Introduction
Diabetes is a chronic disease characterized by the body’s inability to maintain healthy levels of blood glucose, which is associated with long-term health problems including an increased risk of mortality with an estimated global prevalence of 10.5% in 2021.1–3 Diabetes care is centered around the cornerstone of metabolic control, specifically keeping glucose levels as close to normal as possible through medication, a careful diet, physical activity and self-monitoring of blood glucose (SMBG).4 5 SMBG has traditionally been done using the finger-prick test and is associated with improvements in glycemic control.6 While highly accurate,7 this technique represents a large burden to patients, which can result in non-compliance to medical treatment advice.8–10 Studies examining the adherence of patients to SMBG regimens report adherence rates ranging from 88% in Australia11 to as low as 44% in Sweden,12 26% in the USA13 and 20% in Hungary.14 These low adherence rates are related to barriers to the practice of SMBG including low socioeconomic status (SES), fear of testing and fingertip pain, distressing emotions and thoughts, frustration about ‘poor’ blood glucose reading, lack of awareness of hypoglycemia and hyperglycemia, lack of social support and difficulty in interpreting SMBG results.15
Recent technological developments have resulted in commercially available medical devices which can (semi-)continuously monitor blood glucose levels (or proxies thereof).16 17 These devices are often less invasive, quicker and easier to use, and can give more detailed daily blood glucose-level information by showing trends over time compared with SMBG with finger pricking.18–20 However, these devices vary in regard to functionality and features including (but not limited to) differences in accuracy, size, battery requirements, range of transmitter, calibration requirements, scanning procedures and longevity (replacement time). Further, these devices are often not reimbursed through insurance plans and can have high out-of-pocket costs for the patient.21 The differences in function, features and costs have resulted in a situation where personal preferences may guide the choice of device used for SMBG.
Despite growing interest in patient preference assessment, limited research has been done quantifying patient preferences for glucose monitors. Hannah et al found that for patients with type 1 diabetes (T1DM), the most important factors for choosing a continuous glucose monitor (CGM) were method of data retrieval, longer sensor wear time with more adhesive durability, and personalized alerts and alarms.22 Engler et al found that the reasons related to stopping CGM usage for patients with T1DM were poor accuracy due to lag times, insurance reimbursement or cost, comfort and false alarms.18 They also found that for patients with T1DM without CGM experience cost, having a device attached to the body and expectations of discomfort in wearing were primary reasons for not using a CGM for SMBG.18 Both studies highlight the preference-sensitive nature of these devices; however, neither included patients with type 2 diabetes mellitus (T2DM), a growing population of patients who may need to monitor their blood glucose.19 20 23 Further, only Hannah et al22 used a method of relative valuation to show how important these attributes were in regard to each other but did not include a cost attribute, which is a major concern for many patients. There is thus a gap in knowledge regarding the relative valuation information that regulatory authorities and decision makers use to guide policies for medical treatments.24 This study aimed to fill that gap by quantitatively assessing the factors that patients with T1DM and T2DM consider important when choosing a glucose-monitoring device for SMBG and identify willingness to pay (WTP) and expected device uptake rates.