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

May combine two claims.

For GLP-1 RAs, drug efficacy issues were the most commonly reported reason for discontinuation (5/13 [38%]), followed by side effects (4/13 [31%]).

“drug efficacy issues were the most commonly reported reason for discontinuation of GLP-1 RAs (5/13 [38%]), followed by side effects (4/13 [31%])”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Drug efficacy issues (42/161 [26%]; mainly no perceived positive effect 15/42 [36%]) and decision of the medical team (38/161 [24%]) were also common reasons reported for discontinuation.

“Drug efficacy issues (42/161 [26%]; mainly no perceived positive effect 15/42 [36%]) and decision of the medical team (38/161 [24%]) were also common reasons reported for discontinuation.”

• Also stated in: § Discussion · plain

  “About one-quarter of respondents participating in this study also reported drug efficacy issues as a cause of stopping treatment, of which no perceived positive effect was the most common reason in these respondents.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Data on length of time the respondent spent on treatment prior to discontinuation was spontaneously reported by 34 (21%) respondents; 17 (50%) of these respondents reported discontinuing treatment within the first year and 68% (23/34) reported having taken the treatment for less than 2 years.

“Data on length of time the respondent spent on treatment prior to discontinuation was spontaneously reported by 34 (21%) respondents; 17 (50%) of these respondents reported discontinuing treatment within the first year and 68% (23/34) reported having taken the treatment for less than 2 years.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Injectable antidiabetic therapies were commonly discontinued (53/161 [33%]), with insulin (40/161 [25%]) being the most commonly discontinued followed by GLP-1 RAs (13/161 [8%]).

“Injectable antidiabetic therapies were also commonly discontinued (53/161 [33%]), with insulin (40/161 [25%]) being the most commonly discontinued followed by glucagon-like peptide-1 receptor agonists (GLP-1 RAs; 13/161 [8%])”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Side effects were reported as the most common reason for discontinuation of OADs (35/93 [38%]), followed by decision of the medical team (24/93 [26%]) and drug efficacy issues (22/93 [24%]).

“Side effects were reported as the most common reason for discontinuation of OADs (35/93 [38%]), followed by decision of the medical team (24/93 [26%]) and drug efficacy issues (22/93 [24%]).”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Exempting economic solutions, which was a more notable reason in the USA (12/89 [13%]) than the UK (4/72 [6%]), improvements that would have prevented treatment discontinuation did not differ by country.

“Exempting economic solutions, which was a more notable reason in the USA (12/89 [13%]) than the UK (4/72 [6%]), improvements that would have prevented treatment discontinuation did not differ by country.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of these 161 respondents, 89 were from the USA and 72 from the UK.

“Of these 161 respondents, 89 were from the USA and 72 from the UK.”

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The reason for treatment discontinuation did not tend to depend on the country of residence, except for economic issues, which were reported by 14/89 (16%) US respondents but only 3/72 (4%) UK respondents.

“The reason for treatment discontinuation did not tend to depend on the country of residence, except for economic issues, which were reported by 14/89 (16%) US respondents but only 3/72 (4%) UK respondents.”

• Also stated in: § Discussion · hedged

  “Cost was highlighted as a reason for discontinuation by 16% of US respondents, compared with only 4% of UK respondents, which could be attributed to the direct out-of-pocket costs for individuals in the USA [19] compared with costs being covered by the National Health Service in the UK [20].”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Many respondents also reported more efficacious treatments with fewer side effects (41/161 [25%]) and economic solutions (16/161 [10%]) as factors that would have prevented discontinuation.

“Many respondents also reported more efficacious treatments with fewer side effects (41/161 [25%]), and economic solutions (16/161 [10%]) as factors that would have prevented discontinuation.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Side effects were also the most common reason for discontinuation of insulin (11/40 [28%]), followed by drug efficacy issues and decision of the medical team (each reported by 10/40 [25%] respondents).

“Side effects were also the most common reason for discontinuation of insulin (11/40 [28%]), followed by drug efficacy issues and decision of the medical team (each reported by 10/40 [25%] respondents).”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Overall, for all respondents and most of the treatments, side effects were the most common reason reported for treatment discontinuation (57/161 [35%]), primarily gastrointestinal disorders (10/57 [18%]), weight gain (10/57 [18%]), and hypoglycaemia (9/57 [16%]).

“Overall, for all respondents and most of the treatments, side effects were the most common reason reported for treatment discontinuation (57/161 [35%]), primarily gastrointestinal disorders (10/57 [18%]), weight gain (10/57 [18%]), and hypoglycaemia (9/57 [16%]).”

• Also stated in: § Discussion · hedged

  “Side effects, primarily gastrointestinal disorders, weight gain, and hypoglycaemia, were the main reasons overall for treatment discontinuation among the respondents of this study (35%), indicating a need for well-tolerated treatments.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

Medical information (56/161 [35%]), help with disease management (24/161 [15%]), increased and informative patient-physician interaction (12/161 [7%]), and information linked to the care pathway (9/161 [6%]) were the most needed forms of information.

“Medical information (56/161 [35%]), help with disease management (24/161 [15%]), increased and informative patient–physician interaction (12/161 [7%]), and information linked to the care pathway (9/161 [6%]) were the most needed forms of information.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

These responses did not differ by country of residence or treatment discontinued.

“These responses did not differ by country of residence or treatment discontinued.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

May combine two claims.

The second most common reason for treatment initiation was uncontrolled HbA1c, affecting 32% (52/161) of all respondents, 37% (33/89) of US respondents and 26% (19/72) of UK respondents.

“The second most common reason was uncontrolled HbA1c, affecting 32% (52/161) of all respondents, 37% (33/89) of US respondents and 26% (19/72) of UK respondents.”

• AssumptionRests on an assumption: Self-reported reasons for treatment discontinuation accurately reflect the actual reasons for discontinuation.

Classified as probably not a substantial claim.

Long-term treatment adherence is important to ensure good clinical management of T2DM.

“As T2DM is a chronic disease, long-term treatment adherence is important to ensure good clinical management [4].”

• cites [4] Sabaté E, editor. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.Not checked yet

  Not checked in the free run.

May combine two claims.

Results of an online survey in the USA, France and Germany showed that 32-42% of individuals with diabetes receiving basal insulin therapy were unaware of the need to titrate their insulin and 74% of physicians reported fear of hypoglycaemia as a barrier to optimal titration.

“Indeed, results of an online survey in the USA, France and Germany showed that 32–42% of individuals with diabetes receiving basal insulin therapy were unaware of the need to titrate their insulin and 74% of physicians reported fear of hypoglycaemia as a barrier to optimal titration [16].”

• cites [16] Berard L, Bonnemaire M, Mical M, Edelman S. Insights into optimal basal insulin titration in type 2 diabetes: results of a quantitative survey. Diabetes Obes Metab. 2018;20(2):301–8. sourceNot checked yet

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Current guidelines in the USA and UK stress the importance of structured and individualised education and European Association for the Study of Diabetes/American Diabetes Association guidelines state the importance of shared decision-making.

“Current guidelines in the USA and UK stress the importance of structured and individualised education [21, 22] and European Association for the Study of Diabetes/American Diabetes Association guidelines state the importance of shared decision-making [8, 23].”

• cites [21] Wong W. Exploring the potential of clinical pathways for diabetes. J Clinical Pathways. 2017;2(Suppl 1):S5–6.Not checked yet

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• cites [22] NHS RightCare Pathway: diabetes. 2018. https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2018/07/nhs-rightcare-pathway-diabetes.pdf. Accessed Mar 2020.Not checked yet

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• cites [8] Davies M, D'Alessio D, Fradkin J, et al. Management of hyperglycaemic in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61:2461–98. sourceNot checked yet

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• cites [23] American Diabetes Association. Standards of Medical Care in Diabetes - 2020. Diabetes Care. 2020;43(Supplement 1):S1–212. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

Coupled with an improvement in the care pathway being reported as a key factor for preventing discontinuation in both countries, this emphasises the need for focused education and improved communication between the physician and the patient to enhance treatment understanding and experience.

“Coupled with an improvement in the care pathway (including more information from the doctor) being reported as a key factor for preventing discontinuation in both countries, this emphasises the need for focused education and improved communication between the physician and the patient to enhance treatment understanding and experience.”

May combine two claims.

Little is known about why people discontinue treatment for T2DM and the experiences that lead to discontinuation.

“However, little is known about why people discontinue treatment for T2DM and the experiences that lead to discontinuation [4].”

• cites [4] Sabaté E, editor. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.Not checked yet

  Not checked in the free run.

May combine two claims.

OADs were the most commonly reported treatment discontinued, which is in line with prescription data that shows metformin to be the most commonly prescribed first-line antidiabetic treatment and sulfonylureas the most commonly prescribed second-line antidiabetic treatment.

“OADs were the most commonly reported treatment discontinued, which is in line with prescription data that shows metformin to be the most commonly prescribed first-line antidiabetic treatment and sulfonylureas the most commonly prescribed second-line antidiabetic treatment [10].”

• cites [10] Montvida O, Shaw J, Atherton J, Stringer F, Paul S. Long-term trends in antidiabetes drug usage in the U.S.: real-world evidence in patients newly diagnosed with type 2 diabetes. Diabetes Care. 2018;41:69–78. sourceNot checked yet

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May combine two claims.

In people with T2DM who discontinue or do not properly adhere to their therapy, there is an increased risk of microvascular and macrovascular complications, which can in turn increase healthcare costs further.

“In people with T2DM who discontinue or do not properly adhere to their therapy, there is an increased risk of microvascular and macrovascular complications [7], which can in turn increase healthcare costs further [5, 6].”

• cites [7] Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26(2):77–82. sourceNot checked yet

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• cites [5] Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–307. sourceNot checked yet

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• cites [6] Guerci B, Chanan N, Kaur S, Jasso-Mosqueda JG, Lew E. Lack of treatment persistence and treatment nonadherence as barriers to glycaemic control in patients with type 2 diabetes. Diabetes Ther. 2019;10(2):437–49. sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The questionnaire was designed by Sanofi and validated by Carenity.

“The questionnaire was designed by Sanofi and validated by Carenity.”

May combine two claims.

Despite these guidelines, individuals still perceived a need for improved care pathways and may benefit from additional information and support.

“However, our results indicate that, despite these guidelines, individuals still perceived a need for improved care pathways and may benefit from additional information and support.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Patient-related factors that contribute to poor adherence are perceived treatment efficacy, fear of hypoglycaemia, the complexity and burden of treatment regimens and inconvenience associated with treatment, cost, and lack of diabetes knowledge.

“Patient-related factors that contribute to poor adherence are perceived treatment efficacy, fear of hypoglycaemia, the complexity and burden of treatment regimens and inconvenience associated with treatment, cost, and lack of diabetes knowledge [5].”

• cites [5] Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–307. sourceNot checked yet

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Probably not a substantial claim: may not pass S2 (checkable).

Data from such surveys emphasise the importance of considering the perspective of individuals early in the drug development process.

“Furthermore, data from such surveys emphasise the importance of considering the perspective of individuals early in the drug development process.”

May combine two claims.

Without proper communication on the rationale behind initiating therapies and shared decision-making, individuals with diabetes may not fully understand the implications of discontinuing their therapy or may be receiving therapies that they consider to be unsuitable for them, potentially making discontinuation of the treatment more likely.

“Without proper communication on the rationale behind initiating therapies and shared decision-making, individuals with diabetes may not fully understand the implications of discontinuing their therapy or may be receiving therapies that they consider to be unsuitable for them, potentially making discontinuation of the treatment more likely.”

May combine two claims.

While 40% of respondents reported that no information would have prevented them from discontinuing treatment, a third of respondents reported that medical information would have improved their experience and 15% said they would have liked support, stressing the importance of adequate and appropriate patient engagement.

“While 40% of respondents reported that no information would have prevented them from discontinuing treatment, it is important to note that a third of respondents reported that medical information would have improved their experience and 15% said they would have liked support, stressing the importance of adequate and appropriate patient engagement.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Patient-HCP discussions before treatment initiation may help people with T2DM to better understand their options and allow for individualisation of therapy, as recommended by the American Diabetes Association/European Association for the Study of Diabetes guidelines.

“Patient–HCP discussions before treatment initiation may help people with T2DM to better understand their options and allow for individualisation of therapy, as recommended by the American Diabetes Association/European Association for the Study of Diabetes guidelines [8, 23].”

• cites [8] Davies M, D'Alessio D, Fradkin J, et al. Management of hyperglycaemic in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61:2461–98. sourceNot checked yet

  Not checked in the free run.

• cites [23] American Diabetes Association. Standards of Medical Care in Diabetes - 2020. Diabetes Care. 2020;43(Supplement 1):S1–212. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable).

The current study provides important insights into the attitudes of people with T2DM that impact treatment adherence.

“The current study provides important insights into the attitudes of people with T2DM that impact treatment adherence.”

• AssumptionRests on an assumption: Participants recruited from the online patient community are representative of people with T2DM who discontinue treatment in the USA and UK.

May combine two claims.

The data from this survey highlight patient perspectives on reasons for treatment discontinuation among people with T2DM in the USA and UK and provide focal points for communication for these individuals when they are initiating new therapies.

“The data from this survey highlight patient perspectives on reasons for treatment discontinuation among people with T2DM in the USA and UK and provide focal points for communication for these individuals when they are initiating new therapies [5].”

• cites [5] Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–307. sourceNot checked yet

  Not checked in the free run.

• AssumptionRests on an assumption: Participants recruited from the online patient community are representative of people with T2DM who discontinue treatment in the USA and UK.

Probably not a substantial claim: may not pass S2 (checkable).

On the basis of the results of our survey, there is an opportunity to further communicate specifically on side effects and drug efficacy issues.

“On the basis of the results of our survey, there is an opportunity to further communicate specifically on side effects and drug efficacy issues.”

May combine two claims.

Such communication may help more people with T2DM improve treatment adherence and persistence, and subsequently achieve glycaemic control and prevent short- and long-term complications.

“Such communication may help more people with T2DM improve treatment adherence and persistence [5], and subsequently achieve glycaemic control and prevent short- and long-term complications.”

• cites [5] Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016;10:1299–307. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Data analyses were descriptive and variables such as education and income were not captured.

“Additionally, data analyses were descriptive and variables such as education and income were not captured.”

May combine two claims.

An improvement in treatment, including fewer side effects and increased efficacy, would have helped prevent treatment discontinuation in a quarter of respondents, highlighting that individualised treatment that fits the needs of each person is important among those with T2DM.

“An improvement in treatment, including fewer side effects and increased efficacy, would have helped prevent treatment discontinuation in a quarter of respondents, highlighting that individualised treatment that fits the needs of each person is important among those with T2DM.”

May combine two claims.

This study captured patient-reported outcomes with no access to the participants' medical records, so it could not be confirmed whether reasons given for discontinuation were accurate.

“This study captured patient-reported outcomes with no access to the participants’ medical records, so it could not be confirmed whether reasons given for discontinuation were accurate (i.e. whether respondents reached glycaemic control or if the HCP had prescribed a decrease or change to their prescription).”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

This may lead to better patient experience, reported outcomes, and adherence.

“This may lead to better patient experience, reported outcomes, and adherence.”