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
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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.
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
Population
Inclusion
•Adults with type 2 diabetes
Interventions •None required
Comparison
•None required
Outcome
measures
•Preferences for treatment-related
outcomes including complications,
symptom control, and treatment burden
•Any appropriate measure
Timing
•Short or long term
•Any dates
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Exclusion
•Type 1 diabetes only
•Gestational diabetes
•Pre-diabetes or metabolic syndrome
•Physicians or caregivers only
•General public
•Treatments for complications of type 2
diabetes
•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
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 "multicriteria 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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Conclusions
• 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
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