Abstract
Background: Factors considered when selecting a diabetes medication for patients with type 2 diabetes (T2D) in clinical practice may differ from those recommended by professional societies. Objective: To identify factors that play a major role in guiding the selection of diabetes medications in the real world. Method: We asked 135 physicians [67% Generalists (Internists and General Practitioners) and 33% Specialists (Endocrinologists and Diabetologists) ] in Saudi Arabia to select a diabetes medication they frequently prescribe in certain clinical scenarios. Then we asked them to rank a set of factors as ("Major," "Minor," or "Not" a consideration) according to the degree those factors would typically influence their selection of a particular medication. Results: Sulfonylurea is the most frequently prescribed second-line agent. Majority (89%) reported prescribing GLP-1 receptor agonists (GLP-1 RA) to "50% of their patients with T2D and ischemic heart disease; and over 2/3 prescribe SGLT-2 inhibitors (SGLT-2i) to <50% of their patients with T2D and heart failure. Strikingly, 41% and 32% of the Generalists did NOT rank "Renal benefits" with SGLT-2i and "cardiovascular benefits" with GLP-1 RA, respectively, as "major consideration" when prescribing these agents. Medication cost was ranked as a "major consideration" by 75% of Specialists and 65% of Generalists when prescribing GLP-1 RA, and by 57% of Specialists and 71% Generalists when prescribing SGLT-2i. Conclusion: Despite the recent advances in diabetes therapy, medication cost and inadequate awareness of the cardiovascular and renal benefits of novel diabetes agents, particularly among non-specialists, remain major barriers to the wide adoption of recommendations from professional societies. Policies to improve access to novel diabetes medications and disseminate the awareness about the evidence-based benefits of these medications are needed.