Zhongguo quanke yixue (Dec 2024)
The Differences in Second-line Medication Preferences for T2DM Patients between North and South China
Abstract
Background In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated. Objective To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making. Methods The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022. Results In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P<0.05). Patients with type 2 diabetes in South China prefer to take oral second-line hypoglycemic drugs with 0 yuan, no risk of gastrointestinal side effects, strong blood sugar control effect, no risk of hypoglycemia events, and can protect the cardiovascular system (P<0.05). When the risk of gastrointestinal side effects changes from high to no risk, patients in South China are willing to pay 408.06 yuan per month. The effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking medicine, out-of-pocket expenses/month, and the change of body mass within half a year are the influencing factors of the preference for second-line medication in northern patients (P<0.05). The patients with type 2 diabetes in the north prefer the second-line hypoglycemic drugs with 0 yuan, strong blood sugar control effect, no risk of hypoglycemia events, cardiovascular protection and no risk of gastrointestinal reaction, taking orally and reducing body weight by 2.0 kg within six months (P<0.05). When the blood sugar control effect is weak and changed to strong, the patients in the north are willing to pay 435.98 yuan per month. Conclusion In addition to out-of-pocket expenses/month, patients with type 2 diabetes in the south pay more attention to gastrointestinal side effects, while patients with type 2 diabetes in the north pay more attention to the effect of blood sugar control. There are differences in second-line medication preferences between the two places. Regional differences provide a basis for individualized treatment of patients with type 2 diabetes mellitus. Clinical diagnosis and treatment should be "patient-centere" and pay attention to individual preference differences.
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