Multinational Internet-based survey of patient preference for newer oral or injectable Type 2 diabetes medication

Figures & data

Table 1 Medication profiles shown to patients in wave 1 and wave 2

	Drug A	Drug B
Wave 1
How you take the medication	Oral tablet taken once a day	Injection (needle) self-administered once a day
Blood sugar lowering efficacy	If you have a blood sugar reading of 183, taking this oral medication can lower it to about 164 (individual results may vary)	If you have a blood sugar reading of 183, using this injection medication can lower it to about 154 (individual results may vary)
Side effects	Generally similar to a sugar pill with very low risk of hypoglycemia (ie, low blood sugar)	– Nausea (occurs in 11 to 19% of patients), vomiting (occurs in 5 to 7% of patients) and diarrhea (occurs in 8 to 15% of patients), which goes away for most patients after about 1 month (individual results may vary)
		– Other side effects generally similar to a sugar pill with very low risk of hypoglycemia (ie, low blood sugar)
Other effects	– Weight: no change	–Weight: loss of about 6.2 pounds (individual results may vary)
	– Blood pressure: no change	– Blood pressure: decrease in systolic blood pressure of about 2 to 3 mm of mercury (Hg) (individual results may vary)
Wave 2
How you take the medication	Oral tablet taken once a day	Injection (needle) self-administered once a day
Blood sugar lowering efficacy	If you have a blood sugar reading of 197, taking this oral medication can lower it to about 171 (individual results may vary)	If you have a blood sugar reading of 197, using this injection medication can lower it to about 154 (individual results may vary)
Side effects	Generally similar to a sugar pill with very low risk of hypoglycemia (ie, low blood sugar)	– Nausea (occurs in 11 to 19% of patients), vomiting (occurs in 5 to 7% of patients) and diarrhea (occurs in 8 to 15% of patients), which goes away for most patients after about 1 month (individual results may vary)
		– Other side effects generally similar to a sugar pill with very low risk of hypoglycemia (ie, low blood sugar)
Other effects	– Weight: no change	–Weight: loss of about 7.7 pounds (individual results may vary)
	– Blood pressure: no change	– Blood pressure: decrease in systolic blood pressure of about 2 to 3 mm of mercury (Hg) (individual results may vary)

Note: In the EU countries, blood sugar efficacy was displayed as 10.1 and 9.1 for drug A and 10.1 and 8.5 for drug B in wave 1, and 10.9 and 9.5 for drug A and 10.9 and 8.5 for drug B in wave 2. Similarly, weight loss was displayed in kilograms for drug B (2.8 kg in wave 1 and 3.5 in wave 2).

Table 2 Frequency and percentage of patients who chose each medication under varying scenarios

	Drug A (sitagliptin-like profile)		Drug B (liraglutide-like profile)
	n	%	n	%
Wave 1 preferences
Which drug would you prefer	1098	81.9%	242	18.1%
Which drug would you prefer to take first if you could switch later	1110	82.8%	230	17.2%
Which drug could you take for longer	1117	83.4%	223	16.6%
Wave 2 preferences
Which drug would you prefer	1131	84.4%	209	15.6%
Which drug would you prefer to take first if you could switch later	1139	85.0%	201	15.0%
Which drug could you take for longer	1159	86.5%	181	13.5%

Note: Significantly more patients preferred drug A in each scenario (p’s < 0.001).

Table 3 Reasons for preference ranked by importance

	Ranked 1st
	Drug A (sitagliptin-like profile)		Drug B (liraglutide-like profile)
	n	%	n	%
How you take the medication (oral or injection)	650	57.5%a	27	12.9%
Blood sugar lowering	261	23.1%	117	56.0%a
Side effects (nausea, vomiting, and diarrhea)	202	17.9%a	9	4.3%
Other effects (weight loss and blood pressure decrease)	18	1.6%	56	26.8%a

Note:

a The percentage of patients who noted each reason as the most important was significantly different between the two groups (P < 0.001).

Table 4 Patient characteristics and overall medication preference

	Total		Drug A (sitagliptin-like profile) n = 1131 (84.4%)		Drug B (liraglutide-like profile) n = 209 (15.6%)		P
	n	% of total sample	n	Row %	n	Row %
Country							<0.001
Germany	266	19.9%	214	80.5%	52	19.5%
France	111	8.3%	99	89.2%	12	10.8%
Italy	212	15.8%	185	87.3%	27	12.7%
Spain	208	15.5%	188	90.4%	20	9.6%
United Kingdom	265	19.8%	205	77.4%	60	22.6%
United States	278	20.8%	240	86.3%	38	13.7%
Gender							0.01
Male	713	53.2%	619	86.8%	94	13.2%
Female	627	46.8%	512	81.7%	115	18.3%
Employment							0.01
Employed full-time	425	31.7%	357	84.0%	68	16.0%
Employed part-time	120	9.0%	96	80.0%	24	20.0%
Self-employed	99	7.4%	88	88.9%	11	11.1%
Not employed, but looking for work	51	3.8%	42	82.4%	9	17.6%
Not employed and not looking for work	18	1.3%	10	55.6%	8	44.4%
Retired	433	32.3%	381	88.0%	52	12.0%
On disability	107	8.0%	80	74.8%	27	25.2%
Student	8	0.6%	6	75.0%	2	25.0%
Homemaker	79	5.9%	71	89.9%	8	10.1%
Insurance status							0.06
No health insurance	459	34.3%	375	81.7%	84	18.3%
Health insurance	881	65.8%	756	85.8%	125	14.2%
Race							0.04
Non-white	127	9.5%	114	89.8%	13	10.2%
White	1213	90.5%	1017	83.8%	196	16.2%
Education							0.84
Less than college/university degree	944	70.5%	798	84.5%	146	15.5%
College/university degree	396	29.6%	333	84.1%	63	15.9%
Diagnosed comorbidity
Dyslipidemia	571	42.6%	478	83.7%	93	16.3%	0.55
Hypertension	641	47.8%	531	82.8%	110	17.2%	0.13
Obesity	430	32.1%	331	77.0%	99	23.0%	<0.001
Health problems in last 12 months
Cardiovascular event (eg, heart attack, stroke)	39	2.9%	29	74.4%	10	25.6%	0.15
Nausea or vomiting	217	16.2%	174	80.2%	43	19.8%	0.09
Constipation or diarrhea	515	38.4%	432	83.9%	83	16.1%	0.68
Weight gain	343	25.6%	267	77.8%	76	22.2%	<0.001
Diabetes management steps
I try to maintain a healthy diet	1054	78.7%	877	83.2%	177	16.8%	0.01
I try to maintain an exercise regimen	559	41.7%	456	81.6%	103	18.4%	0.02
I use a glucose monitor and test strips	835	62.3%	693	83.0%	142	17.0%	0.06
Participated in diabetes educational program							0.03
Yes	471	35.2%	383	81.3%	88	18.7%
No	869	64.9%	748	86.1%	121	13.9%
Time of last A1Ctest							0.42
Within the past 3 months	823	61.4%	691	84.0%	132	16.0%
4–6 months ago	310	23.1%	265	85.5%	45	14.5%
7–12 months ago	113	8.4%	91	80.5%	22	19.5%
Over a year ago	59	4.4%	53	89.8%	6	10.2%
Never	35	2.6%	31	88.6%	4	11.4%
What doctor said at last test (of those who had a test)							0.02
A1C was below the target	220	16.4%	188	85.5%	32	14.6%
A1C was at the target	533	39.8%	466	87.4%	67	12.6%
A1C was higher than the target	371	27.7%	293	79.0%	78	21.0%
My physician did not provide me with the lab results	83	6.2%	67	80.7%	16	19.3%
I don’t remember	98	7.3%	86	87.8%	12	12.2%
	M	SD	M	SD	M	SD	P
Age	55.35	12.13	55.89	12.13	52.45	11.79	<0.001
Years of T2DM diagnosed	6.24	5.88	6.22	5.87	6.35	5.95	0.78
Importance of diabetes medication attributes (unimportant to important)
Side effects	3.92	1.17	3.91	1.19	3.98	1.04	0.35
Method of administration (oral vs injectable)	3.86	1.23	3.90	1.22	3.65	1.29	0.008
Effectiveness of medication	4.49	0.84	4.47	0.85	4.55	0.77	0.26
Experience of prescribing physician with medication	4.11	0.96	4.10	0.97	4.13	0.85	0.67
Out-of-pocket costs of medication	3.42	1.43	3.42	1.43	3.43	1.46	0.94

Table 5 Likelihood of preference for the drug with the sitagliptin-like profile (drug A) over the drug with the liraglutide-like profile (drug B)

	OR (95% CI)	P
Germany	0.82 (0.48–1.41)	0.47
France	1.79 (0.80–3.99)	0.16
Italy	1.92 (0.97–3.79)	0.06
Spain	1.92 (0.98–3.73)	0.06
UK	0.86 (0.45–1.64)	0.64
US (reference)	–	–
Age	1.02 (1.01–1.04)	0.003
Male	1.30 (0.93–1.80)	0.12
White	0.57 (0.29–1.14)	0.11
Employeda	1.08 (0.76–1.53)	0.67
Have health insurance	1.26 (0.75–2.12)	0.39
Diagnosed hypertension	0.99 (0.71–1.39)	0.96
Obesity	0.54 (0.38–0.75)	<0.001
Cardiovascular event in last year	0.50 (0.22–1.12)	0.09
Nausea or vomiting in last year	0.93 (0.62–1.41)	0.74
Weight gain in last year	0.62 (0.44–0.87)	0.01
Maintain a healthy diet	0.81 (0.51–1.28)	0.37
Maintain an exercise regimen	0.68 (0.49–0.96)	0.03
Use of glucose monitor and test strips	0.78 (0.55–1.10)	0.16
Participated in diabetes educational program	0.83 (0.59–1.16)	0.27
A1C at or below target (reference)	–	–
A1C above target	0.59 (0.41–0.83)	0.006
A1C unknown/not remembered	0.80 (0.48–1.31)	0.36
Importance of side effects	1.01 (0.86–1.18)	0.91
Importance of method of administration	1.32 (1.15–1.52)	<0.001
Importance of effectiveness of medication	0.79 (0.62–1.01)	0.05
Importance of experience of prescribing physician with medication	0.93 (0.77–1.13)	0.49
Importance of out-of-pocket costs of medication	1.00 (0.88–1.13)	0.98

Note:

a Due to small sample sizes in some of the employment categories, those who were currently employed (full-time, part-time, or self-employed) were grouped together and compared with all other categories (which collectively served as the reference).