Knowledge, Prescribing Practices, and Perceived Barriers Regarding Novel Glucose-Lowering Medications Among Community Physicians: A Cross-Sectional Survey Across 36 Primary Healthcare Institutions in Pudong, Shanghai
A cross-sectional survey of 444 community physicians in Shanghai reveals that while they possess a moderate understanding of novel glucose-lowering medications, significant knowledge gaps regarding special populations and complex clinical decisions persist, with prescribing practices positively associated with higher knowledge scores, specific departmental roles, and participation in training.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Type 2 diabetes is no longer treated just by watching blood sugar numbers. Modern medicine has shifted its focus to a broader picture, looking at how a patient's heart, kidneys, and weight are doing alongside their glucose levels. New classes of medications have emerged to help manage these complex needs, offering protection against heart disease and kidney failure while also helping with weight loss. However, these drugs are powerful tools that require careful handling. They are not one-size-fits-all; a medicine that helps one patient might need adjustment or avoidance for another, depending on their specific health history. For the millions of people living with diabetes, the doctors they see most often are not specialists in a big hospital, but community physicians in local clinics. These local doctors are the gatekeepers who decide which medicine a patient gets, when to start it, and how to manage it over the long term. If these doctors are unsure about the newest tools, or if they face obstacles in getting them to patients, the benefits of modern science may never reach the people who need them most.
In the Pudong New Area of Shanghai, a team of researchers set out to understand exactly how well these local doctors were equipped to handle this new reality. They conducted a survey of 444 physicians working across 36 different community health centers. The goal was to measure three things: what these doctors knew about the new medications, how often they were actually prescribing them, and what barriers they felt were stopping them from doing so. The researchers asked the doctors to answer questions about how the drugs work, when to use them for specific conditions like heart failure or kidney disease, and what side effects to watch for. They also asked the doctors to report their recent habits, specifically whether they had prescribed these newer drugs in the three months before the survey.
The results revealed a story of mixed readiness. The doctors generally understood the basic mechanics of the new drugs. They knew well how a class of medicines called SGLT2 inhibitors works to lower blood sugar and how another class, known as GLP-1 receptor agonists, helps the body manage glucose. They also knew how to handle common side effects like nausea. However, when the questions got more specific, the answers became much less certain. The doctors struggled significantly with complex scenarios. For instance, very few could correctly identify how to use a new weekly insulin for patients with special needs, and many were unsure about which drugs were safe for patients with severe kidney problems. There was a clear gap between knowing how a drug works in a textbook and knowing how to apply that knowledge to a real patient with multiple health issues.
When the researchers looked at what these doctors were actually doing in their clinics, a pattern emerged. About 69 percent of the doctors had prescribed an SGLT2 inhibitor in the previous three months, making it the most commonly used new drug. In contrast, only about 39 percent had prescribed a GLP-1 receptor agonist. The study found that doctors who knew more about the medications were more likely to prescribe the SGLT2 inhibitors. They were also more likely to do so if they worked in a general practice department and felt confident in the benefits of the drugs. For the GLP-1 receptor agonists, the picture was different. Prescribing these was not strongly linked to general knowledge scores but was instead tied to how much training the doctors had received. Those who had attended at least three training sessions on the topic were significantly more likely to use these medications.
Despite the knowledge some doctors possessed, the study highlighted that knowing the right answer is not the only thing that matters. The biggest hurdles were not always inside the doctors' heads. The most frequently reported barrier was the high cost of the medications, which influenced decisions for nearly 86 percent of the respondents. Another major issue was patient acceptance; many doctors felt that patients were hesitant to use these new treatments, perhaps due to concerns about injections or side effects. Furthermore, more than half of the doctors felt that the official guidelines were not clear enough to guide their daily decisions, and about half were unsure about which medicines were actually available in their specific clinics.
The researchers concluded that simply teaching doctors the basic science of these drugs is not enough to change practice. The education needs to move beyond the basics and focus on the difficult, real-world decisions, such as choosing the right drug for a patient with both heart and kidney disease. At the same time, the system needs to address the practical obstacles. Doctors need clear, updated information on what medicines are available to them, and they need support to help patients understand and afford these treatments. The study suggests that improving care requires a combination of better, case-based training for doctors, clearer communication about drug availability, and stronger support systems to help patients navigate the costs and complexities of their treatment.
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