Comparison of Usability, Accuracy, Preference, and Satisfaction Between Three Once-Weekly GLP-1 Receptor Agonist Pen Devices in Patients with Type 2 Diabetes Sara A. Wettergreen, PharmD, BCACP1; Morgan P. Stewart, PharmD, BCACP2; Katelyn Kennedy, PharmD Candidate1; Jennifer M. Trujillo, PharmD, FCCP, BCPS, CDCES, BC-ADM1 1: University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences; 2: University of Texas at Austin College of Pharmacy

Background Results Methods *Indicates significance (p-value <0.05) • The study design was a multi-center, • GLP-1 receptor agonists (GLP-1 RAs) Satisfaction Responses prospective cohort study. are widely used in the treatment of type Demographic (N=60) n (%) Response Age (mean age) 61 years 1 2 3 4 5 6 7 • GLP-1 RA pen devices were compared 2 diabetes (T2D). Very Unsatisfied Somewhat Neutral Somewhat Gender 30 (50%) Male Satisfied Very Unsatisfied for time and accuracy of administration, • Design varies among GLP-1 RA pen Race 39 (65%) White/Caucasian 6.4 * user satisfaction, and preference devices, which impacts usability and Previous use of a non-GLP-1 Comfort Using Device 5.7 * 26 (43.3%) 5.5 ratings as primary outcomes. ultimately patient satisfaction, dosing RA injectable agent Education 22 (36.7%) College – graduate level accuracy, and medication adherence.1 • Detailed methods are available in the Health Literacy (HL) Score: Limited HL Possibly Adequate HL 6.7 * supplemental materials. Newest Vital Signs^ limited HL Time to Prepare Device 5.8 • Pen devices and pharmacologic options * * for once-weekly GLP-1 RAs have 10 (16.7%) 12 (20%) 38 (63.3%) 5.2 changed since 2016, and no study has Exenatide XR Dulaglutide Semaglutide Statistical 6.4 BCise (9 steps) (11 steps) Comparison Overall Experience 5.7 * compared usability and patient (9 steps) * Discussion preferences between the three once- 5.2 p <0.001 D vs E Accuracy (mean, • Most study participants preferred the weekly GLP-1 RA devices currently 62.7% 74.4% 73.1% p <0.001 D vs S % steps correct) Dulaglutide Semaglutide Exenatide XR BCise available. p =0.826 E vs S dulaglutide pen based on satisfaction p <0.001 D vs E and usability. • Results of this study may aid clinicians Time to complete p <0.001 D vs S 69 sec 126 sec 146 sec Usability Responses in the decision-making process when (mean, seconds) p =0.08 E vs S • While dulaglutide took the least amount 1 2 3 4 5 of time to demonstrate use, it also had selecting a specific GLP-1 RA agent. Accuracy p-values are adjusted for multiple comparisons using Tukey's adjustment and Very Difficult Difficult Neutral Easy Very from univariate mixed models; Easy least accurate administration. Time to complete p-values result from univariate generalized linear mixed model 4.7 Mixing the Medication 4.5 4.1 * * • The number of steps of demonstration

4.7 varied for each pen device. Missing a Research Question Which pen device did you Removing Needlecap or Cover 4.3 * 3.8 * * single step when there were less steps prefer the most? 4.8 overall could have impacted accuracy How do three once-weekly Injecting the Medication 4.3 * * 12% 4.3 ratings.

GLP-1 RA pen devices 4.7 13% Knowing Injection is Complete 4.2 * * compare with respect to 3.9 References 4.5 Understanding the Instructions 3.8 * 1. Toscana D, Brice J, Alfaro C. Usage and perceptions of pen usability, accuracy, 3.9 * 75% injectors for diabetes management: a survey of type 2 diabetes satisfaction, and patient 4.6 in the United States. J Diabetes Sci Technol. 2012;6:686-694. Overall Ease of Use 3.9 * * 2. Zhou AY, Trujillo JM. Comparison of Usability, Accuracy, 3.7 Preference, and Satisfaction Among Three Once-Weekly GLP-1 preferences? Receptor Agonist Pen Devices. Diabetes Spectr. 2018 Dulaglutide Semaglutide Exenatide XR BCise Dulaglutide Semaglutide Exenatide XR BCise Nov;31(4):359-366. Dulaglutide pen device was preferred based on usability and satisfaction. Demonstration was fastest, but least accurate, with the dulaglutide pen device.