Global survey investigating causes of treatment inertia in type 2 diabetes cardiorenal risk management

Abstract

Aim: To explore reasons behind treatment inertia in current approaches to early cardiorenal risk management in type 2 diabetes (T2D).

Methods: A global, web-based, quantitative panel survey of primary care physicians (PCPs) and primary care diabetes specialists treating people living with T2D. The questions covered current management of T2D, particularly the use of sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors as second-/third-line therapies.

Results: Of 1677 respondents from 18 countries who completed the survey, 73.4% were responsible for second-/third-line therapy initiation. Two thirds had modified treatment decisions based on recent cardiovascular outcomes trials (CVOTs). Respondents cited restricted access to therapies and limits on regular appointments as the greatest barriers to second-/third-line therapy prescription. Although 81.6% agreed that early intensification to second-/third-line therapies is associated with clinical benefits, 46.1% of respondents still reserve these for later lines of therapy, and 23.8% would not consider changing therapeutic approach in patients with well-controlled T2D but increasing cardiovascular risk.

Conclusions: Substantial barriers still prevent optimization of primary setting T2D patient care. Education programs which enable PCPs to translate CVOT evidence into clinical benefits for patients with T2D could address many of the remaining knowledge gaps identified.

Keywords: Cardiovascular diseases; Diabetes mellitus, type 2; Dipeptidyl-peptidase IV inhibitors; Glucagon-like peptide-1 receptor; Primary health care; Sodium-glucose transporter 2 inhibitors.