pen ready for injection.a • Multidose prefilled pen, used with disposable injection needles, dosage selection required.b
Frequency of nausea	• 5.4% of patients experience nausea anytime in the first 6 months of treatment.a • 8.0% of patients experience nausea anytime in the first 6 months of treatment.b	• 20.4% of patients experience nausea anytime in the first 6 months of treatment.a • 18.0% of patients experience nausea anytime in the first 6 months of treatment.b
Frequency of low blood sugar event (hypoglycemia)	• 1.5% of patients experience a low blood sugar (hypoglycemic) event in the first 6 months of treatment.b • 2.1% of patients experience a low blood sugar (hypoglycemic) event in the first 6 months of treatment.a	• On average a patient would experience one low blood sugar (hypoglycemia) event every 2 years.b • On average a patient would experience one low blood sugar (hypoglycemia) event every 3 years.a

Notes:

a Level representing dulaglutide.

b Level representing liraglutide. The results of clinical trials conducted in Japan¹³ and the UK²² were used to generate country-specific attribute levels for each study, respectively.

Abbreviations: SE, standard error; HbA1c, hemoglobin A1c.

MiyagawaJOdawaraMTakamuraTIwamotoNTakitaYImaokaTOnce-weekly glucagon-like peptide-1 receptor agonist dulaglutide is non-inferior to once-daily liraglutide and superior to placebo in Japanese patients with type 2 diabetes: a 26-week randomized phase III studyDiabetes Obes Metab2015171097498326179187

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DunganKMPovedanoSTForstTEfficacy and safety of once weekly dulaglutide versus once daily liraglutide in type 2 diabetes (AWARD-6)Paper presented at: American Diabetes Association’s 74th Scientific SessionsJune 13–172014San Francisco, CA

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