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Carlos Morillas,1 Rosa Feliciano,2 Pablo Fernández Catalina,3 Carla Ponte,4 Marta Botella,5 João Rodrigues,6 Enric Esmatjes,7 Javier Lafita,8 Luis Lizán,9 Ignacio Llorente,10 Cristóbal Morales,11 Jorge Navarro-Pérez,12 Domingo Orozco-Beltran,13 Silvia Paz,9 Antonio Ramirez de Arellano,14 Cristina Cardoso,15 Maribel Tribaldos Causadias9 1Hospital Universitario Dr Peset, Valencia, Spain; 2USF São Domingos, Santarém, Portugal; 3Hospital Montecelo de Pontevedra, Galicia, Spain; 4USF Porta do Sol, Matosinhos, Portugal; 5Hospital Universitario Principe de Asturias, Madrid, Spain; 6USF Serra da Lousã, Lousã, Portugal; 7Hospital Clinic, Barcelona, Spain; 8Hospital de Navarra, Navarra, Spain; 9Outcomes’10, Universidad Jaume I, Castellón, Spain; 10Hospital Universitario Nuestra Señora de la Candelaria, Canarias, Spain; 11Hospital Universitario Virgen de la Macarena, Sevilla, Spain; 12INCLIVA, CIBERESP, Universidad de Valencia, Valencia, Spain; 13Sociedad Española de Medicina Familiar y Comunitaria, Valencia, Spain; 14Novo Nordisk EU-HEOR Europe, Madrid, Spain; 15Novo Nordisk, Lisbon, Portugal Objective: To assess Spanish and Portuguese patients’ and physicians’ preferences regarding type 2 diabetes mellitus (T2DM) treatments and the monthly willingness to pay (WTP) to gain benefits or avoid side effects.Methods: An observational, multicenter, exploratory study focused on routine clinical practice in Spain and Portugal. Physicians were recruited from multiple hospitals and outpatient clinics, while patients were recruited from eleven centers operating in the public health care system in different autonomous communities in Spain and Portugal. Preferences were measured via a discrete choice experiment by rating multiple T2DM medication attributes. Data were analyzed using the conditional logit model.Results: Three-hundred and thirty (n=330) patients (49.7% female; mean age 62.4 [SD: 10.3] years, mean T2DM duration 13.9 [8.2] years, mean body mass index 32.5 [6.8] kg/m2, 41.8% received oral + injected medication, 40.3% received oral, and 17.6% injected treatments) and 221 physicians from Spain and Portugal (62% female; mean age 41.9 [SD: 10.5] years, 33.5% endocrinologists, 66.5% primary-care doctors) participated. Patients valued avoiding a gain in bodyweight of 3 kg/6 months (WTP: €68.14 [95% confidence interval: 54.55–85.08]) the most, followed by avoiding one hypoglycemic event/month (WTP: €54.80 [23.29–82.26]). Physicians valued avoiding one hypoglycemia/week (WTP: €287.18 [95% confidence interval: 160.31–1,387.21]) the most, followed by avoiding a 3 kg/6 months gain in bodyweight and decreasing cardiovascular risk (WTP: €166.87 [88.63–843.09] and €154.30 [98.13–434.19], respectively). Physicians and patients were willing to pay €125.92 (73.30–622.75) and €24.28 (18.41–30.31), respectively, to avoid a 1% increase in glycated hemoglobin, and €143.30 (73.39–543.62) and €42.74 (23.89–61.77) to avoid nausea.Conclusion: Both patients and physicians in Spain and Portugal are willing to pay for the health benefits associated with improved diabetes treatment, the most important being to avoid hypoglycemia and gaining weight. Decreased cardiovascular risk and weight reduction became the third most valued attributes for physicians and patients, respectively. Keywords: diabetes, discrete choice model, preferences, willingness to pay, hypoglycemia, weight, cardiovascular risk, HbA1c

Margarida Jansà,1 Mercè Vidal,1 Marga Giménez,1 Ignacio Conget,1 Mercedes Galindo,2 Daria Roca,1 Cristina Colungo,3 Enric Esmatjes,1 Manel Salamero4 1Diabetes Unit, Endocrinology and Nutrition, Hospital Clinic, Barcelona, 2Endocrinology and Nutrition Department, Hospital Clinico, Madrid, 3Primary Care Centre, Hospital Clinic, Barcelona, 4Psychology Department, Hospital Clinic, Barcelona, Spain Background: The purpose of this study was to validate the Spanish and Catalan versions of the Diabetes Self-Care Inventory-Revised Version (SCI-R) questionnaire to assess the degree of adherence to self-care among adults with diabetes. Methods: We validated the Spanish and Catalan translation from, and back translation to, English and cultural adaptation of the SCI-R in type 1 diabetes patients on multiple insulin doses or continuous subcutaneous insulin infusion and in type 2 diabetes patients on oral agents and/or insulin. Internal reliability, structural validity, and external validity (correlation with glycated hemoglobin) were evaluated. Responsiveness to change was assessed in patients 1 year after onset of type 1 diabetes and following a structured education program. Results: The SCI-R presented good internal reliability Cronbach's α: 0.75, test-retest reliability (r = 0.82) and structural validity (r > 0.40). The external validity was also good; the SCI-R correlated with HbA1c in patients with type 1 diabetes on multiple insulin doses (r = -0.50) or continuous subcutaneous insulin infusion (r = -0.66) and in patients with type 2 diabetes on multiple insulin doses (r = -0.62). However, it was not satisfactory in patients on oral agents (r = -0.20) and/or bedtime insulin (r = -0.35). Responsiveness to change was analyzed in 54 patients (age 27.3±7.4 years, 26% men, HbA1c 6.8% ±1.1%); the SCI-R score was 72.3% ±13.7% and correlated negatively with glycated hemoglobin (r = -0.42) and 3 scales of the Diabetes Quality of Life questionnaire (lower score indicating better perception): Impact (r = -0.37), Social Worry (r = -0.36) and Diabetes Worry (r = -0.38), all at P < 0.05. Conclusion: The Spanish and Catalan versions of the SCI-R questionnaire show good psychometric properties and both could be considered as useful tools for evaluating self-care behavior in patients with type 1 or type 2 diabetes. However, there are still some subgroups of patients with type 2 diabetes in which the validity of this questionnaire needs further evaluation. Keywords: diabetes, self-care, questionnaire, adherence, validation, patient education