Factors Influencing the Choice of Glucose-Lowering Medications Among Physicians Treating Patients With Type 2 Diabetes.

Background The factors considered by physicians when prescribing a glucose-lowering agent to patients with type 2 diabetes (T2D) in real-world settings are not necessarily consistent with those recommended by clinical practice guidelines. Here, we identify the major factors that drive physicians' selection of glucose-lowering agents in the real world and how these factors may differ by physician's specialty.  Methods A web-based survey was conducted among 135 physicians who manage patients with T2D in Saudi Arabia. Physicians were categorized according to their specialty into "specialists" (endocrinologists and/or diabetologists) and "generalists" (internists, family physicians, and primary care physicians). Physicians were asked about the type of glucose-lowering medication that they would typically prescribe in certain clinical scenarios and what factors drive such a selection. Results Sulfonylurea remains the most frequently prescribed second-line agent, as an add-on to metformin, according to 50% of the physicians surveyed. Most physicians (89%) reported prescribing glucagon-like peptide 1 receptor agonists (GLP-1RA) to less than half of their patients with T2D and ischemic heart disease; over two-thirds reported prescribing sodium-glucose cotransporter 2 inhibitors (SGLT-2i) to less than half of their patients with T2D and heart failure. When prescribing GLP-1RAs, the cost was a "major consideration" by 75% and 65% of the specialists and generalists, respectively. Likewise, when prescribing SGLT-2i, the cost was a major consideration by 57% and 71% of the specialists and generalists, respectively. Several other factors differed between the generalists and specialists when prescribing thiazolidinedione(TZD), sulfonylurea, dipeptidyl peptidase 4 (DPP-4) inhibitors, GLP-1RAs, and SLGT-2i, but not insulin.  Conclusion Our findings highlight several challenges faced by physicians in the real world that may prevent them from adopting the latest evidence-based guidelines when managing patients with T2D. Health policies to increase accessibility to novel glucose-lowering agents, particularly for patients with T2D and cardiovascular/renal diseases, are needed.