Early treatment of type 2 diabetes mellitus (T2DM) improves glycaemic control and reduces the risk of complications. We undertook a survey to investigate whether physicians’ knowledge about the beneficial effects of early pharmacological intervention in T2DM translates into treatment algorithms in clinical practice.
The 20-minute online survey was conducted in Brazil, Japan, India, Spain, UK and USA, enrolling 652 adult T2DM patients and 337 physicians (264 general practitioners [GPs] and 73 specialists). Physicians were required to treat a minimum number of patients (GPs >50; specialists >100) and to spend at least 70% of their time per month in direct patient care.
Half of the physicians acknowledged that early treatment using combination oral anti-diabetic therapy is important, supports glycaemic control and reduces the risk of complications. However, in clinical practice, physicians rarely (8%) reported use of combination therapy as first-line, whereas the majority (66%) reported this as second-line therapy. Remarkably, 23% of patients were not prescribed any medication at first consultation. Overall, 56% of patients reported having had a medication switch or addition to the initial treatment; the mean time before change in treatment was 8.8 months. On average, patients with renal impairment continued on failing monotherapy for 4 weeks before treatment was intensified. For other patients the required initiation of combination treatment after monotherapy failure may take up to 7 weeks. Among physicians, the main triggers for treatment change were hypoglycaemia (47%) or lack of glycaemic control (46%), often due to lack of adherence to diet and exercise regimens. According to physicians, >60% of patients reported that difficulties in exercising enough or making necessary diet changes were the main barriers to achieving glycaemic targets.
These findings suggest that there might be communication gaps in the healthcare partnership(s), around the benefits of treating T2DM early and aggressively using combination therapy.