title: Self-reported Barriers to Adherence and Persistence to Treatment With Injectable Medications for Type 2 Diabetes.
abstract: This study explored the barriers that adult Americans experience when taking injectable medications for type 2 diabetes, from the time of filling the initial prescription through the decision to discontinue the medication.
  
  
  
  An Internet-based survey was conducted in 2 waves among adult patients (N = 2000) who had received a physician prescription for insulin, liraglutide, or exenatide once weekly (QW), regardless of whether the prescription was filled by a pharmacy. In wave 1, patients were surveyed on their medication history and experience and, if relevant, the medication discontinuation process. Those still taking their injectable medication at the time of wave 1 were contacted 6 months later (wave 2, n = 585) to assess any changes in their medication experience.
  
  
  
  Among patients who delayed filling their prescription by ≥1 week, cost was a common reason for delay for refilling of liraglutide (63%) and exenatide QW (49%). The most commonly reported barrier to maintaining injectable medication was injection concerns (42%) such as aversion to needles, pain, or needle size. Lack of perceived need was the most common reason for discontinuation for basal (47%) and prandial/premixed (44%) insulin. For liraglutide, the most common reason for discontinuation was experiencing an adverse event (33%); for exenatide QW, it was injection concerns (38%).
  
  
  
  The diverse barriers we identified underscore the need for better patient-prescriber communication to ensure that newly prescribed injectable medications are consistent with a patient's ability or willingness to manage them, to appropriately set expectations about medications, and to address new barriers that arise during the course of treatment.
authors.affiliation: GlaxoSmithKline, Philadelphia, Pennsylvania. Electronic address: cvs2@cornell.edu.
authors.forename: C Victor
authors.initials: CV
authors.lastname: Spain
authors.affiliation: Harris Poll, Rochester, New York.
authors.forename: Jonathon J
authors.initials: JJ
authors.lastname: Wright
authors.affiliation: Harris Poll, Rochester, New York.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Hahn
authors.affiliation: GlaxoSmithKline, King of Prussia, Pennsylvania.
authors.forename: Ashley
authors.initials: A
authors.lastname: Wivel
authors.affiliation: GlaxoSmithKline, Uxbridge, United Kingdom.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Martin
mesh_terms: D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D000077270:Exenatide; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D000069450:Liraglutide / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010455:Peptides / Q000627:therapeutic use*; D012189:Retrospective Studies; D057566:Self Report; D011795:Surveys and Questionnaires; D014688:Venoms / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D014688:Venoms; D000069450:Liraglutide; D000077270:Exenatide
keywords: adherence; discontinuation; injectable medication; persistence; type 2 diabetes