San Diego, CA—Patients with type 2 diabetes who only take oral antidiabetic drugs report a more favorable treatment experience than those taking insulin, said Richard R. Rubin, MD, Professor of Medicine and Pediatrics, Johns Hopkins University, Baltimore, MD, at the 2011 Scientific Sessions of the American Diabetes Association.
Through the use of a newly developed, validated questionnaire—the Diabetes Medication System Rating Questionnaire (DMSRQ)—he and colleagues found the highest treatment preference for glucagon-like peptide (GLP)-1 antagonists, and the lowest preference for a combination of insulin and oral antidiabetic agents.
The DMSRQ contains 9 scales, including:
- Convenience (6 items)
- Negative events (10 items)
- Interference (11 items)
- Self-monitoring of blood glucose burden (1 item)
- Efficacy (8 items)
- Social burden (3 items)
- Psychological well-being (11 items)
- Treatment satisfaction (3 items)
- Treatment preference (if the respondent previously used another regimen).
All items are scored on a 0-to-100 scale (a higher score indicates greater levels of the construct measured).
“This questionnaire, with all of its subscales, totally covers everything that would determine a person’s treatment preference for a medication,” Dr Rubin said.
The study population consisted of 537 US adults with type 2 diabetes receiving different diabetes medication regimens who completed the DMSRQ as an online survey. Participation was roughly equal between men and women, 57.4% of patients were aged <65 years, and 58.3% had been diagnosed with diabetes for more than 10 years.
Of the 537 participants, 110 took oral agents only, 110 took oral agents plus insulin, 112 took insulin only with syringe, 110 took insulin only with pen, and 95 took GLP-1 agents (exenatide or liraglutide).
Patients taking only oral antidiabetic drugs generally had the most favorable experience regarding most DMSRQ measures other than treatment satisfaction. Scores among this group were significantly (P <.05) more favorable than among those receiving insulin. Scores on the convenience and negative effects scales were significantly higher for the GLP-1 agents; these agents had higher scores for:
- Efficacy and well-being versus all insulin-user groups
- Self-monitoring of blood glucose relative to insulin-only and insulin pen users
- Convenience and interference versus insulin-only syringe users
- Social burden versus insulin-only pen users and those using both insulin and oral drugs
- Treatment satisfaction relative to those using both insulin and oral drugs.
The overall treatment preference score was not significantly different between groups, but was highest for the GLP-1 agents (85.2); those using only oral agents had a treatment satisfaction score of 81.2. The insulin groups had treatment preference scores ranging from 75.0 (insulin plus oral drugs) to 79.2 (insulin pen).
The findings “make sense when you consider how hard it is to manage each of these treatments,” Dr Rubin said. In previous studies by his group, patients’ perception of treatment efficacy was “powerfully related to actual clinical results” when those results were available in the study.