Template for Patient Group Input

to New Drugs for Type 2 Diabetes:

A Therapeutic Review Update

Name of patient group
Patient group’s website
Primary contact for this submission
Email
Telephone number
Name of author (if different)

Email completed forms to by 5pm on Monday May 2nd, 2016

CADTH is undertaking a therapeutic review to assess the clinical and cost-effectiveness of drugs for the treatment of patients with type 2 diabetes. The review focuses on drugs as second- and third-line treatments for adults with type 2 diabetes who need more than metformin monotherapy or metformin plus sulfonylurea to maintain glycemic control. For more information on the project, see: https://www.cadth.ca/new-drugs-type-2-diabetes-therapeutic-review-update

Should you have any questions about completing this form, please contact CADTH, by telephone at 613-226-2553, or email .

·  This template form should be used by patient groups to submit patient group input. Individual patients should contact a patient group that is representative of their condition to have their input added to that of the patient group.

·  Please provide the input in Engish, using a Word document. Please use a minimum 11-point font and do not exceed eight pages. You may delete the instructions for more space.

·  Privacy: Your patient group input submission, with personal information removed, will be posted on the CADTH website. The information provided in submissions to CADTH will be shared with the CADTH Canadian Drug Expert Committee (CDEC) and the publicly funded drug plans that participate in the CADTH Common Drug Review (CDR) to use in their decision-making. A summary of all submitted patient group input will be included in the CADTH Therapeutic Review report, which will be posted publicly.

Section 1 — General Information

1.1  Submitting Organization

Please provide an overview of the organization that is making the submission, including the purpose or aims of the organization and an outline of the type of membership.

1.2  Conflict of Interest Declarations

CADTH requires that all participants in the CADTH reviews disclose any potential conflicts of interest, to ensure that the objectivity and credibility of the CADTH reviews is maintained. Patient groups must declare any interests that may influence or have the appearance of influencing the information submitted. This information is requested for transparency — a declaration of conflict of interest does not negate or preclude the use of the patient input.

(Examples of conflicts of interest include, but are not limited to, financial support from the pharmaceutical industry [e.g., educational or research grants, honorariums, gifts, and salary], as well as affiliations or personal or commercial relationships with drug manufacturers or other interest groups.)

a)  We have the following declaration(s) of conflict of interest with regard to corporate members and joint working, sponsorship, or funding arrangements:

b) We have the following declaration(s) of conflict of interest with regard to those playing a significant role in compiling this submission:

Section 2 — Treatment Outcomes

1.  What would patients, their familes, and caregivers like therapies for type 2 diabetes to achieve?

2.  Consider the treatment outcomes you have describe above. Which ones are most important? Why?

3.  If treatment were able to achieve these outcomes, what would it mean for patients’, their families’, and caregivers’ daily activities and quality of life?

4.  Describe any difficulties patients currently have in achieving desired outcomes. What is the impact of this on patients, their families, and caregivers? Difficulties could include access to care, coordinating care, or challenges specific to medication.

5.  Please briefly identify how the information used to complete Section 2 was obtained. Was it obtained, for example, through a survey, focus groups, or one-to-one conversations?

Section 3 — Patients’ Experiences With Drug Therapies

CADTH is interested in hearing about patients’ and their families’ lived experiences with:

·  DPP-4 inhibitors (Nesina, Trajenta, Onglyza, Januvia, Kazano, Jentadueto, Komboglyze, Janumet)

·  GLP-1 analogues (Trulicity, Byetta, Victoza)

·  SGLT-2 inhibitors (Invokana, Forxiga, Jardiance, Xigduo, Synjardy)

·  Sulfonylureas (chlorpropamide, gliclazide, glimepiride, glyburide, tolbutamide)

·  Insulin and insulin analogues

When answering the below, please specify to which drug or drug class your comments relate:

1.  How well does the therapy address outcomes considered important by those with type 2 diabetes?

2.  What side effects are experienced and how are they managed?

3.  Are the drugs easy or difficult to use? What is the impact of this on patients and their families or caregivers?

4.  Please briefly identify how the information used to complete Section 3 was obtained.

Section 4 — Additional Information

Please provide any additional information related to this Therapeutic Review that would be helpful to CADTH, CDEC, and the participating drug plans.

Template for Submitting Patient Group Input for CADTH Therapeutic Reviews

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