Content area
Full text
Introduction
Diabetes causes significant clinical and economic burden in the US and the UK [1–4]. Achieving effective glycemic control in patients with diabetes reduces microvascular complications, as well as long-term risks of macrovascular disease [5]. Even with glycemic control, complications and comorbidities, including cardiovascular disease, depression, and obesity, have significant effects on both the clinical and economic burden of type 2 diabetes. In particular, patients with type 2 diabetes have two to four times higher risk of cardiovascular disease than adults without diabetes, which constitutes the largest share of the cost of diabetes [1, 5, 6]. Depression is at least twice as prevalent among individuals with diabetes as it is among non-diabetics, increasing the risk of diabetic complications [7, 8]. Finally, obese adults are much more likely to have diabetes than adults who are not obese [3]. About 13% of the expenditures on metabolic conditions (including the estimated annual costs of $92.6 billion on obesity in the US) are attributable to diabetes [3, 9, 10]. In addition, liver abnormalities are more prevalent among individuals with diabetes; thus, managing diabetes could be complicated by liver-related alterations in drug metabolism, drug interactions, and risk of hepatotoxicity [11].
An additional challenge is that almost one-third of diabetic patients do not adhere to their treatment regimen, leading to poorer glycemic control and increased risk of complications, hospitalizations, and death [12–14]. A recent review identified more frequent or complex dosing, treatment-related weight gain, persistent gastrointestinal (GI) side effects, and depression to be among the factors that impair adherence [15].
Diabetes outcomes are improved when management goes beyond glycemic control to managing comorbidities and complications [5], and such therapies have been a focus of research and clinical practice [16]. However, little is known about how prescribing physicians weigh the relative importance of glucose control, managing comorbidities and complications, and other treatment attributes that could affect adherence. The objective of this study was to quantify US and UK physicians’ preferences for extra-glycemic benefits of type 2 diabetes relative to other attributes of type 2 diabetes treatments. There are no type 2 diabetes treatments with proven depression benefits, and most treatments (with the exception of thiazolidinediones) do not require liver monitoring. Thus, the latter two outcomes are novel with respect to existing treatments,...