A quantitative assessment of patients' barriers to insulin

CASCIANO R; MALANGONE E; RAMACHANDRAN A; GAGLIARDINO J

Vienna

Congreso; 45th EASD Annual Meeting; 2009

EASD

Background and aims: The International Diabetes Management Practices Study (IDMPS) is a 5-year study aimed at assessing therapeutic management of diabetic patients in Africa, Asia, Latin America and the Middle East. Within the third wave of lhe study (2008), a patient questionnaire was administered to assess preferences and perceptions of diabetes treatments, with a focus on identifying patient barriers to insulin treatment. Materials and methods: The questionnaire was administered using indirect and direct methods. Discrete choice modeling was used to assess how product attributes (formulation [oral/injection], dosing [number of daily doses, blood sugar maintenance, risk of hypoglycemia symptoms, and presence of side effects [dermatological, Gl, and cardiac]) influence patients´ preferences for diabetes treatment. These attributes were translated into hypothetical scenarios within choice sets for inclusion in the patient questionnaire. A multinomial logit model was used to analyze the discrete choice data and to find the odds ratio for each parameter. This model allowed for analysis of the probability of selecting a chosen alternative given a choice set as well as the derivation of relative attribute importance, an indication of how influential product attributes are in the respondents´ choices. Such analyses were performed to explore the impact of factors such as diabetes understanding, comfort with needles and geographic location. Results: ´The IDMPS questionnaire was administered to 14,033 diabetes patients in 18 countries. The majority of respondents were female (54%), with a high proportion suffering from Type 2 diabetes (T2DM) (n=II,883; 85%). More than half (56%) of respondents reported receiving diabetes education. Additionally, 48% of patients self-monitor their blood glucose levels. Across subgroups, formulation was a primary driver of patient preference while risk ofhypoglycemia symptoms did not heavily influencc treatment decisions. Patient preferences vary significantly by diabetes type, with T2DM patients assigning much higher relative importance to formulation than Type 1 patients (30.86% vs.4.99%, respectively; p<0.0001).Experience with insulin treatment also has a significant impact on the importance placed on formulation. Insulin treated T2DM patients placed less importance on formulation than insulin naive T2DM patients (3.09% vs. 47.48%, respectively; p <0.0001). Furthermore, patients treated with insulin placed greater importance on side effects compared to insulin naive patients (31.59% vs. 13.75%, respectively; p=0.0298). Diabetes education also appears to have a significant effect on the priority given to formulation between T2DM patients who received diabetes training and those who did not (33.68% vs. 28.21 %, respectively; p<0.0001). Conclusion: The insulin barriers perceived by patients with diabetes evolve with their experience of the disease. Formulation is the primary driver of preference for insulin naive patients. However, patients become increasingly concerned with more clinically relevant barriers (eg side effects, blood glucose levels) as they gain experience with insulin. This finding indicates that patients using insulin understand the importance of achieving an optimal balance between safety and efficacy. Education is important when selecting a treatment option, as the optimal regimen will change over the course of disease duration. Supported by sanofi-aventis.