Quantifying the Basal Insulin Treatment Preferences of People Living in Canada With Type 2 Diabetes When Glycemic...

Basal insulin treatments have historically been administered once daily (OD) or twice daily (BD). Once weekly (OW) treatments are now available. In this study we aimed to quantify the relative importance of frequency of administration in basal insulin treatment preferences of Canadians living with type 2 diabetes (T2D) when glycemic management and cost are held constant, using a discrete choice experiment (DCE).

A targeted literature review and qualitative interviews informed the development of an attributes-and-levels grid. Pilot interviews assessed survey feasibility. Hierarchical Bayesian estimation was used to identify the relative importance of each attribute.

The DCE survey was completed by 155 participants across 3 treatment experience categories: basal insulin naïve but injectable glucagon-like peptide-1 receptor agonist (GLP-1 RA) experienced (n=55); basal insulin experienced (n=53); and basal insulin and injectable GLP-1 RA naïve (n=47). Frequency of administration had a relative importance of 41% (confidence interval 38% to 45%), more than double any other attribute tested in this study. A preference for OW administration was observed relative to OD or BD. A reduction in the frequency of missing doses and taking doses at the prescribed time were considered the most positive impacts of OW administration.

This study demonstrates the importance of frequency of administration in basal insulin treatment decisions when glycemic management and cost are held constant. Using prespecified conditions, participants indicated a preference for OW dosing, making trade-offs between treatment risks and convenience. Findings have implications for health-care decision-makers in ensuring patient preferences are considered in treatment decisions.