889-P: Prescriber Perceptions of the Implementation of Liraglutide into Pediatric Type 2 Diabetes Care

Abstract

Background: In 2019, nearly two decades after metformin approval, liraglutide became the third medication approved by the U.S. FDA for pediatric type 2 diabetes (T2D). However, successful uptake of liraglutide in practice depends on prescribers’ perceptions of acceptability and appropriateness of use in this population. Objective: We explored pediatric diabetes prescribers’ perceptions on ordering liraglutide, including facilitators and barriers, for youth with T2D at a single, large academic center. Methods: We conducted semi-structured interviews with diabetes attending physicians (A), fellow physicians (F), and nurse practitioners (NP) supplemented with a patient vignette, chart-stimulated recall (CSR), and review of a clinical practice guideline (CPG). Interviews were audio-recorded, transcribed, and analyzed using modified grounded theory by three coders with constant comparison techniques. Results: Nineteen physicians (15 A, 4 F) and 6 NPs with a median experience of 7 years (1.5- 40) participated. Themes identified included 1) primary drivers of use: desire to promote weight loss/maintenance or to avoid/reduce insulin use; 2) acceptance by patients and families: highest for those with familiarity with the medication class and interest in weight benefits; and 3) primary barriers to prescribing: patients’ dislike of injections or prescriber hesitancy due to lack of experience with the drug, concerns about adherence, or issues with insurance coverage. Although most responders recommended liraglutide when presented with a patient vignette, they recalled prescribing barriers in actual practice during CSR. The CPG was endorsed as a facilitator to prescribing, but additional dissemination and use strategies were recommended. Conclusions: Although liraglutide adds to the toolbox for pediatric T2D, our findings highlight the challenges of introducing new therapeutics and provide insights that may guide implementation efforts in pediatric diabetes clinics. Disclosure T. A. Hitt: None. S. Vazquez diaz: None. Y. Sanchez-kleinberg: None. J. A. Shea: None. L. E. Katz: None. M. Vajravelu: None. Funding National Institutes of Health (5T32DK063688-17, K23DK125719-01); University of Pennsylvania