Understanding Diabetes Drug Initiation and Offerings (aUDIO)

In the last 15 years, novel antidiabetic medications such as glucagon-like peptide-1 receptor agonists (GLP-1) and sodium-glucose cotransporter-2 inhibitor (SGLT2i) have shown high effectiveness for treating diabetes with additional cardiovascular, renal, and obesity-related health benefits. Despite their clinical effectiveness, promising cost-effectiveness, and expert recommendations, fewer than 10% of eligible patients with Type 2 Diabetes are prescribed GLP-1 or SGLT2i medications and disparities in access persist. Even among those who do receive a prescription, medication adherence is low, especially for those with high out of pocket costs. Cost-related medication non-adherence is associated with worse health outcomes.

Research has previously explored characteristics of those who adhere to GLP-1 and SGLT2i medications, the impact of insurance design on medication access, and disparities in access. Accordingly, decision makers are actively considering policy changes to improve access to these medications. However, interventions are needed at every systems level to improve equitable T2D treatment access. Less research has explored clinician behaviors—clinicians are one of the first-line gatekeepers of prescriptions. Even if systemic and individual barriers to medication access are reduced, patients will not get medication unless their clinician supports the idea.

The goal of this study is therefore to understand how patients and providers discuss initiating a new medication in clinic visits, the degree of shared decision making occurring around that choice, and efforts made to reduce cost-related barriers. This analysis will employ a content analysis of clinic visit recordings from a diverse national U.S. sample from December 2013 to present where a U.S.-based primary care clinician or endocrinologist is discussing use of a GLP-1 or SGLT-2 medication with an adult patient with type 2 diabetes.