The Perspectives of Physicians Regarding Antidiabetic Therapy De-Intensification and Factors Affecting their Treatment Choices: A Cross-Sectional Study

Background: Comprehensive diabetes management includes an appropriate dietary plan, exercise, and antidiabetic medications. Nevertheless, the target glycaemic control is not always achieved using single antidiabetic, patients may need to start treatment intensification by increasing the dose of the single antidiabetic agent or by the administration of antidiabetic combination therapy. However, it has been shown that intensive antidiabetic therapy should be used carefully as it is associated with an increased risk of adverse events and death. The aim of this study is to understand physicians’ perspectives regarding treatment de-intensification and factors affecting their treatment choice for patients with type 2 diabetes mellitus.Methods: A cross-sectional study was conducted in governmental specialised primary and secondary care units in Saudi Arabia using online questionnaire. Two previously validated questionnaires were used to understand physicians’ awareness of, agreement with, and their practices of individualising HbA1c goals and antidiabetic treatment de-intensification, and to assess factors affecting physicians’ treatment choice when prescribing antidiabetic treatment for patients with type 2 diabetes mellitus. Study population were physicians who are treating patients with diabetes mellitus during the period between October 2018 and May 2019.Results: A total of 205 physicians have participated in the study. Approximately 50% of physicians had family medicine speciality (n = 98, 47.8%). The majority of physicians (n = 183, 89.3%) were familiar with the concept of HbA1c goals individualisation. However, only 66.3% of them (n = 136) reported that they apply it either always or most of the time. 58.5% (n = 120) of physicians reported that they would not initiate conversations about de-intensifying antidiabetic therapy even if their patients had a stable HbA1c values for one year. Physicians showed higher consideration to objective patient clinical data and their assessment of patient’s health status, with minor consideration to patient-related factors.Conclusions: Healthcare professionals should focus more on implementing contemporary practices and applying any necessary treatment de-intensification. Subjective patient factors should be taken into account, as these factors are associated with better disease management.