Global survey investigating causes of treatment inertia in type 2 diabetes cardiorenal risk management.

To explore reasons behind treatment inertia in current approaches to early cardiorenal risk management in type 2 diabetes (T2D). A global, web-based, quantitative panel survey of primary care physicians (PCPs) and primary care diabetes specialists treating people living with T2D. The questions covered current management of T2D, particularly the use of sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors as second-/third-line therapies. Of 1677 respondents from 18 countries who completed the survey, 73.4% were responsible for second-/third-line therapy initiation. Two thirds had modified treatment decisions based on recent cardiovascular outcomes trials (CVOTs). Respondents cited restricted access to therapies and limits on regular appointments as the greatest barriers to second-/third-line therapy prescription. Although 81.6% agreed that early intensification to second-/third-line therapies is associated with clinical benefits, 46.1% of respondents still reserve these for later lines of therapy, and 23.8% would not consider changing therapeutic approach in patients with well-controlled T2D but increasing cardiovascular risk. Substantial barriers still prevent optimization of primary setting T2D patient care. Education programs which enable PCPs to translate CVOT evidence into clinical benefits for patients with T2D could address many of the remaining knowledge gaps identified.

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Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest N.K. has received speaker's bureau, advisory board and consultancy honoraria from Abbott, AstraZeneca, Boehringer Ingelheim, Janssen Pharmaceuticals, Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, and Sanofi-Aventis. S.B. has received speaker's bureau and advisory board honoraria from Abbott, Bayer U.S., AstraZeneca, Boehringer Ingelheim, Lilly Diabetes, Janssen Pharmaceuticals, Merck & Co., Novo Nordisk, and Xeris Pharmaceuticals. X.C. has received speaker's bureau and advisory board honoraria from AstraZeneca, Boehringer Ingelheim, Esteve, Lilly Diabetes, Novo Nordisk A/S, Roche, and Sanofi. G.D. has received speaker's bureau and advisory board honoraria from AstraZeneca, Boehringer Ingelheim, Lilly Diabetes, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk, and Sanofi-Aventis. P.K. has received speaker's bureau and advisory board honoraria from Abbott, AstraZeneca, Bayer U.S., Boehringer Ingelheim, Eli Lilly and Company, Janssen Pharmaceuticals, Novo Nordisk. P.L. has received speaker's bureau and advisory board honoraria from Abbott, AstraZeneca, Bausch + Lomb, Bayer Inc., Boehringer Ingelheim, Eli Lilly and Company, Mead Johnson Nutrition, Merck & Co., Novo Nordisk, and Sun Pharmaceutical Industries. J.N. has received advisory board honoraria from AstraZeneca.