Table 2 All reasons selected by general practitioners for non-treatment of patients with type 2 diabetes mellitus
Reasons, n (%) | Patients < 65 years n = 1, 023 | Patients ≥65 years n = 1, 005 | p-value |
|---|---|---|---|
Mild Hyperglycaemia | 897 (87.7) | 866 (86.2) | 0.323 |
HbA1c value stable, drug therapy not necessary | 278 (27.2) | 264 (26.3) | 0.652 |
HbA1c value close to NICE recommended threshold | 316 (30.9) | 326 (32.4) | 0.474 |
Blood glucose values under control with diet and exercise | 301 (29.4) | 330 (32.8) | 0.103 |
Factors Related to Antihyperglycaemic Agents | 386 (37.7) | 463 (46.1) | < 0.001 |
May cause hypoglycaemia | 176 (17.2) | 250 (24.9) | < 0.001 |
May cause fluid retention | 67 (6.6) | 98 (9.8) | 0.009 |
May cause weight gain | 173 (16.9) | 157 (15.6) | 0.435 |
May cause gastrointestinal side effects | 203 (19.8) | 200 (19.9) | 0.999 |
May increase risk of fracture | 45 (4.4) | 68 (6.8) | 0.026 |
May increase cardiovascular risk | 49 (4.8) | 68 (6.8) | 0.057 |
May increase risk of lactic acidosis | 78 (7.6) | 96 (9.6) | 0.132 |
Uncertainty how to dose certain drug | 26 (2.5) | 25 (2.5) | 0.999 |
Not clear if several agents are safe | 30 (2.9) | 34 (3.4) | 0.612 |
Efficacy of agents not clear | 30 (2.9) | 24 (2.4) | 0.492 |
Safety of agents not clear | 34 (3.3) | 30 (3.0) | 0.704 |
Primary Care Trust cost concerns | 24 (2.4) | 26 (2.6) | 0.776 |
Cognitive burden of therapy administration too high for patient | 66 (6.5) | 121 (12.0) | < 0.001 |
Cognitive burden of monitoring glucose too high for patient | 48 (4.7) | 87 (8.7) | < 0.001 |
Difficulties/ability to change patient's lifestyle | 118 (11.5) | 119 (11.8) | 0.836 |
Risk of non-compliance (not related to side effects) | 115 (11.2) | 132 (13.1) | 0.198 |
Risk of non-compliance due to side effects | 80 (7.8) | 115 (11.4) | 0.007 |
Lack of monitoring due to physical limitations (e.g., dexterity) | 32 (3.1) | 82 (8.2) | < 0.001 |
Comorbidities and Polypharmacy | 192 (18.8) | 333 (33.1) | < 0.001 |
Patient has other severe disease(s) | 69 (6.7) | 172 (17.1) | < 0.001 |
Medical diabetes treatment is contraindicated | 27 (2.6) | 38 (3.8) | 0.166 |
Patient is taking several other medications already | 108 (10.6) | 216 (21.5) | < 0.001 |
Risk of side effects (related to polypharmacy) | 124 (12.1) | 191 (19.0) | < 0.001 |
Risk of drug-drug interactions (related to polypharmacy) | 60 (5.9) | 100 (10.0) | < 0.001 |
Patient-Related Reasons | 443 (43.2) | 416 (41.4) | 0.419 |
Patient denial/anger/depression related to diabetes diagnosis | 120 (11.7) | 108 (10.8) | 0.527 |
Patient's follow-up visit is overdue | 92 (9.0) | 64 (6.4) | 0.030 |
Patient does not want to take (additional) medication | 325 (31.8) | 305 (30.4) | 0.502 |
Fear of hypoglycaemia | 71 (6.9) | 93 (9.3) | 0.061 |
Fear of weight gain | 112 (11.0) | 78 (7.8) | 0.015 |
Fear to change from diet/exercise to oral agents | 100 (9.8) | 88 (8.8) | 0.445 |
Fear to change from diet/exercise to insulin | 54 (5.3) | 53 (5.3) | 0.999 |
Patient has physical difficulty taking medication | 29 (2.8) | 44 (4.4) | 0.073 |
Drug therapy decreases quality of life | 61 (6.0) | 76 (7.6) | 0.158 |