Treatment Algorithms: Type 2 Diabetes – Novel classes drive fragmentation of treatment choices in type 2 diabetes

Introduction

Datamonitor surveyed 199 primary care physicians and specialists across the seven major markets (the US, Japan, France, Germany, Italy, Spain, and the UK) on their type 2 diabetes treatment choices and prescribing behavior. Physicians in different markets favor different drug classes at different treatment lines, and there is wide variation in type 2 diabetes treatment and trends.

Features and benefits

* Follow the patient segmentation and treatment pathways for type 2 diabetes in each market
* Compare drug use across all therapy lines and single/combination treatment strategies
* Identify opportunities to consolidate patient share in the widely fragmented diabetes treatment algorithm.
* Gain insight into physicians’ perceptions on trends in use of key antidiabetic classes.

Highlights

Physicians estimate that a mean of 37% of people with type 2 diabetes in the seven major markets remain undiagnosed. Of the diagnosed patients, 16% are not being treated with drugs. Datamonitor estimates that the adult type 2 diabetes drug-treated population in the seven major markets is close to 27 million patients.
Physicians report 278 different class combinations used across first line, second line, and third and later line. Patient treatment varies with individual response, lifestyle, and comorbidities. However, the top 10 combinations account for 47% of all combination-treated patients, suggesting the use of common approaches in managing diabetes.
Type 2 diabetes patients are fairly evenly split between first-line, second-line, and third-line and later therapies. Specialist diabetologists and endocrinologists report more later-line patients compared with primary care physicians (PCPs). While 75% of treatment at first line is monotherapy, combinations dominate later-line treatment.

Your key questions answered

* Delve into primary data from 199 seven major market physicians on current usage and future trends of type 2 diabetes therapies.
* Follow through the most used monotherapies and combination therapies at each therapy line, in each market.
* Identify the different opportunities in the type 2 diabetes treatment algorithm in each of the seven major markets.

Executive Summary
OVERVIEW
Catalyst
Summary
COUNTRY PATIENT PROFILE TREES
Methodology
Overview of patient profiles in type 2 diabetes
Complications in type 2 diabetes
Comorbidities in type 2 diabetes
Seven major markets
US
Japan
France
Germany
Italy
Spain
UK
COUNTRY TREATMENT TREES
Methodology
Seven major markets
US
Japan
France
Germany
Italy
Spain
UK
Overview of treatment trees in type 2 diabetes
Patients are evenly spread among first-line, second-line, and later-line regimens
Monotherapies in type 2 diabetes
Combination therapies in type 2 diabetes
Therapy choice in type 2 diabetes
TYPE 2 DIABETES DEFINITION AND DIAGNOSIS
Disease definition
Segmentation of diabetes
Type 1 diabetes
Type 1.5 diabetes
Type 2 diabetes
Etiology of type 2 diabetes
Mechanisms of development of diabetes
Genetic or acquired causes
Risk factors and symptoms of type 2 diabetes
Risk factors and comorbidities
Symptoms
Prognosis
Diagnosis in type 2 diabetes
Over one third of patients are undiagnosed
Reasons for a low diagnosis rate
Screening can increase diagnosis rates
Managing physicians in type 2 diabetes
The majority of diabetics are diagnosed and managed by primary care practitioners
Physicians rank their own practice type as having higher involvement
TREATMENT OPTIONS IN TYPE 2 DIABETES
Pharmacological and non-pharmacological management of diabetes
Patient compliance with drug therapy
Use of monotherapy versus combination therapy
Most monotherapy takes place at first line
Therapy change in type 2 diabetes: 39% of patients have changed lines within a year
KEY CLASSES IN TYPE 2 DIABETES
Overview of available drug classes
Use of different classes in type 2 diabetes
Patient share of key drug classes: metformin dominates type 2 diabetes treatment
Trends in use of key antidiabetic classes: incretin mimetics growing strongly
Metformin
Metformin use will continue to rise
Metformin used as first-line monotherapy, combined with other drugs at later lines
Metformin dominates the US and Europe but has lower penetration in Japan
Sulfonylureas
Alternatives lead to decrease in sulfonylurea use
Sulfonylureas can be used at all therapy lines
Japan leads the prescribing of sulfonylureas
Key branded classes in type 2 diabetes
Pioglitazone
DPP-IV inhibitors
GLP-1 agonists
Insulins
Most physicians have increased the use of insulin in the past 3 years
Insulins used as a later-line therapy
Countries vary widely in their insulin use
Other classes
Alpha-glucosidase inhibitors
Prandial glucose regulators
SGLT-2 inhibitors
BIBLIOGRAPHY
Journal papers
Websites
Datamonitor reports
APPENDIX A
Datamonitor’s Type 2 Diabetes Physician Survey
APPENDIX B
Contributing experts
Report methodology