Preference for Type 2 Diabetes Therapies in the United States: A Discrete Choice Experiment

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic condition associated with substantial clinical and economic burden. As multiple therapeutic options are available, patient preferences on treatment characteristics are key in T2DM therapeutic decision-making. This study aimed to determine the preferences of US patients with T2DM for therapies recommended for first pharmacologic intensification after metformin.

Methods: As part of a discrete choice experiment, an online survey was designed using literature review and qualitative interview findings. Eligibility was met by US patients with T2DM who were aged 18 years or older with an HbA_1c ≥ 6.5%. Anonymized therapy profiles were created from six antidiabetic therapies including oral and injectable semaglutide, dulaglutide, empagliflozin, sitagliptin, and thiazolidinediones.

Results: Eligible patients (n = 500) had a mean HbA_1c of 7.4%, and a mean BMI of 32.0 kg/m², the majority of which (72.2%) were injectable-naïve. The treatment characteristic with greatest importance was mode and frequency of administration (35.5%), followed by body weight change (29.2%), cardiovascular event risk (19.1%), hypoglycemic event risk (9.9%), and HbA_1c change (6.5%). An oral semaglutide-like profile was preferred by 91.9-70.1% of respondents depending on the comparator agent, and preference was significant in each comparison (p < 0.05); an injectable semaglutide-like profile was preferred by 89.3-55.7% of respondents in each comparison depending on the comparator agent.

Conclusion: Patients with T2DM in the USA are significantly more likely to prefer oral or injectable semaglutide-like profiles over those of key comparators from the glucagon-like peptide 1 receptor agonist, sodium-glucose cotransporter 2 inhibitor, dipeptidyl peptidase 4 inhibitor, and thiazolidinedione classes.

Keywords: Discrete choice experiment; Patient preference; Therapy; Type 2 diabetes (T2D).

Fig. 1

Relative preference weights for each attribute level presented in hypothetical choice sets, in full sample

Fig. 2

Estimated contribution of each attribute to treatment decision-making in the full population, and injectable-experienced and injectable-naïve subgroups

Fig. 3

Relative preference weights for each attribute level presented in hypothetical choice sets, in injectable-experienced and injectable-naïve subgroups

Fig. 4

Preference for oral (a) and injectable (b) semaglutide (full population, injectable-experienced and injectable-naïve subgroups)

Fig. 5

Willingness to initiate treatment with (anonymized) real therapy profiles (injectable-experienced and injectable-naïve subgroups)