Understanding Patient Preferences of Patients With Type 2 Diabetes in Second-Line Drug Intervention: A Discrete Choice Experiment

OBJECTIVES: Type 2 diabetes (T2D) and its treatment plays an increasing role in health care systems. Clinical guidelines provide serval options for second-line therapies without incorporating patient preferences. This study aims to analyze patient's perspective.

METHODS: Data was collected between August and November 2023 among German people with diabetes who received metformin monotherapy (inexperienced with study subject) or second-line therapy (prior experiences with study subject). The study developed a discrete choice experiment with literature review, qualitative interviews, pre-tests and quantative online surveys. With a partial profile design, patients were given 12 choice tasks with 3 alternatives. The alternatives differed systematically in terms of benefits, side effects, and administration including risk of myocardial infarction, risk of stroke, risk of nerve damage, risk of nausea, risk of severe hypoglycemia, weight change, type and frequency of intake, and schedule of intake. A random parameter logit model was used for statistical analyses.

RESULTS: A final study population of 583 adult patients (50% in each group) was reached. Risk of nausea, risk of nerve damage, and weight change were the most important attributes influencing choice decision followed by type and frequency of intake, risk of myocardial infarction, risk of stroke, and risk of severe hypoglycemia. In contrast, intake schedule has the least impact. Both study populations seem to have the same preferences on average. However, large standard deviations indicate considerable heterogeneity between respondents, particularly regarding weight changes and type and frequency of intake.

CONCLUSIONS: Low to no risk of nausea and nerve damage as well as weight changes are desirable features of treatment regimens for patients with T2D. Risk of myocardial infarction and weekly application also appear to play a crucial role in the evaluation of treatment from patient's perspective. For both groups, some respondents react more strongly to specific attributes than others.