Supplementary appendix 1

Survey questionnaire for people with diabetes (N = 652)

Q1) Please think about the first consultation when the doctor told you that you had type 2 diabetes. How did you feel when they told you that you had type 2 diabetes? [Please select all that apply (Shocked; relieved; confused; nervous; scared; depressed; resigned; accepting; detached; positive; guilty; none of these)]

Q2) Which type of healthcare professional did you have this consultation with? (Primary care physician / general practitioner / Internist; endocrinologist / diabetologists; nephrologist; cardiologist; geriatrician; nurse; other, please specify; don’t know / don’t remember)

Q3) How long did this consultation last? (Range 1–99 minutes; don’t remember)

Q4) Which of the following topics, if any, do you remember discussing with him/her during the initial consultation and approximately how many [answer from Q3] minutes did he/she spend explaining the following? (Lifestyle changes such as diet and exercise; drug treatment; the importance of blood sugar control levels targets and glucose monitoring; the potential cost of medicine; the potential risk and complications of type 2 diabetes; the link between very low blood glucose levels and some treatments; the link between weight gain and some treatments; potential side effects including stomach problems and dizziness; my personal risk of complications as related to my age, general health and other medications I’m taking; managing the disease during periods of fasting e.g., during Ramadan; my concerns about the social stigma of the disease; potential impact of the disease on quality of life; the impact the disease might have on my sexual health and fertility; other, please specify; I don’t remember)

Q5) Did you feel the length of the consultation was? (Too short, about right, too long)

Q6) If answered too short in Q5 Why did you feel that this initial consultation was too short? [Tick all that apply (The doctor did not have time to explain the treatment option he has chosen and any potential side effects; there was no time to ask about what happens if I forget / miss my medication; the doctor did not have time to explain the disease progression and the risk of developing complications (i.e., potential heart, vision or circulatory problems) fully; the doctor did not have time to explain the importance of reducing hypoglycaemic episodes (low blood sugar, or ‘hypos’); I did not have time to explain my fears and concerns; other, please specify)]

Q7) To what extent, if at all, did you understand the information that was discussed during this consultation? [Please use a scale of 1 to 7 where 1 means ‘did not understand at all’ and 7 means ‘understood very well (The disease and its causes; drug treatment; lifestyle changes such as diet and exercise; the importance of blood sugar control – levels, targets and glucose monitoring; the potential cost of medicine; the potential risks of complications (i.e., potential heart, vision or circulatory problems) associated with type 2 diabetes; the link between hypoglycaemia (blood glucose that is too low, also called a ‘hypo’) and some treatments; The link between weight gain and some treatments; potential side effects including stomach problems and dizziness; my personal risk of complications as related to my age, general health and other medications I’m taking; managing the disease during periods of fasting e.g., during Ramadan)]

Q8) If ‘Explaining potential complications of type 2 diabetes’ What complications did the healthcare

professional mention during your initial diagnosis consultation? (Potential vision problems; potential heart problems; potential circulatory problems; potential kidney problems; other, please specify)

Q9) How did you feel about the potential complications of type 2 diabetes that were discussed during this consultation? (I was devastated to hear I might develop complications; I knew that these health problems might affect me in the future, but the risk seemed remote; I was not really concerned; none of these)

Q10) What complications were of most concern to you?

Q11) In your opinion, what concerned you the most about type 2 diabetes during this initial diagnosis consultation? [Please use a scale of 1 to 7 where 1 means ‘not concerned at all’ and 7 means ‘very concerned’ (Having to live with a chronic condition; having to see the doctor regularly; having to make changes to my diet; having to do more exercise; my ability to fast (e.g. during Ramadan); the increased risk of complications (i.e., potential heart, vision or circulatory problems); having to take drugs every day; having to take injections now or in the future; the risk of very low blood glucose levels (‘hypos’); weight gain; having to monitor blood glucose levels; the cost of medicines; side effects such as gastrointestinal problems and dizziness; impact of the treatment on daily routine (i.e., injecting or taking pills at work or social gatherings); social stigma of the disease (i.e., the impact the disease might have on my career or personal life); the impact of the disease on my quality of life; the impact the disease might have on my sexual health and fertility; the impact the disease might have on my health or life insurance; other, please specify)]

Q12) What concerns you the most about having type 2 diabetes now? [Please use a scale of 1 to 7 where 1 means ‘not concerned at all’ and 7 means ‘very concerned’ (Having to live with a chronic condition; having to see the doctor regularly; having to make changes to my diet; having to do more exercise; my ability to fast (e.g., during Ramadan); the increased risk of complications (i.e., potential heart, vision or circulatory problems); having to take drugs every day; having to take injections now or in the future; the risk of very low blood glucose levels (‘hypos’); weight gain; having to monitor blood glucose levels; the cost of medicines; side effects such as gastrointestinal problems and dizziness; impact of the treatment on daily routine (i.e., injecting or taking pills at work or social gatherings); social stigma of the disease; the impact of the disease on my quality of life; the impact the disease might have on my sexual health and my fertility; other, please specify; none of these / nothing)]

Q13) How many hypoglycemic (low blood sugar or ‘hypo’) episodes have you had? [If you have not had any, please answer 0 in each box (that required third party intervention from a family member / friend / colleague; that required referral to a specialist; that caused you to go to hospital; that resulted in you having a fall; that resulted in you having an accident)]

Q14) What, if anything, do you know about hypoglycaemic episodes (very low blood sugar also known as ‘hypos’)?

Q15) What, if anything, do you fear the most about hypoglycaemic episodes (very low blood sugar also known as ‘hypos’)?

Q16) Do you tell your healthcare provider each time you have a hypoglycaemic episode? [Please tick one (Yes, I tell them every time; yes, I tell them sometimes; no, I never tell them; I’ve never had a hypoglycaemic episode)]

Q17) Some of the following statements are true and some are false. Which of the following statements do you think to be true about hypoglycaemia, known as ‘hypos’ (episodes of low blood sugar)? [Please tick all that apply (Severe 'hypos' can make you lose consciousness (blackout) and have seizures – TRUE; Hypos' may be associated with an increased risk of heart problems – TRUE; alcohol consumption can increase the risk of a 'Hypos' – TRUE; some medications increase the risk of 'hypos' – TRUE; the best thing to avoid a 'hypo' is to eat a high calorie chocolate bar – FALSE; Hypos' can make you feel breathless – FALSE)]

Q18) Did the healthcare professional prescribe medication at the same time as he or she told you that you had type 2 diabetes? (yes or no)

Q19) If no at Q18, how did you feel about being asked to make changes to your diet and lifestyle, rather than being prescribed medication for your type 2 diabetes? [Please select one response (Disappointed –I felt that it would be easier to manage my condition with medication than diet and exercise; surprised – it seemed unrealistic to expect me to lose weight and start exercising; confused – given the potential serious risks associated with the disease; relieved - I did not have to take drugs, maybe the disease was not as bad I thought; pleased - I dislike taking drugs so the longer I could avoid them, the better; positive – I was certain I could control the disease myself; other, please specify)]

Q20) If no at Q18 and if currently on medication (oral or injectable) Approximately how long did it take between diagnosis and the first time you were prescribed medication for your type 2 diabetes? (Range years 0–50; months 0–11; weeks 0–51)

Q21) If yes at Q18 what is the name of the medication that your doctor prescribed at this consultation (diagnosis)? (If you were prescribed several medications please list them all; If you don’t remember please write ‘don’t know’)

Q22) Has your doctor ever changed your medication or added another medication to it? (yes or no)

Q23) If yes at Q22 how long did it take before your medication was changed or supplemented? (Up to three months; three to six months; six months to one year; one year to eighteen months; eighteen months to two years; more than two years; I don’t remember)

Q24) If yes at Q 22 what is the name of the medication that you were prescribed in place or in addition to your existing type 2 diabetes medication at this consultation? (If you were prescribed several medications please list them all; If you’re unsure please write don’t know’)

Q25) If yes at Q22 why was your medication changed or why was another medication added? [Please tick all that apply (The doctor changed / added another medication without explaining why; I found it difficult to make sufficient changes to my diet; I was not able to increase my exercise levels to the level needed; I was not able to reach the target blood sugar level; I was having side effects such as stomach problems and / or dizziness; I had at least one ‘hypo’(very low blood sugar level episode); I was putting on weight; I was about to start fasting (e.g., for Ramadan); the doctor was worried my treatment might react with another medication I was taking; other, please specify; don’t know / don’t remember)]

Q26) To all those who are not on injectable currently, to what extent, if at all, are you concerned about having to inject medication for your type 2 diabetes in the future? (Please use a scale of 1 to 7 where 1 means ‘not at all’ and 7 ‘to a great extent’)

Q27) To all those on medication (Oral and / or injectable), how often, if at all, do you miss a dose of your medication? [Never; rarely (less than once a month); sometimes (less than once a week); often (more than once a week); very frequently (most days)]

Q28) To all those except who answered ‘never’ at Q27, why do you [answer from Q27] miss doses of your medication? [Please select all that apply (I do not like taking medication; I forget about my medication; I take too many tablets / pills; I do not need my medication as often as my doctor recommended; my medication makes me put on weight; my medication gives me hypoglycaemia (blood glucose that is too low, also called a ‘hypo’); my medication gives me side effects like stomach problems and / or dizziness; I cannot afford to take my medication every day; none of these)]

Q29) How often, if at all, do you monitor your blood sugar levels on your own / at home? (Daily; at least once or twice a week; at least once or twice a month; occasionally (less than once a month); never)

Q30) What is your average blood sugar level (HbA1c)? (Less than or equal to 6.5%; greater than 6.5% and less than or equal to 7.0%; greater than 7.0% and less than or equal to 7.5%; greater than 7.5% and less than or equal to 8.0%; greater than 8.0% and less than or equal to 8.5%; more than 8.5%; I don’t know)

Q31) What is your target blood glucose level (HbA1c)? (Less than or equal to 6.5%; greater than 6.5% and less than or equal to 7.0%; greater than 7.0% and less than or equal to 7.5%; greater than 7.5% and less than or equal to 8.0%; greater than 8.0% and less than or equal to 8.5%; more than 8.5%; I don’t know)

Q32) How many times did you see your doctor in the past year with regards to your type 2 diabetes? (range 0–30 minutes)

Q33) Do you think that this number of visits is? (too frequent, about right, not frequent enough)

Q34) To what extent, if at all, did you make the changes to diet that were suggested by your doctor? (Please

use a scale of 1 to 7 where 1 means ‘not at all’ and 7 means ‘to a great extent’)

Q35) To what extent, if at all, did you increase the amount of exercise you do, as suggested by your doctor? (Please use a scale of 1 to 7 where 1 means ‘not at all’ and 7 means ‘to a great extent’)

Q36) What challenges, if any, did you face when trying to make changes to your diet or increasing your exercise levels? [Please select all that apply (I have health problems that make it very difficult to do more exercise; I have financial problems which mean I can’t join the gym or buy more expensive food; I find it very difficult to make changes to the way I live; I didn’t try too hard to make any changes as I did not consider it very important; I had no problems making the changes needed)]

Q37) Do you currently pay for the type 2 diabetes medication that you are prescribed? [Please select all that apply (Yes, I pay the cost in full for my type 2 diabetes medication; yes, family members pay the cost of my type 2 diabetes medication; yes, I pay part of the cost for my type 2 diabetes medication, the rest is paid for by governmental or insurance benefits please specify percentage; I pay % of my medication; no, I do not pay anything at all for my type 2 diabetes medication / it is all reimbursed; Don’t know)]

Q38) If yes to Q37, has the cost of your type 2 diabetes medication had any impact on the treatment you have opted for? (yes or no)

Q39) How satisfied are you with the relationship you have with the healthcare professional(s) who manage(s) your type 2 diabetes? (Please use a scale of 1 to 7 where 1 means ‘not at all’ and 7 means ‘to a great extent’)

Q40) What would make you more satisfied with the treatment of your type 2 diabetes? [Please select all that apply (more guidance on changing my diet; more guidance on increasing exercise levels; more information on the treatment options; less complicated treatment options; more time seeing my healthcare professional; my healthcare professional taking time to listen to my concerns; other, please specify; no changes, I am currently very satisfied)]

Q41) If there was one thing you would change about how you were diagnosed or your treatment or anything related to diabetes what would it be?

Q42) Is there anything else you would like to share with us about your type 2 diabetes?

Survey questionnaire for physicians (N = 357)

Q1) Please think about a typical diagnosis consultation with a type 2 diabetes patient. You are about to inform them for the first time that they have type 2 diabetes. How long would such a consultation typically last? (Range 1–99 minutes; don’t remember)

Q2) Approximately how many of the [answer from Q1] minutes would you spend explaining the following: (The disease and its causes; drug treatment; lifestyle changes; importance of HbA1c targets and blood glucose monitoring; the potential cost of the medication; the potential risks and complications of T2D; link between hypoglycaemia and some treatment; link between weight gain and some treatments; potential side effects including gastrointestinal problems and / or dizziness; individual patient related to age, comorbidities, and drug-drug interactions; managing the disease during period of Ramadan; potential impact of the disease on quality of life; the impact the disease might have on sexual health and fertility; the impact of other health conditions / multiple conditions on the management of diabetes; others please specify)

Q3) To what extent, if at all, do you feel that patients will follow the instructions that you give them during this consultation at diagnosis? [Please give a score on a scale of 1 to 7 where 1 is ‘not at all’ and 7 ‘to a great extent’ (Taking drug treatment as directed; measure their HbA1c / FPG / PPG as directed; lifestyle changes related to diet ; lifestyle changes related to exercise; managing the disease to prevent complications; managing the disease to reduce the risk of hypoglycemia; managing the disease during periods of fasting (e.g., during Ramadan)]

Q4) Which of the following potential complications do you explain to your type 2 diabetes patients? (Potential early death; vision problems; cardiovascular risks; renal problems; circulation problems; hypoglycaemia; I don’t have time to talk to my patients about potential complications; I don’t talk to my patients about potential complications as I don’t want to worry them; others please specify)

Q5) Think about the questions that your patients ask at diagnosis and five years after diagnosis. To what extent, if at all, do you think that the following items concern your type 2 diabetes patients at diagnosis and five years later? [Please give a score on a scale of 1 to 7 where 1 is ‘not at all’ and 7 ‘to a great extent’ (Having to live with a chronic condition; having to see the doctor regularly; changes to diet; managing diabetes during periods of fasting (e.g., during Ramadan); having to do more exercise; potential heart problems (including increased risk of heart attack and stroke); potential kidney failure; potential vision loss; potential amputations; potential early death; having to take drugs every day; having to take injections now or in the future; risk of hypoglycaemia; weight gain; HbA1c targets and blood glucose monitoring (FPG, PPG); the cost of medicines; side effects such as gastrointestinal problems and dizziness; concerns about social stigma of disease; impact of treatment on daily routine; impact of the disease on quality of life; potential impact of the disease on sexual health and fertility; potential impact of the disease on life or health insurance; other, please specify; nothing seems to worry them)]

Q6) What proportion of your type 2 diabetes patients do you estimate may have the following comorbidities? (Hypertension; dyslipidaemia; renal impairment; cardiovascular disease; retinopathy; peripheral vascular disease; neuropathy; Other, please specify)

Q7) On average how frequently would you typically see a patient treated with the following medications as

part of their type 2 diabetes management? (Diet and exercise only; diet and exercise + metformin; diet and exercise + DPP-4 inhibitor; diet and exercise + combination therapy; diet and exercise + sulphonylurea; diet and exercise + thiazolidinedione; diet and exercise + GLP-1 agonist; diet and exercise + oral therapy + insulin; diet and exercise + oral therapy + GLP-1 agonist; diet and exercise + insulin; other)

Q8) How long would such a follow-up consultation typically last? (range 1–99 minutes)

Q9) In follow-up consultations, approximately how many of the [answer from Q8] minutes do you spend? (Taking the necessary history and diagnostic tests to see if the disease is under control; explaining the disease and its causes; explaining drug treatment options; explaining lifestyle changes such as diet and exercise; finding out the patients concerns and fears; explaining the importance of blood glucose targets and monitoring; explaining the potential risks and complications of type 2 diabetes; explaining the link between hypoglycaemia and some treatments; explaining the link between weight gain and some treatments; explaining potential side effects of medication including gastrointestinal problems and / or dizziness; explaining the patient’s individual risk related to age, comorbidities and drug-drug interactions; managing the disease during periods of fasting (e.g., during Ramadan); addressing concerns about the social stigma of the disease; discussing the impact of treatment on daily routine; explaining the potential impact of the disease on quality of life; explaining the potential impact of the disease on sexual health and fertility; other, please specify)

Q10) To what extent do you think each of the following treatment options offer [(Low cost; efficacy in reducing blood glucose; low risk of hypos, weight gain and tolerability issues; high burden on the healthcare system)? diet and exercise only; diet and exercise + metformin, ; diet and exercise + sulphonylurea; diet and exercise + thiazolidinedione; diet and exercise + DPP-4 inhibitor; diet and exercise + GLP-1 agonist; diet and exercise + oral therapy + GLP- 1 agonist; diet and exercise + insulin]

From Q11 please think of three distinct patients: 50 year old patient; 80 year old patient and patient with renal impairment

Q11) In what percentage of your type 2 diabetes patients at first diagnosis would you prescribe? (diet and exercise + metformin; diet and exercise only; diet and exercise + DPP-4 inhibitor; diet and exercise + sulphonylurea; diet and exercise + combination oral therapy; diet and exercise + insulin; diet and exercise + oral therapy + insulin)

Q12) Thinking about patients on diet and exercise alone who consistently fail to reach their HbA1c targets, how long would you typically wait until initiating monotherapy medication? [range 0–99 (weeks, months, years)]

Q13) Thinking about patients on monotherapy who consistently fail to reach their HbA1c targets, how long after first noticing that the patient’s HbA1c is not controlled would you typically wait until initiating combination medication? [range 0–99 (weeks, months, years)]

Q14) For what percentage of your type 2 diabetes patients would you recommend the following treatment approach as a second line therapy? (diet and exercise + metformin; diet and exercise + metformin + DPP-4 inhibitor; diet and exercise + metformin + sulphonylurea; diet and exercise + combination oral therapy; diet and exercise + oral therapy + insulin; diet and exercise + metformin + GLP-1 agonist; diet and exercise + insulin)

Q15) To what extent, if at all, do the following have an impact on your treatment choice? [Please give a score on a scale of 1 to 7 where 1 is ‘not at all’ and 7 ‘to a great extent’ (Likelihood of patients to make diet changes and increase exercise level; treatment guidelines; cost of treatment to patient; reimbursement cost of treatment to the healthcare system; number of other pills taken daily; patient reluctance to take more medication; likelihood of patient compliance; likely efficacy of treatment (ability to lower blood glucose); likely tolerability of treatment; likelihood of treatment-related hypoglycemia; method of administration; drug interactions with other existing treatments taken for concomitant conditions; comorbidities and safety issues; periodic fasting e.g., during Ramadan; other, please specify)]

Q16) What are your target HbA1c level for these patients? (Less than or equal to 6.5%; greater than 6.5% and less than or equal to 7.0%; greater than 7.0% and less than or equal to 7.5%; greater than 7.5% and less than or equal to 8.0%; greater than 8.0% and less than or equal to 8.5%; greater than 8.5%)

Q17) To what extent, if at all, do you think these patients are likely to reach their HbA1c target consistently? (Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’)

Q18) Approximately, what percentage of your type 2 diabetes patients consistently reach their HbA1c target? [range 0–100% (percentage who reach their target; percentage whose HbA1c levels are less than within 0.5% of target; percentage whose HbA1c levels are less than within 1.0% of target; percentage whose HbA1c levels are less than within 2.0% of target; percentage whose HbA1c levels are above 2.0% of target)]

Q19) To what extent, if at all, do you think that these patients are likely to comply with their diet and exercise regimen? (Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’)

Q20) To what extent, if at all, do you think that these patients are likely to take their medication as prescribed? (Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’)

Q21) Why do you think your patients fail to take their medication as prescribed? [Please select all that apply (they do not like taking medication; they forget to take their medication; they take too many tablets / pills; they think they don’t need to take their medication as often as prescribed; their medication makes them put on weight; their medication can make them more likely to have a hypoglycaemic event; their medication gives them side effects like stomach problems and / or dizziness; they cannot afford to take their medication every day; none of these)]

Q22) To what extent, if at all, do the following prompt you to change the diet and exercise / treatment regimen? [Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’ (Patients find it difficult

to make sufficient changes to their diet; patients find it difficult to increase the amount of exercise they do; patients are not at blood glucose goal; patients are experiencing side effects, such as gastrointestinal problems and / or dizziness; patients experience hypoglycaemia; patients experience weight gain; patients are about to start fasting e.g., for Ramadan; concern about drug-drug interactions; Other, please specify)]

Q23) To what extent, if at all, are the following patients likely to have severe hypoglycemic episodes that require the following: [Please use a scale of 1 to 7 where 1 means ‘not at all’ and 7 means ‘very likely’ (Third party intervention from a family member / friend / colleague; referral to a specialist; hospitalization)]

Q24) In clinical practice do you consider that hypoglycaemic events are generally (please tick one answer, under reported, accurately reported, over reported)?

Q25) Which of the following statements around hypoglycaemia reporting, if any, do you agree with? [please tick all that apply (patients don't understand the serious consequences of hypoglycaemia and the importance of reporting event; patients don't appreciate the importance of reporting hypoglycaemia and the potential need to adjust or change treatment; we don't see patients frequently enough to gauge the frequence of hypoglycaemic episodes; we don't have time to discuss hypoglycaemia in the consultation and the long-term consequences to health; others please specify; none of these)]

Q26) To what extent, if at all, do you consider the following as barriers to patients reaching their blood glucose targets? [Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’ (Patients find it very difficult to make the necessary changes to their diet; patients find it difficult to do enough exercise; many patients have had diabetes for a long time and beta cell function is already compromised; treatment guidelines recommend that patients are treated in a step-wise fashion, rather than starting them on what may be the most effective treatment from diagnosis; healthcare providers / insurance companies stipulate that cheaper generic drugs should be used; patients can be unwilling to pay for the newer drugs; I don’t have time or see my patients frequently enough to collect all the information I need to make an informed decision; patients don’t take the treatment as recommended; the treatments are ineffective; patients struggle with the gastrointestinal side effects; fear of hypoglycemic events associated with some treatments can make me more likely to treat patients conservatively and compromise efficacy for safety; the weight gain associated with some treatments can make me prescribe less aggressively than I otherwise might; patients are often taking concomitant medications and I’m concerned about drug-drug interactions; other, please specify)]

Q27) If there was one thing you could change about the way type 2 diabetes is managed what would it be?

Q28) To what extent, if at all, do you agree with the following points? [Please use a scale of 1 to 7 where 1 means ‘not at all likely’ and 7 means ‘very likely’ (Early treatment with combination therapy to get blood sugar levels under control and reduce the risk of complications is very important; newer drugs may result in cost savings for healthcare systems; improved blood sugar control may lead to fewer long-term complications; it is unrealistic to expect patients who have always struggled with their weight to make diet and exercise changes; I always start patients with diet and exercise regardless of blood sugar level and will only slowly increase dose of metformin after several years; I don't move patients onto combination therapy until they have a HbA1c of around 8.0% for fear of increasing risk of hypos; I never expect my patients to achieve a HbA1c of less than 7.0%; good enough if within 1.0%; newer drugs such as DPP-4s and GLP-1s

may result in cost savings for healthcare systems over the long-term, as patients don’t need close monitoring, are less likely to suffer hypoglycemic events; Improved blood sugar may lead to fewer long-term complications)]

Supplementary Table 1 – Quotas applied to ensure the sample is representative of the T2D population of each country

Age To ensure older age groups were included

Gender To include slightly more male than female patients

Time since T2D diagnosis To have about half of sample diagnosed five years ago or

less

Type of medication taken (oral vs. injectable) To ensure that the majority of sample were receiving oral

treatment, and that patients on diet and exercise only

were excluded

Number of pills taken for T2D To ensure sample was approximately split between those

receiving one pill vs. those on two pills or more

Level of income To ensure inclusion of respondents on lower and average

incomes

T2D, type 2 diabetes

Supplementary Table 2 – List of variables in both the participating patient and physician groups on which statistical analysis was carried out to assess the existence of difference

Patient variables Physician variables

Country, age group, BMI index, oral/injectable

treatment, comorbidities, number of years since

diagnosis, income bands, employment status,

compliance levels, concern levels about the

increased risk of complications, HbA1c target,

monotherapy vs. combination therapy, changes

made to diet/exercise

Specialty, country, T2D workload, time spent on

diagnosis consultation, whether the doctor explains

potential complications to patients, whether the

doctor believes in early treatment

BMI, body mass index; T2D, type 2 diabetes

Supplementary Fig. 1 – Risks discussed by physicians at diagnosis across the six counties. N = 337, includes all the participating physicians.

Supplementary Fig. 2 – First line therapy across different age groups. N = 337, includes all the participating physicians. Values <6% across all profiles are not displayed

Supplementary Fig. 3 – Physician perceptions on frequency and quality of care for hypoglycaemia episodes (hypos) and patient understanding of hypoglycaemia. N, all physicians (N = 337)

Supplementary Fig. 4 – First line therapy for 80 year old persons with diabetes across the six participating countries. N = 337, includes all the participating physicians. Values <6% across all profiles are not displayed