Abstract
Introduction
Although current guidelines for type 2 diabetes (T2D) underscored the importance of attaining glycemic control and weight management goals, the patient perspectives on achieving these goals remained unclear in China. This study aimed to understand Chinese patients’ perspectives on stringent glycemic control (hemoglobin A1c [HbA1c] ≤ 6.5%) and weight loss (≥ 10%) and their treatment preferences.
Methods
Adult Chinese patients diagnosed with T2D who were aware of their latest HbA1c were enrolled in this survey study. An electronic questionnaire was designed to collect patients’ characteristics, perspectives on safely achieving stringent glycemic control and weight loss, and preferences for different T2D treatment profiles.
Results
The study included 495 patients. Patients predominantly indicated that safely achieving stringent glycemic control was extremely (82.83%) or moderately (12.12%) important. Nearly half of the patients (n = 231) perceived ≥ 10% weight loss as beneficial, among whom 117 (50.65%) and 84 (36.36%) indicated it was extremely and moderately important, respectively. Both having HbA1c > 6.5% within the past 6 months and body mass index ≥ 24 kg/m2 were associated with increased odds of choosing the T2D treatment with a higher chance of achieving stringent glycemic control and weight loss, given a similar safety profile. Conversely, age ≥ 60 years was associated with decreased odds of having the outcomes listed above.
Conclusion
This study demonstrated that most surveyed patients with T2D in China recognized the importance of safely achieving stringent glycemic control and weight loss. The identified factors associated with patients’ perspectives and preferences could benefit clinical decision-making.
Supplementary Information
The online version contains supplementary material available at 10.1007/s13300-024-01690-8.
Keywords: Patient perspective, Stringent glycemic control, Treatment preference, Type 2 diabetes, Weight loss
Key Summary Points
| Why carry out the study? |
| Despite current type 2 diabetes (T2D) guidelines emphasizing glycemic control and weight management, achieving these goals remains challenging in China, highlighting the need for patient-centered care. |
| While studies in the USA and UK have explored patient perspectives on glycemic control, weight loss, and treatment preferences, similar research is lacking in China. |
| This cross-sectional survey aimed to understand the perspectives of Chinese patients with T2D on achieving stringent glycemic control (hemoglobin A1c ≤ 6.5%) and significant weight loss (≥ 10%), and their treatment preferences. |
| What was learned from the study? |
| The study provided insights into patient perspectives on stringent glycemic control, ≥ 10% weight loss, and medication preferences, along with an overview of their experiences with T2D and its treatment. |
| Findings are valuable for the T2D community and may improve clinical practice by supporting joint decision-making between patients and healthcare providers. |
Introduction
Diabetes is a crucial public health challenge causing large and increasing disease burden worldwide. In 2021, the estimated global prevalence of diabetes was at 10.5% with approximately 536.6 million adults affected and led to 6.7 million deaths [1]. In China, several national multicenter studies reported the prevalence of diabetes ranging from 8.7% to 12.8% in 2015–2018 [2–4]. Among the total population with diabetes, over 90% are afflicted with type 2 diabetes (T2D) [5]. The aggregate prevalence of T2D in China was 8.7% in 2010–2014, with a projection of reaching 12.5% by 2025 [6].
T2D imposes a substantial physical and psychological burden on patients, resulting in a decline in health status and quality of life [5]. Mitigating T2D requires prioritizing key elements of diabetes care, notably glycemic control and weight management, owing to their well-documented benefits [7–10]. Current guidelines from both the American Diabetes Association (ADA) and the Chinese Diabetes Society (CDS) recommended that adult patients with T2D attain a glycemic target of hemoglobin A1c (HbA1c) < 7.0% [11, 12]. A more stringent goal for glycemic control, for instance, to achieve HbA1c levels ≤ 6.5% or as close to normal as possible, was advocated by the American Association of Clinical Endocrinologists Consensus for most patients and it was also recommended in the CDS guideline for some patients in better overall health conditions [11, 13]. Simultaneously, ADA guidelines emphasized that weight management was a critical component of diabetes care for patients with overweight or obesity. Weight loss ≥ 3% improves the control of glycemia and cardiovascular risk factors, and a sustained weight loss (10–15%) could bring disease-modifying effects and potential remission of diabetes [12]. This recommendation was aligned with that set forth by the CDS, which delineated a more specific target population as patients with T2D and overweight or obesity [11]. Moreover, to achieve both goals of glycemic control and weight management concurrently, antihyperglycemic medications with the benefit on weight loss were prioritized by the ADA guideline, such as glucagon-like peptide 1 (GLP-1) receptor agonists and the glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist (tirzepatide) [12].
Despite these recommendations, sufficient glycemic control is still lacking in China. Two national studies published in 2021 revealed that only half of patients undergoing diabetes treatment achieved adequate glycemic control, defined as HbA1c < 7.0% [2, 3]. Moreover, a national survey in 2018 reported that 47.3% of Chinese patients with diabetes were overweight, and 25.0% were obese [2]. These findings underscored the persistent and substantial challenges faced by patients with T2D in China, necessitating a more effective strategy to enhance diabetes care.
Furthermore, with a growing emphasis on patient-centered care in the management of T2D, there is increasing research interest highlighting the significance of incorporating patient perspectives and preferences in personalizing T2D management [14, 15]. A 2021 qualitative study in the United States (USA) and United Kingdom (UK) suggested that many patients with T2D perceived achieving near normoglycemia (HbA1c < 5.7%) as life-changing for their physical and emotional health [16]. A subsequent quantitative survey study further found that achieving near normoglycemia (HbA1c < 6.0%) was meaningful and important to the majority of patients with T2D [17]. Similarly, a USA survey reported that over 85% of patients with obesity and 68% of overweight patients recognized the importance of weight loss [18]. In 2023, a study in the USA and UK further evaluated the impact of substantial improvements in HbA1c and weight loss on patients with T2D, revealing that both were critical drivers of treatment preferences [19]. In recent years, some studies in China have suggested that Chinese patients with T2D prioritize blood glucose control over weight loss when it comes to medication choices [20, 21]. Although these studies filled the knowledge gap of patients’ perspectives on glycemic control and weight loss and the treatment preference in the USA and UK, similar evidence focusing on both the patients’ perspective and treatment preferences among patients with T2D in China remained unclear. This emphasized the need for further research in this area.
This cross-sectional survey study aimed to understand the perspectives of Chinese patients with T2D on safely achieving stringent glycemic control (defined as HbA1c ≤ 6.5%) and weight loss (≥ 10%), to explore patient preferences on different T2D treatment profiles, and to identify factors associated with patient perspectives and treatment preferences.
Methods
Study Design and Population
This cross-sectional study was conducted among patients with T2D in China. To meet the requirements of the primary analysis, we assumed that 50% of patients perceive achieving near normoglycemia as important and calculated a sample size of at least 384 for primary analysis at the 0.05 significance level, or 95% confidence level, with a margin of error of 5%. To ensure the final sample size for analysis meets this requirement, we increased the target sample size to 500 patients. Furthermore, to ensure the representativeness of the study population, quotas were established for each geographic region, including Northeast China, East China, Central China, and West China. These quotas were determined according to the prevalence of total diabetes [4] and the total population in each region [22, 23]. Patients were recruited between July and August 2023 and included if they were (1) aged ≥ 18 years, (2) diagnosed with T2D by a physician, (3) aware of their latest HbA1c level within the past 6 months, and (4) capable of understanding and responding to the survey in Chinese. Patients were excluded if they (1) were diagnosed with type 1 diabetes, gestational diabetes, or other types of diabetes, (2) had a history of tirzepatide use, or (3) were employed in pharmaceutical companies or providing care to patients with diabetes. Ethical approval for the study was obtained from the Ethics Committee of Peking University First Hospital (Approval No. 2023-yan-008), and all patients provided informed consent. The study was conducted in accordance with the principles of international ethics guidelines, including the Declaration of Helsinki, and applicable local laws and regulations.
Questionnaire
The questionnaire, designed by a research team comprising endocrinologists, epidemiologists, health services researchers with survey design skills, and statisticians, was validated for clarity and understandability through face-to-face interviews with two endocrinologists and five patients with T2D from the target geographical regions. Furthermore, two endocrinologists reviewed all questions from a scientific perspective to determine whether the questions could reflect the research objectives. Adjustments to the content and wording were made on the basis of feedback from these interviewees. The finalized questionnaire was then programmed for completion on mobile devices using Confirmit [24], an online survey platform.
The questionnaire contained single-choice questions, multiple-choice questions, and text-entry questions covering five domains: sociodemographic characteristics, clinical experiences with T2D, perspectives on safely achieving stringent glycemic control, perspectives on weight loss, and preferences for different T2D treatment profiles. To increase data accuracy, patients were informed at the beginning of the questionnaire that their responses would remain confidential to reduce potential social desirability bias. Clear and concise instructions were provided to avoid any confusion about how to answer the questions, accompanied by the sections or questions. Sociodemographic characteristics included age, gender, ethnicity, region of residence, education level, and household total income over the past year. The option “prefer not to answer” was available for all sociodemographic questions. Clinical experiences included patients’ recent weight, height, waist circumference, latest HbA1c levels, duration of disease, diabetes-related complications (including complications of nerve, eye, cardiovascular, kidney, and foot), experienced episodes of severe hypoglycemia (defined as a medical emergency requiring the assistance of another individual to administer carbohydrates, glycogen, or take other proper treatment [25]) in the past year, and T2D treatment experiences.
Perspectives on safely achieving stringent glycemic control were elicited by asking patients whether they had safely lowered their HbA1c to ≤ 6.5% in the past 6 months (“yes”, “no”, or “not sure”). Patients who responded “yes” constituted the “experienced group”, while those who responded “no” or “not sure” constituted the “non-experienced group”. Subsequent questions were tailored to each group, exploring the importance and positive impacts of safely achieving stringent glycemic control as perceived by the patients. Patients were asked to rank a maximum of three selected impacts according to the extent of their perceived impact. For the perspectives on weight loss, patients were asked to provide information on their expectation of weight change, and the attitude and perceived importance of weight loss ≥ 10%.
To elicit preferences for different T2D treatment profiles, patients were presented with four scenarios. Each scenario included two anonymous treatments, labeled as treatment A and treatment B, with three key features: (1) probability of achieving HbA1c ≤ 6.5% (feature 1), (2) probability of achieving ≥ 10% weight loss (feature 2), and (3) probability of side effects occurring (feature 3). Patients were asked to select their preferred treatment option for each scenario. In scenario 1 and scenario 2, treatment A presented higher values for feature 1 and feature 2 compared to treatment B, while the values for feature 3 were similar between the two treatments. In scenario 3 and scenario 4, feature 3 was further broken down into the probabilities of hypoglycemia and gastrointestinal side effects to capture more nuanced differences between the treatments, and treatment A presented higher values for feature 1 and feature 2, a lower probability of hypoglycemia, and a higher probability of gastrointestinal side effects compared to treatment B.
Data Collection
Potential subjects were referred by physicians to participate in the study by scanning a Quick Response (QR) code using mobile devices. The survey was designed to automatically skip irrelevant questions on the basis of previous answers, ensuring that only necessary questions were presented. This approach guaranteed that there were no missing data, as all required questions were answered. Electronic programming ensured that only questionnaires without contradictions in logic were transmitted to the back-end data center. The number of completed questionnaires was monitored back-end, and the data center was closed when the target quota was achieved. To ensure data quality, phone callbacks were conducted to verify the authenticity of the responses after all eligible patients completed the questionnaire. Data were anonymized using unique patient identifier in place of names and were extracted into Excel at the end of recruitment. Data was then transferred to the statisticians for data analysis. Patients with responses containing errors in logic were excluded from the analysis.
Statistical Analysis
Descriptive analyses were performed to summarize patients’ demographics and clinical experience, perspectives on glycemic control and weight loss, and treatment preferences. Statistics including mean, median, standard deviation (SD), and interquartile range were reported for continuous variables. Frequency and proportion were reported for categorical variables. Body mass index (BMI) was calculated by dividing weight (in kilograms) by the square of height (in meters), and further categorized using both China’s and the World Health Organization (WHO)’s criteria, respectively [26, 27]. The results applying BMI using the WHO criteria are presented in the Tables S1 to S5.
Logistic regressions were employed in the following analysis: (1) binary logistic regression to assess factors associated with patient perspectives on the importance of safely achieving stringent glycemic control (extremely important, not extremely important), with patients stratified by “non-experienced group” and “experienced group”; (2) multinomial logistic regression to assess factors associated with expected weight change (weight loss, weight gain, weight unchanged) and whether ≥ 10% weight loss was perceived as a benefit or concern (benefit, concern, other/not sure, neutral); (3) binary logistic regression to assess factors associated with treatment preferences (treatment A, treatment B) under the four scenarios. All these regression models were adjusted for covariates including key sociodemographic and clinical characteristics such as age, gender, education level, HbA1c level, BMI, duration of T2D, experienced episodes of severe hypoglycemia, diabetes treatment, and disease stage, which were selected on the basis of the literature or expert consultation. Adjusted odds ratios (aOR), 95% confidence intervals (CI), and p values were reported for multivariable analyses. All statistical tests were two-sided with a significance level of 0.05. All statistical analyses were conducted using R version 4.2 (R Core Team, Vienna, Austria).
Results
Characteristics of Study Population
At the end of patient recruitment, 500 patients completed the questionnaire. After we excluded one patient whose answers were not self-reported, and four patients who provided invalid body weight information, a total of 495 patients with T2D had valid questionnaires and were included in the analysis. The mean age of patients was 58.02 years (SD 12.44). The majority of patients were male (n = 298, 60.20%), and nearly half held a bachelor’s degree or above (n = 234, 47.27%) (Table 1).
Table 1.
Sociodemographic characteristics and clinical experience of total population
| Total population (N = 495) | |
|---|---|
| Age (in years), mean (SD) [min–max] | 58.02 (12.44) [23–88] |
| Gender (male), n (%) | 298 (60.20) |
| Age group, n (%) | |
| 18–29 years | 9 (1.82) |
| 30–39 years | 42 (8.48) |
| 40–49 years | 64 (12.93) |
| 50–59 years | 114 (23.03) |
| ≥ 60 years | 266 (53.74) |
| Ethnicity, n (%) | |
| Han | 477 (96.36) |
| Other | 16 (3.23) |
| Prefer not to answer | 2 (0.40) |
| Region of residence, n (%) | |
| East | 201 (40.61) |
| West | 135 (27.27) |
| Central | 114 (23.03) |
| Northeast | 45 (9.09) |
| Education level, n (%) | |
| Middle school or lower | 110 (22.22) |
| High school or polytechnic school | 129 (26.06) |
| Bachelor’s degree or college degree | 214 (43.23) |
| Master’s degree or above | 20 (4.04) |
| Prefer not to answer | 22 (4.44) |
| Yearly household income, n (%) | |
| < ¥100,000 | 195 (39.39) |
| ¥100,000–500,000 | 146 (29.49) |
| ≥ ¥500,000 | 7 (1.41) |
| Prefer not to answer | 147 (29.70) |
| Type of health insurancea, n (%) | |
| Urban employee basic medical insurance | 375 (75.76) |
| Basic medical insurance for urban and rural residents | 77 (15.56) |
| Free medical treatment | 35 (7.07) |
| Commercial health insurance | 9 (1.82) |
| Other | 0 (0) |
| No health insurance | 4 (0.81) |
| Prefer not to answer | 3 (0.61) |
| HbA1c level, n (%) | |
| ≤ 6.5% | 142 (28.69) |
| > 6.5% | 353 (71.31) |
| BMI-Chinab, n (%) | |
| < 18.5 kg/m2 | 10 (2.02) |
| ≥ 18.5 and < 24.0 kg/m2 | 206 (41.62) |
| ≥ 24.0 and < 28.0 kg/m2 | 197 (39.80) |
| ≥ 28.0 kg/m2 | 82 (16.57) |
| Duration of T2D, n (%) | |
| < 5 years | 198 (40.00) |
| 5–9 years | 94 (18.99) |
| ≥ 10 years | 203 (41.01) |
| Diabetes-related complicationsa, n (%) | |
| Nerve complications | 64 (12.93) |
| Eye complications | 60 (12.12) |
| Cardiovascular complications | 49 (9.90) |
| Kidney complications | 24 (4.85) |
| Foot complications | 17 (3.43) |
| Other | 0 (0) |
| None | 341 (68.89) |
| Diabetes treatmenta, n (%) | |
| Oral/tablets | 431 (87.07) |
| Diet and exercise | 284 (57.37) |
| Insulin injection | 194 (39.19) |
| Non-insulin injection | 62 (12.53) |
| No treatment/not sure/do not know | 11 (2.22) |
| Experienced episodes of severe hypoglycemiac, n (%) | |
| 0 | 411 (83.03) |
| ≥ 1 | 84 (16.97) |
T2D type 2 diabetes, SD standard deviation, HbA1c hemoglobin A1c, BMI body mass index
aColumn percentages may sum to greater than 100% since it is a multiple-choice question
bBMI is categorized as < 18.5 kg/m2 (underweight), ≥ 18.5 and < 24.0 kg/m2 (normal), ≥ 24.0 and < 28.0 kg/m2 (overweight), and ≥ 28.0 kg/m2 (obesity), according to China’s criteria
cSevere hypoglycemia defined as a medical emergency in the past year requiring the assistance of another individual to administer carbohydrates, glycogen, or take other proper treatment
The majority were overweight/obese (i.e., BMI ≥ 24.0 kg/m2) (n = 279, 56.37%) and had the latest HbA1c > 6.5% within past 6 months (n = 353, 71.31%). There were 41.01% of the patients (n = 203) who had been diagnosed with T2D for at least 10 years. The majority (n = 341, 68.89%) did not have any diabetes-related complications. Patients’ T2D treatment experience predominantly involved oral medication (n = 431, 87.07%). Additionally, over half of the patients managed T2D through diet and exercise (n = 284, 57.37%), while some had undergone insulin injections (n = 194, 39.19%) and non-insulin injections (n = 62, 12.53%). Very few patients did not receive any T2D treatment or did not know what treatment they received (n = 11, 2.22%). Most patients reported no incidents of severe hypoglycemia requiring assistance in the past year (n = 411, 83.03%) (Table 1).
Perspective on Safely Achieving Stringent Glycemic Control
The majority of the study population perceived an extreme (n = 410, 82.83%) or moderate (n = 60, 12.12%) level of importance of safely achieving stringent glycemic control. There were 217 patients who reported that they had safely achieved stringent glycemic control in the past 6 months (“experienced group”) and 278 patients who reported that they had not (“non-experienced group”, as detailed in Sect. “Questionnaire”). Specifically, 85.25% (n = 185) and 11.52% (n = 25) of patients in the “experienced group” and 80.94% (n = 225) and 12.59% (n = 35) of patients in the “non-experienced group” considered the importance of safely achieving stringent glycemic control as “extreme” or “moderate”, respectively (Fig. 1).
Fig. 1.
Patient perspectives on safely achieving stringent glycemic control. A Importance of safely achieving stringent glycemic control; B positive impacts of safely achieving stringent glycemic control; C positive psychological or emotional impacts of safely achieving stringent glycemic control. Non-experienced group: patients who did not safely achieve stringent glycemic control in the past 6 months; Experienced group: patients who safely achieved stringent glycemic control in the past 6 months
The most commonly perceived positive impact of safely achieving stringent glycemic control was on physical health, as reported by 90.10% of the study population (n = 446), while it was 91.71% (n = 199) for the “experienced group” and 88.85% (n = 247) for the “non-experienced group”, respectively. About a third of the study population (n = 192, 38.79%) considered safely achieving stringent glycemic control would benefit their psychological and emotional health, among whom the majority perceived an increased overall health-related quality of life (n = 119, 61.98%). A similar pattern in the reported benefits was shown in the “experienced group” and the “non-experienced group” (Fig. 1). The ranking of these benefits was described in the Table S6.
Multivariable analysis was conducted for the two subgroups (“experienced group” and “non-experienced group”) separately. For the “non-experienced group”, patients with diabetes-related complications of any type had 2.40 times the odds (aOR 2.40, 95% CI 1.09–5.69, p = 0.0360) of perceiving safely achieving stringent glycemic control as extremely important, compared to those without any diabetes-related complications. However, patients aged ≥ 60 years had 53% lower odds (aOR 0.47, 95% CI 0.22–0.95, p = 0.0396) than patients aged < 60 years of perceiving extreme importance regarding safely achieving stringent glycemic control. In the analysis of the “experienced group” to assess factors associated with the same perspective, no factors were found to be statistically significant (Table 2).
Table 2.
Multivariable analysis of patient perspective on the importance for safely achieving stringent glycemic control in non-experienced and experienced groups
| Non-experienced group (N = 275) | Experienced group (N = 217) | |||
|---|---|---|---|---|
| Extremely importanta | Extremely importanta | |||
| aOR (95% CI) | p value | aOR (95% CI) | p value | |
| Age (Reference: < 60 years) | ||||
| ≥ 60 years | 0.47 (0.22, 0.95) | 0.0396 | 0.58 (0.24, 1.37) | 0.2218 |
| Gender (Reference: Male) | ||||
| Female | 1.65 (0.82, 3.46) | 0.1700 | 1.07 (0.48, 2.46) | 0.8761 |
| Education level (Reference: Middle school or lower) | ||||
| High school or polytechnic school | 0.59 (0.21, 1.53) | 0.2864 | 1.22 (0.34, 4.39) | 0.7512 |
| Bachelor’s degree or above | 0.72 (0.27, 1.77) | 0.4845 | 0.69 (0.23, 1.85) | 0.4741 |
| Prefer not to answer | 2.24 (0.34, 44.88) | 0.4784 | 0.79 (0.08, 17.82) | 0.8488 |
| HbA1c level (Reference: ≤ 6.5%) | ||||
| > 6.5% | 3.99 (1.59, 9.89) | 0.0028 | 1.43 (0.64, 3.26) | 0.3860 |
| BMI-Chinab (Reference: < 24.0 kg/m2) | ||||
| ≥ 24.0 kg/m2 | 0.54 (0.26, 1.08) | 0.0886 | 0.61 (0.27, 1.34) | 0.2252 |
| Duration of T2D (Reference: < 5 years) | ||||
| 5–9 years | 0.94 (0.37, 2.45) | 0.8949 | 0.77 (0.29, 2.09) | 0.5913 |
| ≥ 10 years | 0.86 (0.37, 1.98) | 0.7220 | 1.81 (0.65, 5.32) | 0.2634 |
| Experienced episodes of severe hypoglycemia (Reference: 0) | ||||
| ≥ 1 | 1.33 (0.46, 4.87) | 0.6245 | 1.20 (0.44, 3.82) | 0.7409 |
| Diabetes treatment (Reference: Without non-insulin injection) | ||||
| With non-insulin injection | 0.78 (0.30, 2.34) | 0.6391 | 1.32 (0.40, 6.03) | 0.6834 |
| Disease stage (Reference: T2D without any diabetes-related complications) | ||||
| T2D with any diabetes-related complications | 2.40 (1.09, 5.69) | 0.0360 | 1.04 (0.41, 2.79) | 0.9404 |
Non-experienced group: patients who did not safely achieve stringent glycemic control in the past 6 months; Experienced group: patients who safely achieved stringent glycemic control in the past 6 months
T2D type 2 diabetes, aOR adjusted odds ratio, CI confidence interval, HbA1c hemoglobin A1c, BMI body mass index
Patients who selected “not sure” for the importance of safely achieving stringent glycemic control were excluded from the analysis (n = 3)
aReference group: not extremely important, includes responses “not at all important”, “not very important”, “neutral”, and “moderately important”
bBMI is categorized as < 18.5 kg/m2 (underweight), ≥ 18.5 and < 24.0 kg/m2 (normal), ≥ 24.0 and < 28.0 kg/m2 (overweight), and ≥ 28.0 kg/m2 (obesity), according to China’s criteria
Perspective on Weight Loss
Among the study population, 44.65% expected weight loss (n = 221), 41.82% expected no weight change (n = 207), while 13.54% expected weight gain (n = 67) when filling out the questionnaire. Among 279 patients with overweight or obesity, 69.53% (n = 194) expected weight loss, 29.03% (n = 81) expected no weight change, and 1.43% (n = 4) expected weight gain. For ≥ 10% weight loss, nearly half of the patients perceived it as beneficial (n = 231, 46.67%), whereas 16.16% (n = 80) and 26.67% (n = 132) perceived it as neutral or concerning, respectively. Among patients perceiving ≥ 10% weight loss as beneficial, the majority indicated that achieving ≥ 10% weight loss was extremely (n = 117, 50.65%) or moderately (n = 84, 36.36%) important. In contrast, out of the patients with neutral or concerning perceptions of ≥ 10% weight loss, the prevailing sentiment was that “It’s not a good sign for diabetes” (n = 99, 46.70%), followed by “I just don’t want to lose weight” (n = 70, 33.02%) (Table 3).
Table 3.
Patient perspectives on weight loss
| Total population (N = 495) | |
|---|---|
| Expected weight change, n (%) | |
| Weight loss | 221 (44.65) |
| Weight unchanged | 207 (41.82) |
| Weight gain | 67 (13.54) |
| Expected weight change among patients with a BMI ≥ 24.0 kg/m2, n (%)a | |
| Weight loss | 194 (69.53) |
| Weight unchanged | 81 (29.03) |
| Weight gain | 4 (1.43) |
| Whether ≥ 10% of weight loss is perceived as a benefit or a concern, n (%) | |
| Benefit | 231 (46.67) |
| Neutral | 80 (16.16) |
| Concern | 132 (26.67) |
| Other | 5 (1.01) |
| Not sure | 47 (9.49) |
| Importance of safely achieving ≥ 10% weight lossb, n (%) | |
| Extremely important | 117 (50.65) |
| Moderately important | 84 (36.36) |
| Neutral | 7 (3.03) |
| Not very important | 21 (9.09) |
| Not at all important | 1 (0.43) |
| Other | 1 (0.43) |
| Negative perception of weight lossc, n (%) | |
| It’s not a good sign for diabetes | 99 (46.70) |
| I just don’t want to lose weight | 70 (33.02) |
| It’s not a good body image | 29 (13.68) |
| Losing weight is losing fortune | 11 (5.19) |
| Other | 16 (7.55) |
aThe denominator for percentage calculation is the number of patients whose BMI is categorized as ≥ 24.0 and < 28.0 kg/m2 (overweight) and ≥ 28.0 kg/m2 (obesity), according to China’s criteria (n = 279)
bThe denominator for percentage calculation is the number of patients who selected “benefit” in "whether ≥ 10% of weight loss is perceived as a benefit or a concern” (n = 231)
cThe denominator for percentage calculation is the number of patients who selected “neutral” or “concern” in “whether 10% of weight loss or more is perceived as a benefit or a concern” (n = 212). This column’s percentages may sum to greater than 100% since it is a multiple-choice question
In multivariable analysis for weight change expectation, being female (aOR 3.11, 95% CI 1.86–5.18, p < 0.0001) and with BMI ≥ 24.0 kg/m2 (aOR 13.44, 95% CI 7.77–23.26, p < 0.0001) had 3.11 and 13.44 times the odds of expecting weight loss, compared to those being male and with BMI < 24.0 kg/m2, respectively. Meanwhile, patients aged ≥ 60 years had 65% lower odds (aOR 0.35, 95% CI 0.21–0.59, p < 0.0001) than those aged < 60 years of expecting weight loss. On the other hand, patients with BMI ≥ 24.0 kg/m2 had 91% lower odds (aOR 0.09, 95% CI 0.03–0.27, p < 0.0001) than those with BMI < 24.0 kg/m2 of expecting weight gain. No other factors were found to have statistically significant association with expecting weight gain (Table 4). Regarding patient perspectives of ≥ 10% weight loss, patients with BMI ≥ 24.0 kg/m2 had 5.03 times the odds of perceiving it as beneficial (aOR 5.03, 95% CI 2.79–9.05, p < 0.0001), and 0.27 times the odds of perceiving it as concerning (aOR 0.27, 95% CI 0.14–0.51, p < 0.0001), compared to patients with BMI < 24.0 kg/m2. Moreover, patients aged ≥ 60 years had 65% lower odds of perceiving ≥ 10% weight loss as beneficial (aOR 0.35, 95% CI 0.19–0.65, p = 0.0008) and patients who experienced at least one severe hypoglycemia episode in the past year had 70% lower odds than those without experience of perceiving ≥ 10% weight loss as concerning (aOR 0.30, 95% CI 0.13–0.65, p = 0.0024) (Table 5).
Table 4.
Multivariable analysis of patient perspectives on expected weight change in total population
| Expected weight changea (N = 495) | ||||
|---|---|---|---|---|
| Weight loss | Weight gain | |||
| aOR (95% CI) | p value | aOR (95% CI) | p value | |
| Age (Reference: < 60 years) | ||||
| ≥ 60 years | 0.35 (0.21, 0.59) | < 0.0001 | 0.74 (0.39, 1.39) | 0.3435 |
| Gender (Reference: Male) | ||||
| Female | 3.11 (1.86, 5.18) | < 0.0001 | 0.62 (0.32, 1.21) | 0.1623 |
| Education level (Reference: Middle school or lower) | ||||
| High school or polytechnic school | 0.75 (0.39, 1.46) | 0.4001 | 0.55 (0.23, 1.33) | 0.1829 |
| Bachelor’s degree or above | 1.21 (0.65, 2.23) | 0.5528 | 0.85 (0.39, 1.88) | 0.6908 |
| Prefer not to answer | 0.38 (0.11, 1.30) | 0.1230 | 1.23 (0.29, 5.17) | 0.7746 |
| HbA1c level (Reference: ≤ 6.5%) | ||||
| > 6.5% | 1.48 (0.86, 2.52) | 0.1549 | 1.40 (0.72, 2.71) | 0.3249 |
| BMI-Chinab (Reference: < 24.0 kg/m2) | ||||
| ≥ 24.0 kg/m2 | 13.44 (7.77, 23.26) | < 0.0001 | 0.09 (0.03, 0.27) | < 0.0001 |
| Duration of T2D (Reference: < 5 years) | ||||
| 5–9 years | 0.84 (0.42, 1.66) | 0.6132 | 2.07 (0.91, 4.70) | 0.0830 |
| ≥ 10 years | 0.68 (0.37, 1.23) | 0.2017 | 0.93 (0.44, 1.98) | 0.8534 |
| Experienced episodes of severe hypoglycemia (Reference: 0) | ||||
| ≥ 1 | 0.96 (0.51, 1.80) | 0.8920 | 0.91 (0.41, 2.01) | 0.8218 |
| Diabetes treatment (Reference: Without non-insulin injection) | ||||
| With non-insulin injection | 1.88 (0.87, 4.03) | 0.1068 | 0.31 (0.07, 1.47) | 0.1418 |
| Disease stage (Reference: T2D without any diabetes-related complications) | ||||
| T2D with any diabetes-related complications | 1.21 (0.70, 2.09) | 0.4998 | 1.19 (0.59, 2.42) | 0.6250 |
T2D type 2 diabetes, aOR adjusted odds ratio, CI confidence interval, HbA1c hemoglobin A1c, BMI body mass index
aReference group: weight unchanged
bBMI is categorized as < 18.5 kg/m2 (underweight), ≥ 18.5 and < 24.0 kg/m2 (normal), ≥ 24.0 and < 28.0 kg/m2 (overweight), and ≥ 28.0 kg/m2 (obesity), according to China’s criteria
Table 5.
Multivariable analysis of patient perspectives on ≥ 10% of weight loss
| Patient perspective on ≥ 10% of weight lossa (N = 495) | ||||||
|---|---|---|---|---|---|---|
| Benefit | Concern | Other/not sure | ||||
| aOR (95%CI) | p value | aOR (95%CI) | p value | aOR (95%CI) | p value | |
| Age (Reference: < 60 years) | ||||||
| ≥ 60 years | 0.35 (0.19, 0.65) | 0.0008 | 1.01 (0.53, 1.94) | 0.9686 | 0.84 (0.37, 1.92) | 0.6847 |
| Gender (Reference: Male) | ||||||
| Female | 1.39 (0.78, 2.48) | 0.2610 | 0.78 (0.42, 1.45) | 0.4312 | 1.02 (0.47, 2.22) | 0.9617 |
| Education level (Reference: Middle school or lower) | ||||||
| High school or polytechnic school | 0.41 (0.19, 0.89) | 0.0243 | 0.50 (0.22, 1.14) | 0.0980 | 0.74 (0.25, 2.20) | 0.5870 |
| Bachelor’s degree or above | 0.91 (0.43, 1.93) | 0.8032 | 0.95 (0.42, 2.13) | 0.8996 | 1.02 (0.35, 2.99) | 0.9754 |
| Prefer not to answer | 1.99 (0.21, 18.57) | 0.5462 | 0.91 (0.07, 11.27) | 0.9383 | 18.43 (1.94, 175.07) | 0.0112 |
| HbA1c level (Reference: ≤ 6.5%) | ||||||
| > 6.5% | 0.85 (0.45, 1.61) | 0.6166 | 0.79 (0.41, 1.54) | 0.4938 | 1.20 (0.49, 2.90) | 0.6918 |
| BMI-Chinab (Reference: < 24.0 kg/m2) | ||||||
| ≥ 24.0 kg/m2 | 5.03 (2.79, 9.05) | < 0.0001 | 0.27 (0.14, 0.51) | < 0.0001 | 1.04 (0.48, 2.24) | 0.9170 |
| Duration of T2D (Reference: < 5 years) | ||||||
| 5–9 years | 0.61 (0.28, 1.34) | 0.2195 | 0.73 (0.31, 1.72) | 0.4726 | 0.33 (0.11, 1.00) | 0.0510 |
| ≥ 10 years | 0.57 (0.28, 1.15) | 0.1160 | 0.96 (0.45, 2.04) | 0.9196 | 0.32 (0.12, 0.82) | 0.0177 |
| Experienced episodes of severe hypoglycemia (Reference: 0) | ||||||
| ≥ 1 | 0.67 (0.34, 1.33) | 0.2526 | 0.30 (0.13, 0.65) | 0.0024 | 0.50 (0.18, 1.35) | 0.1713 |
| Diabetes treatment (Reference: Without non-insulin injection) | ||||||
| With non-insulin injection | 1.25 (0.49, 3.19) | 0.6372 | 1.32 (0.47, 3.70) | 0.5957 | 1.66 (0.50, 5.49) | 0.4077 |
| Disease stage (Reference: T2D without any diabetes-related complications) | ||||||
| T2D with any diabetes-related complications | 1.45 (0.76, 2.79) | 0.2600 | 1.56 (0.79, 3.11) | 0.2032 | 1.52 (0.63, 3.69) | 0.3538 |
T2D type 2 diabetes, aOR adjusted odds ratio, CI confidence interval, HbA1c hemoglobin A1c, BMI body mass index
aReference group: neutral
bBMI is categorized as < 18.5 kg/m2 (underweight), ≥ 18.5 and < 24.0 kg/m2 (normal), ≥ 24.0 and < 28.0 kg/m2 (overweight), and ≥ 28.0 kg/m2 (obesity), according to China’s criteria
Preference for Different T2D Treatment Profiles
For scenarios 1 and 2, the majority of the study population favored treatment A (scenario 1: 70.71%; scenario 2: 68.89%). Regarding scenarios 3 and 4, patient preferences were similar between treatment A (scenario 3: 49.29%; scenario 4: 52.73%) and treatment B (scenario 3: 50.71%; scenario 4: 47.27%) (Fig. 2).
Fig. 2.
Patient preference for different treatment profiles in four scenarios. To elicit preferences for different T2D treatment profiles, patients were presented with four scenarios. Each scenario included two anonymous treatments, labeled as treatment A and treatment B, with three key features: (1) probability of achieving HbA1c ≤ 6.5% (feature 1), (2) probability of achieving ≥ 10% weight loss (feature 2), and (3) probability of side effects occurring (feature 3). Patients were asked to select their preferred treatment option for each scenario. In scenario 1 and scenario 2, treatment A presented higher values for feature 1 and feature 2 compared to treatment B, while the values for feature 3 were similar between the two treatments. In scenario 3 and scenario 4, feature 3 was further broken down into the probabilities of hypoglycemia and gastrointestinal side effects to capture more nuanced differences between the treatments, and treatment A presented higher values for feature 1 and feature 2, a lower probability of hypoglycemia, and a higher probability of gastrointestinal side effects compared to treatment B
In the multivariable analysis exploring factors associated with treatment preference, having a HbA1c > 6.5% (scenario 1: aOR 1.85, 95% CI 1.19–2.86, p = 0.0059; scenario 2: aOR 1.75, 95% CI 1.14–2.69, p = 0.0108) and with BMI ≥ 24.0 kg/m2 (scenario 1: aOR 1.72, 95% CI 1.14–2.60, p = 0.0097; scenario 2: aOR 1.67, 95% CI 1.12–2.50, p = 0.0126) were associated with higher odds of preferring treatment A in both scenarios 1 and 2. On the other hand, age ≥ 60 years was associated with lower odds of preferring treatment A across all four scenarios (scenario 1: aOR 0.63, 95% CI 0.40–0.98, p = 0.0417; scenario 2: aOR 0.60, 95% CI 0.39–0.92, p = 0.0215; scenario 3: aOR 0.42, 95% CI 0.28–0.63, p < 0.0001; scenario 4: aOR 0.55, 95% CI 0.36–0.81, p = 0.0030) (Table 6).
Table 6.
Multivariable analysis of patients’ different treatment preferences
| Scenario 1 (N = 495) | Scenario 2 (N = 495) | Scenario 3 (N = 495) | Scenario 4 (N = 495) | |||||
|---|---|---|---|---|---|---|---|---|
| Treatment Aa | Treatment Aa | Treatment Aa | Treatment Aa | |||||
| aOR (95%CI) | p value | aOR (95%CI) | p value | aOR (95%CI) | p value | aOR (95%CI) | p value | |
| Age (Reference: < 60 years) | ||||||||
| ≥ 60 years | 0.63 (0.40, 0.98) | 0.0417 | 0.60 (0.39, 0.92) | 0.0215 | 0.42 (0.28, 0.63) | < 0.0001 | 0.55 (0.36, 0.81) | 0.0030 |
| Gender (Reference: Male) | ||||||||
| Female | 1.04 (0.68, 1.59) | 0.8650 | 1.05 (0.69, 1.59) | 0.8341 | 0.86 (0.58, 1.26) | 0.4385 | 0.85 (0.58, 1.25) | 0.4153 |
| Education level (Reference: Middle school or lower) | ||||||||
| High school or polytechnic school | 1.04 (0.58, 1.87) | 0.8888 | 1.10 (0.62, 1.96) | 0.7502 | 1.56 (0.92, 2.67) | 0.1018 | 1.27 (0.75, 2.14) | 0.3760 |
| Bachelor’s degree or above | 1.22 (0.71, 2.08) | 0.4680 | 1.14 (0.67, 1.93) | 0.6156 | 1.55 (0.96, 2.54) | 0.0756 | 1.37 (0.85, 2.21) | 0.2007 |
| Prefer not to answer | 0.21 (0.07, 0.58) | 0.0028 | 0.23 (0.08, 0.62) | 0.0044 | 0.74 (0.26, 1.99) | 0.5668 | 0.45 (0.15, 1.22) | 0.1313 |
| HbA1c level (Reference: ≤ 6.5%) | ||||||||
| > 6.5% | 1.85 (1.19, 2.86) | 0.0059 | 1.75 (1.14, 2.69) | 0.0108 | 1.37 (0.90, 2.07) | 0.1399 | 1.13 (0.75, 1.70) | 0.5625 |
| BMI-Chinab (Reference: < 24.0 kg/m2) | ||||||||
| ≥ 24.0 kg/m2 | 1.72 (1.14, 2.60) | 0.0097 | 1.67 (1.12, 2.50) | 0.0126 | 1.32 (0.91, 1.92) | 0.1506 | 1.26 (0.87, 1.82) | 0.2306 |
| Duration of T2D (Reference: < 5 years) | ||||||||
| 5–9 years | 1.11 (0.63, 1.98) | 0.7277 | 1.10 (0.63, 1.95) | 0.7362 | 1.57 (0.93, 2.69) | 0.0929 | 1.34 (0.80, 2.28) | 0.2664 |
| ≥ 10 years | 1.30 (0.78, 2.18) | 0.3130 | 1.31 (0.80, 2.18) | 0.2873 | 1.57 (0.98, 2.53) | 0.0613 | 1.38 (0.87, 2.20) | 0.1799 |
| Experienced episodes of severe hypoglycemia (Reference: 0) | ||||||||
| ≥ 1 | 1.23 (0.70, 2.21) | 0.4800 | 1.09 (0.64, 1.91) | 0.7593 | 0.82 (0.50, 1.35) | 0.4433 | 0.78 (0.48, 1.28) | 0.3263 |
| Diabetes treatment (Reference: Without non-insulin injection) | ||||||||
| With non-insulin injection | 1.12 (0.59, 2.22) | 0.7380 | 1.27 (0.67, 2.50) | 0.4788 | 0.84 (0.47, 1.49) | 0.5516 | 0.81 (0.46, 1.42) | 0.4544 |
| Disease stage (Reference: T2D without any diabetes-related complications) | ||||||||
| T2D with any diabetes-related complications | 1.37 (0.85, 2.23) | 0.2035 | 1.28 (0.80, 2.06) | 0.3037 | 0.99 (0.65, 1.53) | 0.9809 | 1.04 (0.68, 1.59) | 0.8582 |
To elicit preferences for different T2D treatment profiles, patients were presented with four scenarios. Each scenario included two anonymous treatments, labeled as treatment A and treatment B, with three key features: (1) probability of achieving HbA1c ≤ 6.5% (feature 1), (2) probability of achieving ≥ 10% weight loss (feature 2), and (3) probability of side effects occurring (feature 3). Patients were asked to select their preferred treatment option for each scenario. In scenario 1 and scenario 2, treatment A presented higher values for feature 1 and feature 2 compared to treatment B, while the values for feature 3 were similar between the two treatments. In scenario 3 and scenario 4, feature 3 was further broken down into the probabilities of hypoglycemia and gastrointestinal side effects to capture more nuanced differences between the treatments, and treatment A presented higher values for feature 1 and feature 2, a lower probability of hypoglycemia, and a higher probability of gastrointestinal side effects compared to treatment B
T2D type 2 diabetes, aOR adjusted odds ratio, CI confidence interval, HbA1c hemoglobin A1c, BMI body mass index
aReference group: treatment B
bBMI is categorized as < 18.5 kg/m2 (underweight), ≥ 18.5 and < 24.0 kg/m2 (normal), ≥ 24.0 and < 28.0 kg/m2 (overweight), and ≥ 28.0 kg/m2 (obesity), according to China’s criteria
Discussion
To the best of our knowledge, this was the first study that investigated patient perspectives on stringent glycemic control at HbA1c ≤ 6.5% and ≥ 10% weight loss in a representative sample of patients with T2D in China. The study findings suggested that the majority of patients with T2D in this survey recognized the importance of stringent glycemic control at HbA1c ≤ 6.5%. Among patients with T2D who perceived a ≥ 10% weight loss as beneficial, the majority acknowledged its importance. Patients’ perceptions on the importance of stringent glycemic control and weight loss were also reflected in their treatment preferences. Certain factors were identified to be associated with these perceptions and treatment preferences, including having the latest level of HbA1c > 6.5% within 6 months, age ≥ 60 years, and being overweight/obese.
Our findings revealed that most patients perceived stringent glycemic control as extremely or moderately important, regardless of whether they had safely achieved HbA1c ≤ 6.5% (“experienced group”) or not (“non-experienced group”) as self-reported in the past 6 months. Moreover, the frequency of perceived positive impacts, including the impacts regarding psychological/emotional aspects, were generally identical between the “experienced group” and “non-experienced group”. Specifically, among all patients who perceived psychological and emotional impacts as beneficial, the majority reported safely achieving stringent glycemic control would increase their overall health-related quality of life. In general, our study findings aligned with the prior quantitative survey study in the USA and UK, despite that study assessing the patients’ perspectives of achieving near normoglycemia (HbA1c < 6.0%) [17]. Our findings, as well as those of the prior quantitative survey study, suggested that patients with T2D acknowledged the importance of stringent goal for glycemic control and positive impacts they would bring. Furthermore, a recent study in China reported that patients with T2D with lower HbA1c levels tended to have higher health-related quality of life [28], reinforcing the perspectives reported by patients in the “experienced group” in our study. However, the significant gap between the perspectives on stringent glycemic control and current HbA1c management outcomes remains concerning. A systematic review on T2D in China highlighted that social disparities and environmental factors contribute to unhealthy lifestyles and low health awareness, leading to poor compliance with diabetes care and diminished quality of life [29]. Additionally, a document authored by the CDS emphasized that encountering hypoglycemia during treatment is a significant barrier to achieving blood glucose targets and requires special attention [30]. To address these issues, the review recommended enhancing social support, strengthening the healthcare system, and improving patient education [29]. These recommendations align with the key message we aimed to convey in this study.
In terms of the expectation of weight change, 44.65% of the study population expected weight loss, while the proportion of patients being overweight or obese was 56.37% in this population. Further analysis revealed that among those with overweight or obesity, 69.53% expected weight loss, a higher proportion than that of the study population. However, 30.47% still anticipated no change in weight or even weight gain. The discrepancy may be attributable to misperceptions regarding body weight status within our study population, which was also reported in a previous USA national survey [17]. A recent qualitative study indicated that physical activity was generally ignored and considered less important than diet and medication among patients with T2D and physical activity deficiency in China [31], which may provide a clue about obstacles to weight management and why unsatisfactory weight management status was observed in our study population. Regarding attitudes towards losing ≥ 10% of weight, the proportion of patients who perceived it as beneficial was similar to that of those who viewed it as neutral or concerning. Among those who considered ≥ 10% weight loss as beneficial, the majority agreed on its importance. In contrast, among those who perceived it as neutral or concerning, the most frequently perceived negative impact of losing weight was the belief that losing ≥ 10% weight is not a good sign for diabetes control, and some patients even indicated a lack of intention to lose weight. Overall, our study investigated the perceived importance of achieving ≥ 10% weight loss among patients with T2D, offering additional evidence beyond a previous study that explored the patient perspectives on 5% weight loss [32]. Furthermore, our findings revealed heterogeneity in the understanding of the meaning of weight management among patients with T2D in China. Future enhanced education on weight management is needed for this population, including clarifying the clinical implications of weight status, the potential benefits of losing weight and practical methods to manage weight.
Regarding treatment preferences, the present study indicated that most patients with T2D preferred the treatment with higher rates of achieving both stringent glycemic control and weight loss, when its safety profile was similar to the other treatment. However, if a treatment demonstrated superior efficacy in achieving stringent glycemic control and weight loss with a lower chance of hypoglycemia but a higher frequency of gastrointestinal side effects, patient preference was similar between the treatments. The significance of HbA1c reduction and weight reduction of treatment preference was consistent with a study conducted in the USA and UK using discrete-choice experiment (DCE) [19]. A recent DCE study in China reported that patients with T2D were concerned about treatment efficacy, hypoglycemia risk, and gastrointestinal side effects, rather than weight change, when selecting a second line antihyperglycemic medicine [20]. Future studies employing DCE could be conducted to further investigate T2D treatment preferences among patients in China.
This study also identified several factors associated with patient perspectives and treatment preference. Patients having any type of diabetes-related complications were associated with higher odds of perceiving safely achieving stringent glycemic control as extremely important. In addition, patients being overweight or obese were associated with higher odds of weight loss expectation and perceiving ≥ 10% weight loss as beneficial. Regrading treatment preference, having a HbA1c > 6.5% and being overweight or obese were both associated with higher odds of preferring the treatment with a higher chance of achieving stringent glycemic control and weight loss when both treatments had similar safety profiles. In contrast, patients aged ≥ 60 years had lower odds of presenting all the perspectives and preferences mentioned above. These findings were in accordance with current Chinese guidelines on T2D management, which advocated for less stringent goals for glycemic control and weight management in elderly patients compared to the general population while emphasizing the necessity of individualized and comprehensive therapy for T2D [33–35].
Overall, our findings were based on a geographical representative study population of patients with T2D in China, and the proportions of patients with insulin usage and overweight/obesity in the study cohort were comparable to the general T2D population in China [36, 37]. However, the generalizability of these findings is partially constrained by several limitations. Firstly, HbA1c levels, height, weight, and the experience of whether stringent glycemic control had been safely achieved were all self-reported. This approach may have introduced response bias and inaccuracies. Notably, we observed a slight discrepancy between patients’ response regarding the latest HbA1c levels and whether they had achieved stringent glycemic control in the past 6 months. For instance, some patients reported safely achieving stringent glycemic control during that period, but their latest HbA1c levels were over 6.5%. Callback results indicated that patients might have a positive perception regarding the self-management of their glycemia but could be potentially overlooking the specific definition for glycemic control and time interval provided in the questions. Recall bias was another potential limitation, as certain questions pertained to past events such as the frequency of experiencing severe hypoglycemia in the past year and the time of the initial diagnosis of T2D. While recall bias was inherent in this type of study, its impact was expected to be limited, as most outcomes assessed were based on patients’ current perspectives, experiences, and preferences. Furthermore, the study may be susceptible to selection bias, as the eligibility criteria required patients to be capable of using mobile devices to complete the questionnaire. Another criterion that may induce selection bias was excluding individuals with a history of tirzepatide use. This exclusion was set to minimize the potential impact of prior tirzepatide treatment experience on responses, stemming from tirzepatide’s proven efficacy, demonstrating superior reductions in both HbA1c and weight [38]. However, considering that tirzepatide was not approved in China at the time of patient recruitment, we anticipated that the impact of this exclusion criterion was minimal. Thus, we recommend that further research on patient perspectives among patients with T2D could improve self-reported data through validated methods, such as incorporating medical records. On the other hand, as our study was designed and reported at a total population level because of the absence of prior similar research in China, we encourage future studies to build upon our findings and consider population differences in sociodemographic and clinical characteristics, potentially providing a more comprehensive understanding of the T2D population in China.
Finally, this study uncovered significant concerns and potential unmet needs related to the physical well-being of patients with T2D in China. By investigating patient perspectives and preferences, this study provided evidence through their voices and revealed some knowledge gaps not reported in prior literature. Healthcare providers may gain insights into the profiles of patients who may pursue strict goals or who may lack sufficient knowledge in diabetes management. This allows for timely and patient-centered suggestions and education regarding glycemic control or weight loss, contributing to a more consolidated patient-centered approach. Newly developed T2D medications with proven efficacy in safely achieving glycemic control and weight loss could be considered in T2D management.
Conclusions
This study highlighted patients’ perspectives of stringent glycemic control and ≥ 10% weight loss, as well as their preferences for T2D medications and provided an overview of patients with T2D in China, in terms of past experiences with T2D and its treatment. Findings from this study are valuable for the community of patients with T2D and may benefit clinical practice, aiding joint decision-making by patients and healthcare providers in T2D treatment and management.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors would like to thank all patients who participated in this study.
Medical Writing, Editorial, and Other Assistance
Assistance on study design and medical writing for the development of this manuscript was provided by Jiaqi Kou, Chih-Chi Yang, Jingyu Tong, Bojing Cai, Shuo Yang of IQVIA. This assistance was funded by Eli Lilly and Company, Shanghai, China. The authors would like to thank Jinnan Li and Si Si of Eli Lilly and Company for review and critical suggestions for improvement.
Author Contributions
Jian Zhang contributed to the study conception, study design, data acquisition, and results interpretation. Ang Li contributed to the study conception, study design, and data acquisition. Jinxing Quan, Jun Wu, Hanqing Cai, Yuchen Ding, Jiani Tang and Xiao Ma contributed to the study design and data acquisition. Junqing Zhang contributed to the study design, data acquisition, and results interpretation. All authors contributed to revising and approving the final version for submission.
Funding
The study, including the journal’s Rapid Service Fee, was funded by Eli Lilly and Company, Shanghai, China.
Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Conflict of Interest
Yuchen Ding, Jiani Tang, and Xiao Ma are employed by Eli Lilly and Company. The remainder of authors (Jian Zhang, Ang Li, Jinxing Quan, Jun Wu, Hanqing Cai and Junqing Zhang) have nothing to declare.
Ethical Approval
Ethical approval for the study was obtained from the Ethics Committee of Peking University First Hospital (Approval No. 2023-yan-008), and all patients provided informed consent. The study was conducted in accordance with the principles of international ethics guidelines, including the Declaration of Helsinki, and applicable local laws and regulations.
Footnotes
Prior Presentation: A poster from this study was presented at the 84th Scientific Sessions of the American Diabetes Association, held from June 21 to June 24, 2024, in Orlando, Florida.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.