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Once-daily Oral vs. Once-weekly Injectable Diabetes Medications

May 18, 2021
Editor: Steve Freed, R.PH., CDE

Author: Shalonda Kimble, PharmD Candidate, South College School of Pharmacy 

What motivates type 2 diabetes patients’ preferences for either once-daily oral or once-weekly injectable medication? 

For clinicians and other organizations involved in assessing health care choices for T2DM, knowing patient preferences for once-daily oral versus once-weekly injectable drug administration profiles can be helpful. The current literature offers evidence that patients often prefer less regular administration schedules as they consider them more convenient. Weekly over daily tends to interfere less with a job and social life, which promotes adherence. A separate study of T2DM patients showed that 81.9% of participants favored oral therapy once a day over an injectable once a day, with 57.5% ranking the administration route as the most significant factor influencing their choice. A once-daily oral drug has not been directly compared to once-weekly injectable administration by any known published research to date. Besides, little is known about the reason for their choice among patients who do choose weekly injectable medications over regular oral medications. The goal of this study was to understand the preferences of individuals with T2DM for once-daily oral versus once-weekly injectable drug administration profiles, using both general and product-specific preference questions, and with oral semaglutide and injectable dulaglutide administration profiles used as examples. Additional aims were to consider why patients prefer oral or once-weekly injectable T2DM treatments once-daily, as well as aspects of therapies that might alter their preferences. 


The REVISE study, a crosssectional online survey with 600 contributors, was led among patients with T2DM from the United Kingdom and the United States, which generates general preferences for oncedaily oral versus onceweekly injectable diabetes medications, and explanations for the selection. Contributors then observed two videos detailing the administration procedures for injectable dulaglutide and oral semaglutide, founded on the product directions for use. After that, participants specified their choice for a onceweekly injectable or a oncedaily oral diabetes medication based on the video explanations. Participants who switched preferences were asked to identify the motives prompting their decision. The order of answer options was randomized, so about half of the participants were presented as the first choice with the once-weekly injectable, and about half were presented as the first option with the once-daily oral. 

The participants were primarily male (58.2%), with a mean age of 64 years. Practically all (92.8%) were taking an oral T2DM medicine, and only 26.3% were administering an injectable. Initially, 76.5% (95% confidence interval [CI] 73.1–79.9) favored a oncedaily oral and 23.5% a onceweekly injectable (95% CI 20.1–26.9; P < 0.0001). After observing the videos describing the productspecific administration, the proportions of contributors preferring each option were not statistically different (oral semaglutide administration description (52.5%; 95% CI 48.5–56.5; dulaglutide administration description (47.5%; 95% CI 43.5–51.5; NS, P = 0.2207). The most common motive for switching preferences was the timing and steps of administration. 

In conclusion, the initial reported diabetes patient preference ratio was approximately 3:1 for a once-daily oral medication versus a once-weekly injectable medicine. After learning about the specific treatment drug administration profiles for weekly injectable dulaglutide and daily oral semaglutide, participants were divided in their preference by approximately 50/50. This study shows that a one-size-fits-all approach does not apply to patients’ preferences for treatment with T2DM. Instead, choices depend on several factors, such as the treatment regimen’s flexibility and complexity, the route and frequency of administration, and the patient’s lifestyle. In future patient preference studies, it may be essential to consider this finding, ensuring that the specifics of medication administration profiles, device characteristics, and so on are precisely and accurately described to participants to ensure that studies yield meaningful patient preference data. When deciding on a diabetes treatment that is best for the patient, physicians should discuss how complex treatment regimens will work with their lifestyles and existing treatment regimens. There were limitations in the study. The sample population was predominantly white, and the study was only conducted among T2DM patients, so the results may not be generalizable to all T2DM patients or other conditions and populations.  

Practice Pearls: 

  • The results of the present study support the need for clear and complete communication of medication requirements and administration procedures between prescribing physicians and their patients. 
  • Based on the results of the present study, patients generally prefer a once-daily oral type 2 diabetes medication over a weekly injectable medication.
  • This study demonstrates that a onesizefitsall approach does not apply to patients’ preferences for T2DM treatment. 


References for “Once-daily Oral vs. Once-weekly Injectable Diabetes Medications”:
, Kristina, et al. “Patients’ Preferences for OnceDaily Oral versus OnceWeekly Injectable Diabetes Medications: The REVISE Study.” Diabetes, Obesity and Metabolism, John Wiley & Sons, Ltd, December 13, 2020,   

Bøgelund, Mette et al. “Patient preferences for diabetes management among people with type 2 diabetes in Denmark – a discrete choice experiment.” Current medical research and opinion vol. 27,11 (2011): 2175-83.  


Shalonda Kimble, PharmD Candidate, South College School of Pharmacy