The Unmet Needs of Patients with Type 1 Diabetes 

Can adjunctive therapy over insulin alone solve patient problems with type 1 diabetes?  

The optimal care of patients with type 1 diabetes requires more than multiple daily injections and adjusting doses.  

Being diagnosed with type 1 diabetes can significantly alter a person’s lifestyle. In patients with type 1 diabetes, the cells in the pancreas are destroyed, causing the body not to produce insulin, and the patient becoming dependent on insulin-replacement therapy. With this being the case, multiple daily injections of insulin or a continuous insulin infusion pump is required for these patients. To better monitor and regulate blood glucose levels, also, multiple daily finger-stick readings and continuous glucose monitoring are recommended. The advancement of insulin therapies has developed over many years to achieve glycemic goals. Unfortunately, hypoglycemic events still occur in some patients. Adjunctive therapy of agents used for type 2 diabetes has been studied with concurrent use to therapy to insulin for type 1 diabetes. These agents used as adjunctive therapy aim to help patients with type 1 diabetes achieve target glycemic goals, reduce weight gain, lower hypoglycemic risks, and improve the overall quality of life. Although these adjunct therapies have shown benefit in patients, safety concerns exist.  

The individualized risk and benefit factors are essential when developing a treatment regimen for these patients based on unmet needs and preferences. Studies have not shown much insight on how patients feel about adjunctive therapy being added to their current regimens or their perception if the benefits outweigh the risks with adjunctive therapy. dQ&A Market Research, Inc., conducted a patient-opinionated survey. This double-blinded study examined patients’ current type 1 diabetes therapy, how the patients assessed the benefits vs. risks trade-off, and their preference for using an adjunctive therapy.  

The market research company surveyed 2084 members with type 1 diabetes of its opt-in U.S.-based patient research panel on patients’ opinions with diabetes in November 2017. The patients on the panel were chosen from various type 1 diabetes communities.  The survey analyzed the patient’s unmet needs and the benefits and risks with their current therapy. The research model “jobs-to-be-done” and conjoint analyses were used to assess the different elements of the survey. The survey element, characterization of survey respondents, consisted of demographic data, patient-reported diabetes outcomes, complications, comorbidities, time spent on controlling diabetes, BMI, hypoglycemia risks, use of continuous glucose monitor, and current insulin-delivery method.  The importance and degree of satisfaction with patients’ current therapy and unmet needs were measured by the 5-point Likert scale. Some of the least satisfied unmet patients’ needs analyzed were: postprandial blood glucose <180 mg/dL, blood glucose during the day 70–180 mg/dL, morning (fasting) blood glucose 70–180 mg/dL; HbA1c reduced or achieved the target, etc. Respondents were given pairwise choices of “packages” of drug benefits and side effects to select, using the conjoint analysis. Each package consisted of the SGLT-2 inhibitor adjunct therapy, sotagliflozin, 200 mg, and 400 mg doses, placebo (insulin only), and ten attributes.  

Only 1313 of the 2084 participants returned a completed survey. Sufficient information from the characterization of patients, 78% of the respondents used insulin pumps rather than multiple daily injections. The CGM and non-CGM users only measured the time spent managing diabetes. 58% of the responders reported an HbA1C of <7.0%, 31% between 7% and 8%, and 11% of >8% at the time of the survey. Out of the 15 unmet needs, the most significant unmet needs classified by the responders were predictable and straightforward diabetes management (score of 13.6), HbA1C reduced or maintained at target (score of 13.5), daytime blood glucose 70-180 mg/dL and reduced mental effect needed to manage diabetes (score of 13.2). Prevention of negative impact on family/loved ones and prevention of feelings of isolation due to diabetes was classified as a low priority with a score of 8.3 and 6.7, respectively. Change in body weight (score 25.3) and time in ideal glucose range (score of 18.3) showed the highest attribute importance with assessing patients’ preference. 93% of responders preferred adding adjunctive therapy (200 or 400 mg) to insulin to assist in unmet needs.  

The results from the patients’ survey showed that there are unmet needs in patients with type 1 diabetes. With current therapy alone, the reduction of HbA1C is the highest unmet need and patients’ primary preference in therapy. Weight loss, time achieving target glucose range, and simplified diabetes management are other unmet needs amongst patients with type 1 diabetes. The study concluded that the preference for adjunctive therapies might be vital in assisting these unmet needs in treatment. 

Practice Pearls: 

• This survey highlighted the essential measures that helped address the unmet needs in patients with type 1 diabetes.  

• The reduction of HbA1C was the highest unmet need amongst these patients. Weight loss, time achieving target glucose range, and simplified diabetes management were also classified as other unmet needs patients expressed.  
• Considering the risk-benefit profile, more than 90% of the responders would consider adjunct therapies to help in assisting with unmet needs to reach the optimal care treatment. 

1. “Adjunct Therapy in Type 1 Diabetes: A Survey to Uncover Unmet Needs and Patient Preferences Beyond HbA1c Measures.” Mary Ann Liebert, Inc., Publishers, www.liebertpub.com/doi/full/10.1089/dia.2019.0027?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed&. 

1. “Adjunct Therapy in Type 1 Diabetes: Uncovering Unmet Needs and Patient Preferences Beyond HbA1c.” PracticeUpdate, www.practiceupdate.com/c/83983/2/8/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=OTE0MTIxOTE4NTkS1&lid=10332481. 

Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate