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Identifying the treatment preferences of patients with type 2 diabetes: A systematic review

Jodi Segal, MD, MPH

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Acknowledgements

• This project was supported in part by grant HHSF2232010000072C - Partnership in Applied Comparative Effectiveness Science (PACES) – PI Jodi Segal

• The views expressed here do not represent the official views of the FDA or AHRQ.

• Investigators– Sonal Singh, MD MPH– John FP Bridges, PhD– Nisa M Maruthur, MD MHS– Emily Little, BA – Susan Joy, MPH, MA– Tanjula Purnell, PhD

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Diabetes decision tree model

Maruthur, NM, Bridges, JFP, Joy, SM, Little, E, Singh, S. Modeling decision-making for therapy for type 2 diabetes using the Analytic Hierarchy Process. Economics, Modeling and Diabetes: The Mt Hood 2012 Challenge, June 7, 2012.

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To inform the decision model, the team began with a systematic review of patient preferences for noninsulin diabetes medications in adults with type 2 diabetes

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Systematic review: Key questions

• To identify the preferences of adult patients with type 2 diabetes for diabetes medications.

• The key questions are:– What attributes of treatment are weighted as most

important?– What are the sources of heterogeneity of patient

preferences (e.g. age, sex, race/ethnicity, severity of diabetes, prior treatment)?

– What are the major gaps in the evidence base?– How can the quality of the evidence base be

assessed?

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Methods

• We searched the PubMed, EMBASE, CINAHL, and EconLit databases for articles published on or before January 23, 2013.

• English-language studies of adult patients with type 2 diabetes assessing patient preferences for diabetes medication treatment.

• Titles, abstracts, and articles were reviewed by at least two independent reviewers.

• Study data and quality were abstracted

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Selection criteria

  Inclusion Exclusion

Population •Adults with type 2 diabetes •Type 1 diabetes only•Gestational diabetes •Pre-diabetes or metabolic syndrome•Physicians or caregivers only•General public

Interventions •None required •Treatments for complications of type 2 diabetes

Comparison •None required  

Outcome measures

•Preferences for treatment-related outcomes including complications, symptom control, and treatment burden•Any appropriate measure

•Health status measures, QALYs and quality of life measures •Preferences for treatments for diabetes complications or co-morbidities•Preferences for non-treatment aspects of diabetes management•Measures from secondary analyses

Timing •Short or long term •Any dates 

 

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Search strategy (PubMed)

• "diabetes mellitus, type 2"[mh] OR diabet*[tiab] OR"non-insulin dependent"[tiab] OR type-2[tiab] OR "type II"[tiab] OR "type 2"[tiab]“Ketosis-Resistant Diabetes Mellitus”[tw] OR“Non-Insulin-Dependent Diabetes Mellitus”[tw] OR “Type 2 Diabetes Mellitus”[tw] OR “Stable Diabetes Mellitus”[tw] OR “Maturity-Onset Diabetes Mellitus” [tw] OR “Maturity Onset Diabetes Mellitus”[tw] OR “MODY”[tw] OR “NIDDM”[tw] OR“Adult-Onset Diabetes Mellitus”[tw]

AND • Treatment[tiab] OR management[tiab] OR pharmaceutical[tiab] OR drug

therapy[mesh] OR medication[tiab]

AND • "conjoint analysis" OR "satisfaction" OR "choice model" OR "stated preference"

OR "discrete choice" OR DCE OR "decision analysis" OR preferences OR "multi-criteria decision analysis" OR MCDA OR "multi-attribute utility" OR "analytic hierarchy process" OR "trade off" OR "self-explicated" OR "best-worst scaling" OR utilities OR "preference weight" OR “willingness to pay” OR WTP OR “willingness to accept” OR “contingent valuation” OR priorities[tiab] OR valuation[tiab] 

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Results

• 2,811 titles identified in the original search

• 10 articles met inclusion criteria for the systematic review

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Example 1: Treatment satisfaction

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Example 2: Health status/Quality of life

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Example 3: Revealed preferences

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Example 4: Qualitative

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Example 5: Attributes of treatment

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Example 6: Trade-offs

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Relative Importance of Treatment Benefits versus Treatment Burden and Side Effects When Assessing Patient Preferences for Diabetes Medications (Other than Insulin)

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• Weight loss/control and glycemic control appear to be the treatment-related benefits which drive patient preferences when compared to treatment-related burden and side effects

• Risk of gastrointestinal effects was an important attribute associated with treatment preferences.

• Preference elicitation provides a necessary stepping stone in the path to individualized care and patient-centered decision-making in type 2 diabetes

Conclusions

20 © 2012, Johns Hopkins University. All rights reserved.