The Burden of Type 2 Diabetes and the Value of Achieving Near Normoglycemia from the Patient Perspective

Abstract

Introduction: Type 2 diabetes (T2D) is extremely burdensome to people with T2D and associated with impaired health-related quality of life. This study explores the impact of T2D and potentially relevant outcomes for new therapies using a unique approach to in-depth qualitative interviews where people with T2D are asked to think about their future with T2D.

Methods: A cross-sectional qualitative interview study among people with T2D from the USA and UK. Interviews explored their treatment journey, perceptions of their future with T2D, and the value of achieving normoglycemia (explored through presentation of two vignettes with hypothetical medications that reduced hemoglobin A1c [HbA1c] levels < 7% and < 5.7%).

Results: Patients with T2D (N = 50; US n = 25; UK n = 25) were 66.0% male, had a mean body mass index (BMI) of 30.8 ± 6.3 kg/m², and had a mean of 13.0 ± 10.0 years since diagnosis. Current diabetes treatments included diet and exercise only (8.0%), oral medications only (62.0%), oral plus injections (24.0%), and insulin only (6.0%). Despite being treated, participants reported over 25 different unmet needs related to their T2D across a broad range of domains. The most common concerns were diet, diabetes-related complications, weight changes, and psychological and emotional issues. A large majority of participants indicated that achieving lower HbA1c values would change their life. When reflecting on the value of improved glycemic control, patients primarily anticipated physical improvements and improved psychological well-being. When presented with two hypothetical treatments, about 70% of participants preferred the < 5.7% treatment option over the < 7% HbA1c treatment option.

Conclusions: People with T2D have a high disease burden, a broad range of unmet needs, and extremely varied experiences and expectations on the impacts of T2D on their lives and future. Many patients indicated that achieving near normoglycemia would substantially change their lives primarily in terms of their physical and emotional health.

Keywords: Diabetes; Disease burden; HbA1c; Normoglycemia; Type 2 diabetes; Unmet needs.

Fig. 1

Interview flow

Fig. 2

Challenges, changes, or concerns due to T2D. a Other includes: challenges of tiredness, fatigue, or lack of energy (n=5), concerns of taking too many tablets (n=5), fear of taking injections (n=2), risk of family members getting diabetes (n=2), concerns of keeping HbA1c low (n=2), frequency of administration (n=1), fear of worsening immune system (n=1), concerns of increased vulnerability (n=1), fear of worsening health (n=1), and fear of treatment side effects (n=1). b Percentages are based on the number of respondents for each question. N=50 responded to overall challenges, changes, or concerns due to T2D. N=46 responded to the most important challenge, change, or concern

Fig. 3

Anticipated changes in participants’ lives with lower HbA1c. a N=50 responded to anticipated changes (e.g., psychological and emotional). b Other includes: better convenience (e.g., fewer doctor visits, less time required for treatment administration; <5.7% n=7, <7% n=7), reduced treatment or frequency of treatment (e.g., fewer pills, once a week; <7% n=5), less monitoring (<5.7% n=2), increased complacency or recklessness (<5.7% n=1, <7% n=3), increased quality of life (<5.7% n=1), reduced likelihood of going on insulin (<7% n=1), better cognition (<7% n=1), and reduced doctor concerns (<7% n=1)

Fig. 4

Participants’ preferences for medication scenarios and rationale