糖尿病患者及其照护者更倾向于选择具有更宽储存温度范围和鼻腔给药途径、且疗效相似的急救用胰高血糖素：一项来自西班牙的离散选择实验。
People With Diabetes and Caregivers Prefer Rescue Glucagon Treatment With a Wider Storage Temperature Range and a Nasal Administration, When Efficacy is Similar: A Discrete Choice Experiment in Spain.
机构信息
Eli Lilly and Company, Indianapolis, IN, USA.
Evidera, Bethesda, MD, USA.
出版信息
J Diabetes Sci Technol. 2023 Nov;17(6):1623-1633. doi: 10.1177/19322968221095882. Epub 2022 May 9.
BACKGROUND
Conventional injectable glucagon (IG) and nasal glucagon (NG), both having similar efficacy, are two options for the emergency treatment of severe hypoglycemia in Spain. This study elicited the effect of changes in key attributes on preferences for NG and IG medication profiles of people with diabetes and caregivers in Spain.
METHODS
The relative attribute importance (RAI) that participants placed on glucagon preparation, preparation and administration time, delivery method, recovery time, device size, storage temperature, and headache risk was estimated from an online discrete choice experiment. In addition, patients and caregivers were presented with NG and IG profiles that included rates of successful administration; the proportion of participants choosing each profile was summarized.
RESULTS
The analysis included 276 adults with diabetes (65% type 1) and 270 caregivers (49% type 1). Overall mean age was 40 years; 51% were female. The most important attributes were storage temperature (RAI [95% confidence interval] = 27.3% [22.9-32.2]) and delivery method (17.4% [13.1-21.9]). Headache risk (16.2% [11.8-20.7]), time to prepare and administer (14.5% [10.1-18.8]), glucagon preparation (11.4% [6.8-15.8]), recovery time (8.9% [4.3-13.3]), and device size (4.3% [0.3-8.8]) were also relevant. When comparing medication profiles, significantly more participants (78%) preferred NG over IG profiles ( < .001).
CONCLUSION
Adults with diabetes and caregivers prefer a glucagon treatment with a higher rate of successful administration, wider storage temperature, and nasal delivery method, when efficacy is similar. Participants favored NG over conventional IG as a rescue medication for severe hypoglycemia. This information may help decision-making by payers and treatment discussions between health care professionals and patients.
背景
在西班牙，传统的注射用胰高血糖素（IG）和鼻用胰高血糖素（NG）均具有相似的疗效，是治疗严重低血糖的两种选择。本研究旨在探讨关键属性变化对西班牙糖尿病患者和护理人员对 NG 和 IG 药物特征偏好的影响。
方法
通过在线离散选择实验，估计参与者对胰高血糖素制剂、准备和给药时间、给药方式、恢复时间、设备尺寸、储存温度和头痛风险的相对属性重要性（RAI）。此外，还向患者和护理人员展示了 NG 和 IG 方案，包括给药成功率；总结了选择每种方案的参与者比例。
结果
分析纳入了 276 名糖尿病成人（65%为 1 型）和 270 名护理人员（49%为 1 型）。总体平均年龄为 40 岁；51%为女性。最重要的属性是储存温度（RAI [95%置信区间] = 27.3% [22.9-32.2]）和给药方式（17.4% [13.1-21.9]）。头痛风险（16.2% [11.8-20.7]）、准备和给药时间（14.5% [10.1-18.8]）、胰高血糖素制剂（11.4% [6.8-15.8]）、恢复时间（8.9% [4.3-13.3]）和设备尺寸（4.3% [0.3-8.8]）也很重要。比较药物特征时，与 IG 方案相比，更多参与者（78%）更喜欢 NG 方案（<.001）。
结论
当疗效相似时，糖尿病成人和护理人员更喜欢一种给药成功率更高、储存温度范围更广、鼻内给药方式的胰高血糖素治疗药物。与传统的 IG 相比，参与者更倾向于将 NG 作为严重低血糖的抢救药物。这些信息可能有助于支付方决策和卫生保健专业人员与患者之间的治疗讨论。
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