The Unmet Medical Needs of Current Injectable Antidiabetic Therapies in China: Patient and Health Care Professional Perspectives

• Published in: Clinical therapeutics 2020-08, Vol.42 (8), p.1549-1563
• Main Authors: Chen, Taixiong, Zhou, Li, Wang, Ke, Ma, Xiao, Wu, Haiya, Liu, Xin, Tong, Jingyu, Cai, Bojing, Ji, Qiuhe
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antidiabetics; Attitude to Health; China; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Endocrinologists; Endocrinology; Female; GLP-1 receptor agonists; Glucagon; Glucagon-like peptide 1; glucagon-like peptide 1 receptor agonist; Glucagon-Like Peptide-1 Receptor - agonists; Health care; Health Surveys; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Injection; Insulin; Insulin - adverse effects; Insulin - therapeutic use; Male; Medical personnel; Medical treatment; Middle Aged; Nurses; Patient compliance; Patient Satisfaction; Patients; perception; Physicians; Polls & surveys; Portability; Questionnaires; satisfaction; Signs and symptoms; Sociodemographics; Statistical analysis; Training; training burden; type 2 diabetes
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2020.06.006

Patients with diabetes and health care professionals (HCPs) play important roles in effective application of injectable antidiabetic therapies (IATs). However, their concerns and opinions on IATs are rarely investigated in China. This study aims to assess unmet medical needs of IATs regarding patient concerns, patient satisfaction, aspects that need improvement, and training burden from patient and HCP perspectives. This cross-sectional survey was conducted in 12 representative Chinese cities from December 2018 to January 2019. Patients with adult type 2 diabetes who were receiving IAT currently and had received IAT continuously for at least 1 month before the survey, endocrinologists with ≥5 years of experience and prescribing IAT in the past 1 month, and nurses with ≥3 years of experience and providing IAT training in the past 1 month were eligible participants. The patient survey assessed concerns of initiating IAT, satisfaction with IAT, aspects of IAT that need improvement, and IAT training received. The HCP survey evaluated patient concern of initiating IAT, aspects of IAT that need improvement, experience of providing IAT training, and self-reported burden of training. Descriptive statistical analysis was performed. In total, 500 patients, 200 endocrinologists, and 100 nurses were surveyed. The mean (SD) age of patients was 55.1 (11.8) years, with a disease duration of 7.6 (6.4) years. Of all patients, 391 (78.2%) were insulin users and 109 (21.8%) were glucagon-like peptide 1 receptor agonist users. Of the top 4 concerns about initiating IAT, both patients and endocrinologists reported inconvenience of daily injection (58.0% of patients and 68.5% of endocrinologists), worries about insulin dependence (42.6% of patients and 62.5% of endocrinologists), and fear of injection (37.0% of patients and 66.5% of endocrinologists). Medical expenses, convenience of drug portability and storage, and injection site reactions were the top 3 aspects that need improvement according to both patients and HCPs. High injection frequency was also one of the most urgent aspects for improvement (mean urgency score, 3.8 for physicians and 4.0 for nurses). A typical IAT training session took a mean (SD) of 14.1 (9.7) minutes. Both patients and HCPs considered injection operation after dose is set and symptoms and treatment for adverse effects as the 2 most time-consuming training contents. In addition, 97.1% of endocrinologists who provided training and 97.0% of nurses tho