Factors associated with physicians' decision to discontinue or down-titrate sulfonylureas for type 2 diabetes patients

Expert Rev Pharmacoecon Outcomes Res. 2019 Feb;19(1):71-79. doi: 10.1080/14737167.2018.1510774. Epub 2018 Sep 26.

Abstract

Background: Sulfonylureas (SUs) can help manage type 2 diabetes mellitus, but often have side effects. The objective of this study was to identify factors impacting physicians' decisions to discontinue (DC) or down-titrate (DT) SU therapy.

Methods: 1,026 physicians from the All Global panel were asked to rate level of concern regarding potential reasons for DC or DT on a 7-point Likert scale (1 = not concerned, 7 = extremely concerned). Physicians also provided information regarding treatment decisions from one DC patient, one DT patient, and two current SU users.

Results: When asked to report what factors might lead them to DC or DT an SU, physicians reported that hypoglycemic events requiring medical assistance (DC = 6.0, DT = 5.9), hypoglycemic events requiring nonmedical assistance (DC = 5.9, DT = 5.9), other hypoglycemic events not requiring assistance (DT = 5.7), and treatment goals not being met (DC = 5.6) were most concerning. DC and DT patients were more likely to have experienced ≥ 1 hypoglycemic events in the previous year vs. current users (DC = 41.0%, DT = 43.1%, current = 8.8%; p < .05).

Conclusions: Results highlight the strong influence of hypoglycemia on physicians' decisions to DC or DT SU therapy.

Keywords: Hypoglycemia; discontinuation; down-titration; physician attitudes; sulfonylureas.

MeSH terms

  • Adult
  • Aged
  • Clinical Decision-Making
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Dose-Response Relationship, Drug
  • Female
  • Health Care Surveys
  • Humans
  • Hypoglycemia / epidemiology
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / adverse effects
  • Male
  • Middle Aged
  • Physicians / statistics & numerical data*
  • Sulfonylurea Compounds / administration & dosage*
  • Sulfonylurea Compounds / adverse effects

Substances

  • Hypoglycemic Agents
  • Sulfonylurea Compounds