Murayama Hiroki, Imai Kota, Odawara Masato
Medical Division, Novartis Pharma K.K, Toranomon Hills, Mori tower, 23-1, Toranomon 1-Chome, Minato-ku, Tokyo, 105-6333, Japan.
Department of Diabetes, Endocrinology, Metabolism, and Rheumatology, Tokyo Medical University, Tokyo, Japan.
Diabetes Ther. 2018 Jun;9(3):1185-1199. doi: 10.1007/s13300-018-0431-3. Epub 2018 Apr 25.
The Japanese guidelines for type 2 diabetes mellitus (T2DM) emphasize individualization of treatment based on patient need and encourage physicians to select an appropriate oral antidiabetes drug (OAD). However, limited evidence is available on the factors influencing the selection by physicians (diabetes specialists and nonspecialists) of the first-line OAD to treat drug-naive patients with T2DM. A survey was designed to explore the treatment factors and patient characteristics that influence physicians when they choose an initial OAD to prescribe to a drug-naive patient with T2DM in a real-world setting in Japan.
The 25-min web-based online survey consisted of simple and focused multiple-choice questions, and was circulated to physicians across eight selected regions in Japan. The primary endpoints were the proportions of physicians who considered particular treatment factors and patient characteristics when selecting the appropriate treatment for drug-naive T2DM patients.
A total of 491 physicians participated in the survey. Dipeptidyl peptidase-4 inhibitors (DPP-4is) were the most-preferred first-line OADs, followed by metformin, of both specialists (69% vs. 60%) and nonspecialists (73% vs. 47%). The most influential factors when a DPP-4i was selected were found to be glycated hemoglobin (HbA1c), postprandial glucose (PPG)-lowering effect, and a low risk of hypoglycemia, which were considered by > 80% of physicians, whereas the key factors when metformin was selected were improvement in insulin resistance, low cost, low risk of hypoglycemia, and PPG- and HbA1c-lowering effects, which were considered by > 85% of physicians. Regression analysis revealed that the dominant reason for choosing DPP-4is over metformin was their ease of use in patients with renal impairment, whereas the dominant reasons for choosing metformin over DPP-4is were improvement in insulin resistance and low cost. The key patient characteristics driving the choice of DPP-4is or metformin as the first-line OAD by physicians were similar to those that influenced the treatment intensification decision (DPP-4is: PPG and renal function; metformin: age, BMI, insulin resistance, and renal function).
In Japan, DPP-4is are the preferred first-line OADs, followed by metformin. The key treatment factors and patient characteristics considered when selecting DPP-4is or metformin are similar for both specialists and nonspecialists. These results may prompt further discussion of the differences in T2DM treatment between Japan and other counties.
Novartis.
日本2型糖尿病（T2DM）指南强调根据患者需求进行个体化治疗，并鼓励医生选择合适的口服抗糖尿病药物（OAD）。然而，关于影响医生（糖尿病专科医生和非专科医生）为初治T2DM患者选择一线OAD的因素，现有证据有限。本研究旨在探索在日本的实际临床环境中，医生为初治T2DM患者选择初始OAD时所考虑的治疗因素和患者特征。
这项25分钟的基于网络的在线调查包含简单且有针对性的多项选择题，并分发给日本8个选定地区的医生。主要终点是在为初治T2DM患者选择合适治疗方案时，考虑特定治疗因素和患者特征的医生比例。
共有491名医生参与了调查。二肽基肽酶-4抑制剂（DPP-4i）是最受青睐的一线OAD，其次是二甲双胍，专科医生（69%对60%）和非专科医生（73%对47%）均是如此。选择DPP-4i时最具影响力的因素是糖化血红蛋白（HbA1c）、餐后血糖（PPG）降低效果以及低血糖风险低，超过80%的医生考虑了这些因素；而选择二甲双胍时的关键因素是胰岛素抵抗改善、成本低、低血糖风险低以及PPG和HbA1c降低效果，超过85%的医生考虑了这些因素。回归分析显示，相较于二甲双胍，选择DPP-4i的主要原因是其在肾功能不全患者中使用方便；而相较于DPP-4i，选择二甲双胍的主要原因是胰岛素抵抗改善和成本低。医生选择DPP-4i或二甲双胍作为一线OAD的关键患者特征与影响治疗强化决策的特征相似（DPP-4i：PPG和肾功能；二甲双胍：年龄、BMI、胰岛素抵抗和肾功能）。
在日本，DPP-4i是首选的一线OAD，其次是二甲双胍。专科医生和非专科医生在选择DPP-4i或二甲双胍时考虑的关键治疗因素和患者特征相似。这些结果可能促使人们进一步探讨日本与其他国家在T2DM治疗方面的差异。
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