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 prescribing influences and how different classes perform. Key unmet needs in type 2 diabetes are discussed, as are general influences such as reimbursement status and inclusion in guidelines.

1. Prescribing Influences: Type 2 Diabetes – Opportunities in type 2 diabetes for
drugs with both safety and efficacy
Published:September 2011
No.Of Pages:76
Price:US $ 3800
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 prescribing influences and how different classes perform. Key unmet needs in type
2 diabetes are discussed, as are general influences such as reimbursement status and
inclusion in guidelines.
Features and benefits
* Analyze key opinion leader insight into clinical and associated unmet needs in type 2
diabetes.
* Evaluate physician ratings of important prescribing influences among the seven major
markets.
* Compare physician-reported drug class performance on key influencers of therapy choice.
* Gain insight into the differences between reasons to switch treatment regimes and
reasons to initiate treatment.
Highlights
Survey respondents report that efficacy of glycemic control is the most important influence
on therapy choice in type 2 diabetes across all markets, but beyond this different countries
vary – for example, treatment cost is ranked second in the US but last in France, where
reimbursement is widely available.
Metformin is the “best” antidiabetic drug as measured by performance on all prescribing
criteria. DPP-IV inhibitors rate more highly than sulfonylureas in some markets, while drugs
without a record of use are not highly rated. Physicians consider drugs’ overall performance
rather than individual criteria.
While safety and side-effect profile are key for choosing a drug or drug class in the first
place, safety is rated least important in the decision to switch treatment regimes in type 2
diabetes, with KOLs confirming that they are unlikely to change treatment for a well-
controlled patient even if worrying safety data emerge.

2. Table Of Contents
OVERVIEW
Catalyst
Summary
EXECUTIVE SUMMARY
Strategic scoping and focus
Datamonitor key findings
Diabetes reports in the seven major markets
Published diabetes reports
UNMET NEEDS IN TYPE 2 DIABETES
Physician perceptions of unmet needs
Specialists seek more effective insulin use while PCPs target administration mode and
general drug efficacy
No single unmet need defines type 2 diabetes management
Market unmet needs
Diagnosis of type 2 diabetes
Patient awareness and compliance
Physician education and guideline awareness
Patient and physician education on insulin use
Clinical unmet needs in type 2 diabetes
Improved efficacy and safety balance in type 2 diabetes
Improving cardiovascular mortality
Durability of therapy effect
Stability of glucose control and avoiding hypoglycemia
Better therapy tolerability and weight reduction
Reduced insulin regimen complexity and easier blood glucose monitoring
Non-injected insulins
PRESCRIBING INFLUENCES
Treatment guidelines
ADA/EASD Treatment Guidelines
Treatment targets in type 2 diabetes
Standards of Medical Care 2011
Other Guidelines
Incentive schemes and guidelines
Factors influencing treatment choices
Efficacy of glycemic control is most important
Cost is second-ranked factor in the US
Non-insulin class performance in meeting criteria
Metformin is the comparator for all other antidiabetic classes
Prescribing influences are not independent, and physicians consider a drug's whole
performance
Key prescribing influences
Overall drug ratings
Factors influencing treatment switching

3. Safety concerns are not a strong reason to switch a well-controlled patient off a drug
Lack of HbA1c control is the main reason for therapy switching in most markets, but less
important in Germany
Factors affecting choice of insulin
Concentration profile is main criterion for basal insulin selection
Individual patient response is key for choosing mealtime insulin
Trends in marketing strategies
Marketing strategy for leading brands
Disease management programs
Risk-sharing
Reimbursement
US formulary tier status for leading brands
Reimbursement in the EU
BIBLIOGRAPHY
Journal papers and conference proceedings
Other sources
Datamonitor reports
APPENDIX
Datamonitor Type 2 Diabetes Physician Survey
Contributing experts
Report methodology
LIST OF TABLES
Table: ADA/EASD summary of glucose-lowering interventions, 2009
Table: ADA evidence grading system for clinical practice recommendations
Table: Examples of diabetes support programs from major manufacturers, 2011
Table: Representative formulary tier status in the US for leading brands in type 2 diabetes,
2011
Table: EU type 2 diabetes treatment reimbursement policies, 2011
Table: Survey respondents in the seven major markets, by country and physician type,
2011
LIST OF FIGURES
Figure: Rating of unmet needs in the seven major markets, by physician type, 2011
Figure: Diagnosed type 2 diabetics as a percentage of prevalent patient population in the
seven major markets, 2011
Figure: Reasons for type 2 diabetes going undiagnosed in the seven major markets, 2011
Figure: ADA/EASD algorithm for the metabolic management of type 2 diabetes, 2009
Figure: Physician perceptions of the relative importance of drug characteristics for
prescribing in type 2 diabetes in the seven major markets, 2011
Figure: Physician perceptions of the relative importance of drug characteristics for
prescribing in type 2 diabetes in the seven major markets, by country, 2011
Figure: Physician perceptions of the relative importance of drug characteristics for
prescribing in type 2 diabetes in the seven major markets, by physician type, 2011
Figure: Physician grading of non-insulin classes in the seven major markets, 2011

4. Figure: Physician grading of marketed non-insulin classes in the seven major markets, 2011
Figure: Physician grading of pipeline non-insulin classes compared with metformin in the
seven major markets, 2011
Figure: Physician grading of non-insulin classes in the seven major markets, weighted by
factor importance, 2011
Figure: Physician grading of non-insulin classes' efficacy in the seven major markets, 2011
Figure: Physician grading of non-insulin classes' safety and side-effect profile in the seven
major markets, 2011
Figure: Weighted grading of the non-insulin marketed and pipeline classes across all
criteria, in the seven major markets, 2011
Figure: Weighted grading of the non-insulin marketed and pipeline classes across all
criteria, by country, in the seven major markets, 2011
Figure: Influence of different factors on the decision to change patient treatment in the
seven major markets, 2011
Figure: Influence of different factors on the decision to change patient treatment in the
seven major markets, by country, 2011
Figure: Criteria for choosing a basal insulin in the seven major markets, 2011
Figure: Criteria for choosing a basal insulin in the seven major markets, by country, 2011
Figure: Criteria for choosing a prandial insulin in the seven major markets, 2011
Figure: Criteria for choosing a prandial insulin in the seven major markets, by country, 2011
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