647-P: Patient Preferences Informing Choice of Second-Line Type 2 Diabetes Medications

Abstract

Available second-line glucose-lowering medications for type 2 diabetes (T2D) have variable efficacy and side effect profiles, administration requirements, and impacts on short-term and long-term health outcomes. Therefore, medication choice is informed by each patient's clinical needs and personal preferences. However, patient rationale for selecting a second-line medication for T2D is not well understood. In this mixed methods study, 40 adults with T2D across 2 health systems in the U.S. completed an individual ranking activity, sorting 16 health outcomes and 8 medication attributes by relative importance and providing context on ranking decisions. Participants were between 45-64 years old (38%), non-Hispanic White (50%) or Black (38%), 15% Hispanic, and 55% women. For health outcomes, the highest proportion of patients ranked blindness (63%), death (60%), heart attack (48%), or heart failure (48%) as very important. For medication attributes, most participants indicated that greater efficacy with respect to lowering hemoglobin A1c was very important (68%), followed by oral administration (45%) and absence of gastrointestinal side effects (38%). Combinations of outcomes and attributes ranked as very important were highly heterogeneous across individual participants, with only 2/40 patients ranking the same combination. Qualitative findings indicated that outcome importance is a function of perceived severity, susceptibility, personal relevance, preventability, and potential life impacts. For medication attributes, most participants emphasized the primary importance of lowering blood glucose and hemoglobin A1c, while treatment processes and side effects were secondary and largely idiosyncratic to the patient's lifestyle, prior experiences, and preferences. Findings underscore the importance of engaging patients in conversations about goals and preferences for care and contextualizing therapeutic decisions in patient-described priorities for T2D management. Disclosure E.Golembiewski: None. A.E.Garcia: None. E.Polley: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. V.M.Montori: None. M.Mickelson: None. R.G.Mccoy: Consultant; Emmi. Funding Patient-Centered Outcomes Research Institute (DB-2020C2-20306)