Perceptions of general practitioners on initiation and intensification of type 2 diabetes injectable therapies. A quantitative study in the United Kingdom

Abstract

Most diabetes care is done by general practitioners (GPs) in the UK. This study aimed to determine GPs' comfort level in initiating and intensifying injectable therapies, identifying any associated barriers, and assessing reasons for referral to specialists. This web-interview included 128 general practitioners (GPs) experienced in type 2 diabetes (T2D) management, as well as 57 specialists and 30 nurses who were studied for secondary objectives. GPs felt more comfortable initiating the 1st injectable therapy - typically the glucagon-like peptide-1 receptor agonists (GLP-1 RA) - than the 2nd. The main barriers to initiating injectables were related to the complexity of injectable therapies and the lack of comfort with complex patient profiles, namely patients with difficultly achieving glycaemic control or those with significant comorbidities who GPs would rather refer to specialists. The main attributes that would increase their comfort level with initiation of injectables are improved glycaemic control, weight control and low risk of hypoglycaemia. An injectable therapy with these attributes could help to overcome barriers to initiating injectable therapies among GPs other healthcare professionals in primary care.

Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain

“…For the majority of people with T2D, the primary source of care is their GP, as was the case in this study. However, due to the complexity of managing T2D, primary care providers often maintain patients at suboptimal glycaemic levels, even though there is a willingness to intensify treatment [40, 41, 45]. In this study, just half of the patients achieved the recommended HbA 1c target.…”

“…In this study, just half of the patients achieved the recommended HbA 1c target. This suggests that there is a likely advantage to empowering GPs to improve treatment quality [41, 45].…”

Evaluation of the Short-Term Cost-Effectiveness of IDegLira Versus Basal Insulin and Basal-Bolus Therapy in Patients with Type 2 Diabetes Based on Attainment of Clinically Relevant Treatment Targets

“…10 Barriers to treatment intensification include costs, 12 patient adherence to more complicated treatment regimens, 12 and physician concerns regarding potential treatment-related side effects, particularly weight gain and hypoglycemia. 13 Health care management requires balancing effectiveness with cost, and it is increasingly important for new interventions to represent good value in this challenging economic environment. Long-and short-term cost-effectiveness analyses have been conducted for insulin degludec/liraglutide (IDegLira) compared with 3 other basal intensification strategies: uptitration of insulin glargine 100 units/mL (IGlar U100), addition of liraglutide to a basal insulin regimen (as separate components), and basal-bolus therapy with IGlar U100 + insulin aspart (IAsp).…”