Understanding Reasons for Treatment Discontinuation, Attitudes and Education Needs Among People Who Discontinue Type 2 Diabetes Treatment: Results from an Online Patient Survey in the USA and UK

Abstract

Introduction: Type 2 diabetes mellitus (T2DM) requires long-term treatment to achieve and maintain glycaemic control; however, up to 50% of people with T2DM discontinue treatment by 1 year. It is therefore important to understand the patient perspective of therapeutic adherence and persistence. Methods: An online questionnaire was presented to people with T2DM in the USA and UK on PatientLive Ò , a platform of Carenity, an online patient community. Those who discontinued at least one T2DM treatment within the last 6 months answered open-ended questions aimed to assess the reasons for discontinuation, how discontinuation could have been prevented, and what would have improved the experience with the discontinued treatment. Thematic qualitative analysis was performed on respondents' answers to these questions. Results: Oral antidiabetics were the most commonly discontinued treatments (93/161), followed by insulin (40/161) and glucagon-like peptide 1 receptor agonists (13/161). Main reasons for treatment discontinuation overall were side effects (57/161), mostly gastrointestinal side effects and weight gain. The second most reported reason was drug efficacy issues (42/161). Key factors stated to prevent discontinuation were an improved care pathway (45/161) and more efficacious treatments with fewer side effects (41/161). In the USA, treatment cost played an important role in discontinuation (14/89) and discontinuation prevention (12/89). More information about T2DM and associated treatments (56/161), help with T2DM management (24/161), and increased and informative patient-physician interaction (12/161) would have been helpful for many respondents in both countries, while some patients noted that no additional information would have been useful to improve their understanding and experience with their T2DM treatment (64/161). Conclusions: These results emphasise the need for focused medical education and improved communication to enhance patient experience and prevent treatment discontinuation. Understanding of attributes preferred by people with T2DM can help improve therapeutic adherence and outcomes with current medications, and guide development of future therapies. Digital features To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare. 12301961.

Weight Change and the Association with Adherence and Persistence to Diabetes Therapy: A Narrative Review

“… 48 The quantitative findings from the discontinuation studies reported herein are also consistent with the qualitative evidence from various surveys where weight gain was reported to be a common reason for treatment discontinuation among people with T2D. 49–51 For example, in a multinational online survey evaluating persistence with basal insulin, it was reported that weight gain was one of the most common reasons for interruption or discontinuation of therapy in 44.2% and 37.6% of survey respondents, respectively. 50 Another survey in an online patient community found that 18% of respondents in the USA and UK who had discontinued at least one medication in the previous 6 months (including OADs, insulin, and GLP-1 RAs) did so because of weight gain.…”

Gastrointestinal Tolerability of Once-Weekly Dulaglutide 3.0 mg and 4.5 mg: A Post Hoc Analysis of the Incidence and Prevalence of Nausea, Vomiting, and Diarrhea in AWARD-11

“…GI-related TEAEs are among the most frequent reasons provided for treatment discontinuation of GLP-1 RAs [23], and are an important determinant of tolerability. The time courses of GIrelated TEAEs and other tolerability indicators for dulaglutide 1.5, 3.0, and 4.5 mg are important factors for patients and health-care providers to consider when initiating or escalating dulaglutide doses.…”

“…Few patients who escalated from 1.5 to 3.0 mg and subsequently to 4.5 mg in 4-week increments experienced new or additional GI TEAEs, and for those patients who did, most were mild in severity. Patients' reports of tolerability concerns contribute to poor treatment adherence [23,31]. Providing tolerability information associated with dulaglutide 3.0 mg and 4.5 mg to patients during consultation for dose escalation may improve adherence to a medication regimen.…”

Issues Affecting Medication-Taking Behavior of People with Type 2 Diabetes in Indonesia: A Qualitative Study

“…Treatment complexity and convenience have been widely recognized to affect adherence to medications. [37][38][39] It has been suggested that decreasing the frequency of daily doses and using insulin pens instead of insulin vial may improve adherence. 37,39 However, in the context of Indonesia, the use of insulin pens may provide further burden related to accessibility and cost.…”

“…A large body of literature has shown that experiences of adverse effects have led to discontinuing the medications. [37][38][39]51 Social activities may also affect people's behavior in taking medications. Many participants in this study mentioned that they often skipped taking medications when they were busy with social activities, such as family gathering or other social activities.…”