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Chen R, Aamir AH, Feroz Amin M, Bunnag P, Chan SP, Guo L, Khamseh ME, Mohan V, Nicodemus N, Roberts A, Tarigan TJE, Won KC, Mehta R. Barriers to the Use of Insulin Therapy and Potential Solutions: A Narrative Review of Perspectives from the Asia-Pacific Region. Diabetes Ther 2024; 15:1261-1277. [PMID: 38625535 PMCID: PMC11096289 DOI: 10.1007/s13300-024-01568-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/14/2024] [Indexed: 04/17/2024] Open
Abstract
The rising prevalence of type 2 diabetes (T2D) is posing major challenges for the healthcare systems of many countries, particularly in the Asia-Pacific Region, in which T2D can present at younger ages and lower body mass index when compared with Western nations. There is an important role for insulin therapy in the management of T2D in these nations, but available evidence suggests that insulin is under-utilized and often delayed, to the detriment of patient prognosis. The authors of this article gathered as an advisory panel (representative of some of the larger Asia-Pacific nations) to identify their local barriers to insulin use in T2D, and to discuss ways in which to address these barriers, with their outputs summarized herein. Many of the key barriers identified are well-documented issues of global significance, including a lack of healthcare resources or of an integrated structure, insufficient patient education, and patient misconceptions about insulin therapy. Barriers identified as more innate to Asian countries included local inabilities of patients to afford or gain access to insulin therapy, a tendency for some patients to be more influenced by social media and local traditions than by the medical profession, and a willingness to switch care providers and seek alternative therapies. Strategies to address some of these barriers are provided, with hypothetical illustrative case histories.
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Affiliation(s)
- Roger Chen
- Department of Endocrinology, St Vincent's Hospital, 406 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
- University of New South Wales, Sydney, Australia.
| | - Azizul Hasan Aamir
- Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Mohammod Feroz Amin
- Department of Endocrinology and Metabolic Disease, BIRDEM Hospital, Dhaka, Bangladesh
| | - Pongamorn Bunnag
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siew Pheng Chan
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Nemencio Nicodemus
- Department of Biochemistry and Molecular Biology, University of the Philippines-College of Medicine, Manila, Philippines
| | - Anthony Roberts
- South Australian Endocrine Clinical Research, Keswick, Adelaide, SA, Australia
| | - Tri Juli Edi Tarigan
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kyu-Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Roopa Mehta
- Unidad de Investigación en Enfermedades Metabólicas, Departamento de Endocrinología y Metabolismo, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Deshmukh V, Chaudhury T, Chadha M, Chawla M, Mukherjee S, Pitale S, Basu D, Gadekar A, Menon S, Trivedi C, Salvi V, Ramakrishnan S, Goyal G. LIVE INDIA: Effectiveness of Gla-100 in a Post hoc Pooled Analysis of FINE ASIA and GOAL Registries. Diabetes Ther 2023; 14:2075-2088. [PMID: 37789213 PMCID: PMC10597908 DOI: 10.1007/s13300-023-01469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Real-world evidence on insulin glargine 100 U/ml (Gla-100) initiation in Indian type 2 diabetes mellitus (T2DM) individuals is limited. The present study aimed to evaluate the effectiveness of Gla-100 in insulin-naïve T2DM participants from India. METHODS This post hoc analysis includes real-world data of insulin-naïve Indian participants with T2DM who started Gla-100 treatment in two Asian registries: FINE ASIA and GOAL. Changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, insulin dose, and incidence of hypoglycemia from baseline to 6 months were assessed. RESULTS A total of 955 participants with T2DM were identified and analyzed. The mean [standard deviation (SD)] age and duration of diabetes were 54.7 (9.8) years and 9.8 (6.3) years, respectively. Mean HbA1c and FPG were significantly reduced after 6 months of Gla-100 treatment [- 2.07 (1.4) %; - 94.4 (65.2) mg/dl, respectively]. HbA1c targets of < 7.0% and < 7.5% were achieved by 292 (30.6%) and 589 (61.7%) study participants, respectively. The overall incidence of hypoglycemia was low (n = 52; 5.4%); only two participants (0.2%) reported severe hypoglycemia. Insulin was titrated with a mean (SD) increment of 2.5 (5.6) U/day after 6 months, leading to a mean Gla-100 dose of 18.2 (8.9) U/day. Mean body weight remained unchanged from baseline to 6 months (- 0.1 kg). CONCLUSION In routine clinical practice, Gla-100 significantly improved glycemic parameters after 6 months of treatment with a low risk of hypoglycemia and no weight change in participants with T2DM.
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Affiliation(s)
- Vaishali Deshmukh
- Deshmukh Clinic and Research Centre, Second Floor, Pinnacle Prestige, Landmark: Next to Durvankur Hotel, Near Cosmos Bank, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune, Maharashtra, 411030, India.
| | | | - Manoj Chadha
- P.D. Hinduja Hospital and Research Centre, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Ghanshyam Goyal
- S K Diabetes Research and Education Centre, S V S Marwari Hospital Campus, Kolkata, India
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Chan SP, Aamir AH, Bee YM, Deerochanawong C, Paz-Pacheco E, Tiu F, Foo SH, Tan KEK, Le TQ, Saraswati MR, Bunnag P, Panusunan Sibarani R, Raza SA, Tran NQ. Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus. Diabetes Ther 2022; 13:1511-1529. [PMID: 35767186 PMCID: PMC9309111 DOI: 10.1007/s13300-022-01286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022] Open
Abstract
The global health burden of diabetes is on the rise and has affected more than half a billion people worldwide, particularly in Southeast Asia, North Africa, Africa, and the Western Pacific, Middle East, and South and Central America regions of the International Diabetes Federation (IDF). Despite many new treatments being available for the management of diabetes, glycemic control remains suboptimal in Asia, compared to the rest of the world. Delay in timely insulin initiation and inadequate titration of insulin are regarded to be some of the important reasons for inadequate glycemic control. Additionally, Asian populations have a distinct phenotype, including a younger age of onset and higher glycemic excursions, suggestive of a lower beta-cell function, as compared to non-Asians. Although there are multiple local and international guidelines on insulin initiation and titration, some of these guidelines can be complex. There is an unmet need for guideline recommendations on basal insulin initiation and titration to be simplified and customized for the Asian population with type 2 diabetes mellitus (T2DM). A unified approach would increase adoption of basal insulin initiation by primary care and family medicine physicians, which in turn would help reduce the inertia to insulin initiation. With this background, a consensus-seeking meeting was conducted with 14 experts from seven Asian countries to delineate appropriate practices for insulin initiation and titration in the Asian context. The key objective was to propose a simple insulin titration algorithm, specific for the Asian population, to improve glycemic control and optimize therapeutic outcomes of people with T2DM on basal insulin. Following a detailed review of literature and current guidelines, and potential barriers to insulin initiation and titration, the experts proposed a simplified insulin titration algorithm based on both physician- and patient-led components. The consensus recommendations of the experts related to basal insulin initiation and titration have been summarized in this article, along with the proposed titration algorithm for optimizing glycemic control in the Asian population with T2DM.
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Affiliation(s)
- Siew Pheng Chan
- Subang Jaya Medical Centre, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
| | - Azizul Hasan Aamir
- Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Chaicharn Deerochanawong
- Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Elizabeth Paz-Pacheco
- Division of Endocrinology, Diabetes and Metabolism, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Fatma Tiu
- Diabetes Clinic, University de Zamboanga Hospital, Zamboanga, Philippines
| | | | - Kevin E K Tan
- Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Toan Q Le
- National Hospital of Endocrinology, Hanoi, Vietnam
- University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
| | - Made Ratna Saraswati
- Division of Endocrinology and Metabolism, Internal Medicine Department, Faculty of Medicine, Udayana University/Sanglah Hospital Denpasar-Bali, Denpasar, Indonesia
| | - Pongamorn Bunnag
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Syed Abbas Raza
- Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan
| | - Nam Quang Tran
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Kuo CP, Lu SH, Huang CN, Liao WC, Lee MC. Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063025. [PMID: 33804208 PMCID: PMC7999598 DOI: 10.3390/ijerph18063025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/27/2022]
Abstract
Purpose: Sleep disturbance is one of the major complaints among patients with diabetes. The status of diabetes control and associated complications may contribute to sleep disturbance. This study explored night time sleep and excessive daytime sleepiness in adults with type 2 diabetes and examined the association of diabetes control and associated complications on their sleep quality. Methods: A retrospective cohort study design was used. Type 2 diabetic patients (87 females and 79 males, aged 63.1 ± 10.5 years) were recruited from the outpatient clinics of the endocrine department. Sleep quality was assessed by the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale. Diabetes control and complications were obtained by retrospectively reviewing patients' medical records over 1 year prior to study enrollment. Results: 72.3% of recruited patients had poor glycemic control, and 71.1% had at least one diabetic complication. 56.0% of patients experienced poor sleep quality, and 24.1% had excessive daytime sleepiness. Those who were female (OR = 3.45) and who had ophthalmological problems (OR = 3.17) were associated with poor night time sleep quality, but if they did exercise to the point of sweating (OR = 0.48) reduced the risk of poor sleep quality. Furthermore, poor sleep quality (OR = 4.35) and having nephropathy (OR = 3.78) were associated with a higher risk of excessive daytime sleepiness. Conclusions: Sex, ophthalmological problems, nephropathy, and no exercise to the point of sweating are associated with sleep problems in patients with type 2 diabetes. Both lifestyle behaviors and diabetic complications affect sleep disturbances in patients with diabetes.
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Affiliation(s)
- Ching-Pyng Kuo
- School of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Shu-Hua Lu
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
| | - Chien-Ning Huang
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Wen-Chun Liao
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
- Correspondence: (W.-C.L.); (M.-C.L.)
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- College of Management, Chaoyang University of Technology, Taichung 413310, Taiwan
- Correspondence: (W.-C.L.); (M.-C.L.)
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Guo L, Chang B, Chen L, Yang L, Liu Y, Feng B, He Q. Composite cardiovascular risk and BMI affected comparative profiles of BIAsp 30 + metformin vs BIAsp 30 monotherapy: a MERIT post-hoc analysis. Sci Rep 2021; 11:4131. [PMID: 33602996 PMCID: PMC7893025 DOI: 10.1038/s41598-021-83410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/01/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed whether comparative efficacy and safety of biphasic insulin aspart 30 (BIAsp 30) plus metformin versus BIAsp 30 monotherapy differed for patients with type 2 diabetes mellitus (T2DM) inadequately controlled with oral antidiabetic drugs with different cardiovascular risk scores and different body mass indexes (BMI) by performing a post hoc analysis of the randomized controlled MERIT study. In the MERIT study, eligible patients were randomized 1:1 to receive BIAsp 30 plus metformin or BIAsp 30 for 16 weeks. Patients in the 2 treatment groups were classified into "low" and "high" risk subgroups based on their GloboRisk scores and into "BMI ≤ 26 kg/m2"and "BMI > 26 kg/m2" subgroups. Primary efficacy endpoint was between-treatments comparison of HbA1c changes from baseline for these 2 sets of subgroups. Between-treatments comparisons of secondary efficacy and safety endpoints were also performed. We found that BIAsp 30 plus metformin led to significantly higher percentage of high-risk patients achieving HbA1c target < 7% than BIAsp 30 monotherapy, with an overall comparable safety profile for high-risk patients. Meanwhile, for patients with BMI ≤ 26 kg/m2, compared with BIAsp 30 monotherapy, BIAsp 30 plus metformin led to significantly higher percentages of patients achieving HbA1c target (47.83% vs 28.17%, P = 0.0165) and composite target of HbA1c < 7% without hypoglycemia or weight gain (20.29% vs 6.85%, P = 0.0187) and have a slightly better safety profile. In conclusion, for T2DM patients at high CV risk or with BMI ≤ 26 kg/m2, BIAsp 30 plus metformin was preferable to BIAsp 30 monotherapy.
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Affiliation(s)
- Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dahua Road, Dongcheng District, Beijing, 100730, China.
| | - Baocheng Chang
- Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China
| | - Li Chen
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
| | - Liyong Yang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu Liu
- Sir Run Run Shaw Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Feng
- Shanghai East Hospital Affiliated To Tongji University, Shanghai, China
| | - Qinghua He
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1, Dahua Road, Dongcheng District, Beijing, 100730, China
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Deerochanawong C, Leelawattana R, Kosachunhanun N, Tantiwong P. Basal Insulin Dose Titration for Glycemic Control in Patients With Type 2 Diabetes Mellitus in Thailand: Results of the REWARDS Real-World Study. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2020; 13:1179551420935930. [PMID: 32774082 PMCID: PMC7391425 DOI: 10.1177/1179551420935930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022]
Abstract
This multicenter, longitudinal, descriptive, observational study of T2DM adults in Thailand aimed to assess real-world outcomes of basal insulin (BI) dose titration on glycemic control. Three-hundred and twenty-four patients were recruited and followed up over 24 weeks. Basal insulin titration was physician-driven in 58.2% of patients and patient-driven in the rest. During the 24-week study period, the total daily BI dose moved from 20.9 to 25.6 in the physician-driven group, while in the patient-driven group, it increased from 25.3 to 29.7. Thirty-five patients (11.2%) achieved their individualized HbA1c targets, with 18 patients (5.8%) achieving HbA1c ⩽ 7% without documented hypoglycemia. In summary, this study highlights that BI titration is suboptimal in the real world, and patients are unable to achieve their glycemic targets.
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Affiliation(s)
- Chaicharn Deerochanawong
- Diabetes and Endocrinology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Krung Thep Maha Nakhon, Thailand
| | - Rattana Leelawattana
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Prince of Songkla University Hospital, Hat Yai, Thailand
| | - Natapong Kosachunhanun
- Division of Endocrinology, Department of Medicine, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Puntip Tantiwong
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Lee M, Sun J, Han M, Cho Y, Lee JY, Nam CM, Kang ES. Nationwide Trends in Pancreatitis and Pancreatic Cancer Risk Among Patients With Newly Diagnosed Type 2 Diabetes Receiving Dipeptidyl Peptidase 4 Inhibitors. Diabetes Care 2019; 42:2057-2064. [PMID: 31431452 DOI: 10.2337/dc18-2195] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 07/29/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dipeptidyl peptidase 4 inhibitors (DPP-4i) are useful incretin-based antidiabetes drugs. However, there is a concern that DPP-4i may adversely impact the exocrine pancreas, owing to their pleiotropic effects. In this study, we investigated whether DPP-4i are associated with pancreatitis and pancreatic cancer using a nationwide population-based cohort study. RESEARCH DESIGN AND METHODS We included patients newly diagnosed with type 2 diabetes who were treated with antidiabetes drugs (n = 33,208) from 2007 to 2013. The data were obtained from the Korean National Health Insurance Service-Health Screening Cohort database (n = 514,866). Risk was estimated using a Cox proportional hazards model with time-dependent covariates. A 6-month lag time was used to account for a possible latency time. The risk across various time segments since the first prescription of DPP-4i was also analyzed. RESULTS Out of 33,208 subjects, 10,218 were new users of DPP-4i and 22,990 were new users of other antidiabetes drugs. DPP-4i significantly increased the risks of pancreatitis (adjusted hazard ratio [aHR] 1.24, 95% CI 1.01-1.52; P = 0.037) and pancreatic cancer (aHR 1.81, 95% CI 1.16-2.82; P = 0.009) with a 6-month drug use lag period. The risk of pancreatitis and pancreatic cancer was generally consistent in the first 12 months and 1 year after the initial prescription without showing an increasing trend according to exposure duration. CONCLUSIONS DPP-4i use is associated with increased risks of pancreatitis and pancreatic cancer in patients with newly diagnosed type 2 diabetes. However, the absence of increasing trend according to exposure duration suggests the chances of reverse causality, and long-term pancreatic safety of DPP-4i has to be further investigated.
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Affiliation(s)
- Minyoung Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jiyu Sun
- Biostatistics and Computing, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Minkyung Han
- Department of Public Health, Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yongin Cho
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Seok Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea .,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Republic of Korea
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Wong I. Study of type 2 diabetes management among patients in a Macau primary care setting. Fam Med Community Health 2019; 7:e000031. [PMID: 32148710 PMCID: PMC6910744 DOI: 10.1136/fmch-2018-000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and is associated with premature death and disability and decreased quality of life. Moreover, this condition substantially increases healthcare expenditures. Objective The primary objective was to assess the successful glycaemic control rates, blood pressure (BP) and cholesterol control rates in patients with T2DM in a Macau primary care setting. The secondary objective of this study was to assess the delay of insulin initiation in the Sao Lourence Health Center. Methods Patients were stratified according to age (<65 years vs ≥65 years) and sex. Successful glycaemic control was defined as glycated haemoglobin (HbA1c) <7%. Successful cholesterol control was defined as a low-density lipoprotein cholesterol (LDL-C) level <2.6 mmol/L, and BP control was defined as BP <140/90 mm Hg. Results Among the 2157 participants included in this study, 1046 (48.5%) patients had HbA1c <7%, 1209 (56.1%) patients had BP <140/90 mm Hg and 1244 (57.7%) patients had LDL-C <2.6 mmol/L. In conclusion, only 403 (18.7%) patients met the targets for all three measures. Of the 235 patients who were on insulin therapy, the mean (±SD) duration from T2DM diagnosis to insulin initiation was 7.47±6.52 years, the mean (±SD) duration from HbA1c not meeting the target (HbA1c ≥7% over 1 year and persistently) to insulin initiation was 3.34±3.66 years and the mean baseline HbA1c was 9.13%. Compared with patients with a longer duration (≥5 years) of HbA1c not meeting the target before insulin initiation, those who started insulin within 1 year of HbA1c not meeting the target had a better glycaemic control rate (40.7% vs 13%). Conclusions Nearly half of the patients at Sao Lourence Health Center, a primary care centre in Macau, met the glycaemic control target, but less than one-fifth of patients met all three targets for T2DM control. Moreover, there was a delay in insulin initiation for people with T2DM.
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Affiliation(s)
- In Wong
- Health Bureau, Macau SAR Government, Macau, China
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Tien K, Hung Y, Chen J, Chen C, Wang C, Hwu C, Huang Y, Hsiao P, Tu S, Wang C, Sheu WH. Basal insulin therapy: Unmet medical needs in Asia and the new insulin glargine in diabetes treatment. J Diabetes Investig 2019; 10:560-570. [PMID: 30520564 PMCID: PMC6497775 DOI: 10.1111/jdi.12984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/23/2022] Open
Abstract
Diabetes remains a global epidemic and a tremendous health challenge, especially in the Asian population. Dramatic increases in the prevalence of diabetes across different countries or areas in Asia have been reported in recent epidemiological studies. Although clinical guidelines have strengthened appropriate antihyperglycemic medications and lifestyle modifications for optimal diabetes management, inadequate glycemic control still occurs in many patients with an increased risk of developing microvascular and macrovascular complications. Insulin administration is the main therapy for diabetes in response to the inability to secrete insulin, and is recommended in current guidelines to treat patients with type 2 diabetes after failure of oral antidiabetic drugs. Clinical studies have shown that long-acting insulin analogs improve basal glycemic control with reduced risk of hypoglycemia. In the present review, we discuss previous challenges with basal insulin therapy in Asia, the pharmacological development of insulin analogs to overcome the unmet medical needs and recent clinical studies of the new ultra-long-acting insulin analog, insulin glargine U300. Furthermore, relevant findings of current real-world evidence are also included for the comparison of the efficacy and safety of different insulin formulations. Based on the accumulating evidence showing a low incidence of hypoglycemia and technical benefits of dose titration, treatment with glargine U300 can be a promising strategy for Asian diabetes patients to achieve glycemic targets with favorable safety.
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Affiliation(s)
- Kai‐Jen Tien
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChi Mei Medical CenterTainanTaiwan
| | - Yi‐Jen Hung
- Tri‐Service General HospitalSong‐Shan BranchTaipeiTaiwan
| | - Jung‐Fu Chen
- Division of MetabolismDepartment of Internal MedicineKaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
| | - Ching‐Chu Chen
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChina Medical University HospitalTaichungTaiwan
- School of Chinese MedicineChina Medical UniversityTaichungTaiwan
| | - Chih‐Yuan Wang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chii‐Min Hwu
- Section of Endocrinology and MetabolismDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Yu‐Yao Huang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChang Gung Memorial HospitalCollege of MedicineChang Gung UniversityTaoyuan CityTaiwan
| | - Pi‐Jung Hsiao
- Divisions of Endocrinology and MetabolismDepartment of Internal MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
- Departments of Internal Medicine College of MedicineKaohsiung Medical UniversityKaohsiungTaiwan
| | - Shih‐Te Tu
- Division of Endocrinology and MetabolismDepartment of Internal MedicineChanghua Christian HospitalChanghuaTaiwan
| | - Chao‐Hung Wang
- Division of Endocrinology and MetabolismDepartment of Internal MedicineMacKay Memorial HospitalTaipeiTaiwan
| | - Wayne Huey‐Herng Sheu
- Division of Endocrinology and MetabolismDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan
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Jabbar A, Mohamed WMIBW, Ozaki R, Mirasol R, Treuer T, Lew T, Qi R, Sheu WHH, Deerochanawong C, Babineaux SM. Patterns and trends in insulin initiation and intensification among patients with type 2 diabetes mellitus in the Western Pacific region. Curr Med Res Opin 2018; 34:1653-1662. [PMID: 29863422 DOI: 10.1080/03007995.2018.1484712] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Current and future estimates of the burden of diabetes for the Western Pacific (WP) region are among the highest in the world. Verifying Insulin Strategy and Initial Health Outcome Analysis (VISION) was an 18 month observational study that explored treatment approaches in patients with type 2 diabetes mellitus (T2DM) initiating insulin in the WP region. METHODS A total of 1065 patients aged ≥18 years with T2DM initiating insulin therapy in normal clinical course were enrolled from Hong Kong, Malaysia, Philippines, Taiwan and Thailand. Participants' data was recorded by the treating physicians. Patient-reported outcomes (PROs) were assessed using questionnaires completed by participants. RESULTS The mean age of patients was 57.2 years with mean glycosylated hemoglobin (HbA1c) of 10.0%. About 66% of patients had an HbA1c ≥9.0% at insulin initiation despite 74% of them being on two or more oral antidiabetic agents at the time of insulin initiation. Basal insulin was initiated in 72% and premixed insulin in 27% of patients. Changes in insulin therapy was observed in 63% of patients and, by the end of study, 28% achieved HbA1c levels of <7.5%. The proportion of patients completely satisfied with their insulin treatment increased over the study course and the quality of life (QoL) score increased from baseline to the study end. CONCLUSION As high HbA1C levels indicate a delayed start of insulin therapy, timely initiation and early intensification of insulin therapy is necessary in the region to achieve adequate glycemic control in time and prevent diabetes complications. Data from PROs suggests that the insulin treatment improves QoL in most patients.
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Affiliation(s)
| | | | - Risa Ozaki
- c The Chinese University of Hong Kong , Hong Kong , China
| | | | | | | | - Rong Qi
- g Eli Lilly and Company , Indianapolis , IN , USA
| | - Wayne H-H Sheu
- h Division of Endocrinology and Metabolism, Department of Internal Medicine , Taichung Veterans General Hospital , Taichung , Taiwan
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11
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Yeh JZ, Wei CJ, Weng SF, Tsai CY, Shih JH, Shih CL, Chiu CH. Disease-specific health literacy, disease knowledge, and adherence behavior among patients with type 2 diabetes in Taiwan. BMC Public Health 2018; 18:1062. [PMID: 30143020 PMCID: PMC6108149 DOI: 10.1186/s12889-018-5972-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022] Open
Abstract
Background To examine the association between health literacy, level of disease knowledge, and adherence behavior among patients with type 2 diabetes. Methods A cross-sectional survey study of 1059 Mandarin- and Taiwanese-speaking patients aged 20 years or older with type 2 diabetes was conducted. The demographic profiles of the sample strata were determined by analyzing the Taiwanese National Health Insurance Database. Participants were enrolled and completed questionnaires between April and November of 2015. The patients were assessed using a self-developed questionnaire with high internal consistency (KR-20 = .84). Results Construct validity was supported by Confirmatory Factor Analysis. Respondents scored lowest in diet-related knowledge. Health literacy and diabetes knowledge were significantly greater when patients cared for themselves with additional caretaker assistance. Patient age, gender, and educational attainment were associated with adherence behavior. Conclusion This study conducted a nation-wide survey of patients with diabetes and the results showed that respondents possessed fairly strong diabetes-specific health literacy and knowledge. However, health literacy shouldn’t be assessed as an isolated concept. Instead, it should be assessed in conjunction with adherence behavior.
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Affiliation(s)
- Jue-Zong Yeh
- Department of Pharmacy, Tri-Service General Hospital, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shuen-Fu Weng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Yu Tsai
- School of Health Care Administration, Taipei Medical University, 250 Wu-hsing St., Taipei, Taiwan
| | - Jia-Hui Shih
- School of Health Care Administration, Taipei Medical University, 250 Wu-hsing St., Taipei, Taiwan
| | | | - Chiung-Hsuan Chiu
- School of Health Care Administration, Taipei Medical University, 250 Wu-hsing St., Taipei, Taiwan.
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12
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Gu T, Hong T, Zhang P, Tang S, Bi Y, Lu H, Men L, Ma D, Zhu D. Insulin Glargine Combined with Oral Antidiabetic Drugs for Asians with Type 2 Diabetes Mellitus: A Pooled Analysis to Identify Predictors of Dose and Treatment Response. Diabetes Ther 2018; 9. [PMID: 29524190 PMCID: PMC6104270 DOI: 10.1007/s13300-018-0381-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In Asia, patients with type 2 diabetes mellitus (T2DM) often have suboptimal glycemic control for many years prior to initiating basal insulin. Active titration of basal insulin is also required to improve glycemic outcomes. This pooled analysis was conducted to determine the impact of patient baseline covariates on the required dose of basal insulin and treatment response, for the improved management of Asian patients with T2DM. METHODS Data on insulin-naïve Asian patients with T2DM who initiated and fully titrated insulin glargine 100 U/mL (Gla-100) for ≥ 20 weeks were pooled from seven randomized, controlled, treat-to-target trials. Covariance and multivariate linear/logistic regression analyses were applied to determine the impact of the baseline covariates on Gla-100 dose (primary outcome) and treatment response (secondary outcomes) at week 24 for patients from Asia (N = 724) and from China alone (n = 249). Based on the multivariate analysis for the primary outcome in the Asian population, a nomogram was developed. RESULTS The dose of Gla-100 at week 24 was negatively correlated with age and positively correlated with body mass index (BMI) and fasting plasma glucose (FPG) at baseline in both Asian and Chinese populations. In both populations, higher baseline glycated hemoglobin (HbA1c) was associated with a lower reduction in HbA1c from baseline, higher HbA1c at week 24, and a lower chance of achieving HbA1c < 7% at week 24. The constructed nomogram enables calculation of the likely dose of Gla-100 required by Asian patients with T2DM to achieve HbA1c < 7% at week 24. CONCLUSIONS Higher doses of Gla-100 are likely to be required in younger patients or patients with higher baseline BMI or FPG. The nomogram developed in this study can aid clinicians to titrate the dose of Gla-100 appropriately. Evidence in this pooled analysis also indicates that initiating basal insulin at a lower HbA1c can lead to greater glycemic control. FUNDING Sanofi China Investment Company.
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Affiliation(s)
- Tianwei Gu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Ting Hong
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Pengzi Zhang
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Sunyinyan Tang
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Yan Bi
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Hai Lu
- Sanofi Investment Co., Ltd., Shanghai, China
| | | | - Dongwei Ma
- Sanofi Investment Co., Ltd., Shanghai, China
| | - Dalong Zhu
- Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
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13
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Chan JCN, Bunnag P, Chan SP, Tan ITI, Tsai ST, Gao L, Landgraf W. Glycaemic responses in Asian and non-Asian people with type 2 diabetes initiating insulin glargine 100 units/mL: A patient-level pooled analysis of 16 randomised controlled trials. Diabetes Res Clin Pract 2018; 135:199-205. [PMID: 29179974 DOI: 10.1016/j.diabres.2017.11.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/06/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022]
Abstract
AIMS To compare outcomes between Asian and non-Asian patients with type 2 diabetes (T2D) inadequately controlled on oral antidiabetic drugs (OADs) initiating insulin glargine 100 units (U)/mL (Gla-100) in randomised controlled clinical trials. METHODS Post hoc analysis of patient-level data (Asian n = 235; non-Asian n = 3351) from 16 trials. RESULTS At baseline, Asian patients were younger with lower body mass index (BMI), fasting C-peptide, and fasting plasma glucose (FPG) than non-Asian patients (all P < .001). Asian patients had a higher mean glycosylated haemoglobin (HbA1c) at Week 24 and less reduction in HbA1c from baseline (7.4% vs. 7.2%; -1.3% vs. -1.6%, respectively; P = .0001), and were less likely to achieve HbA1c <7.0% (40% vs. 47%; P = .002) than non-Asian patients. Reductions in FPG and rates of hypoglycaemia were similar between Asian and non-Asian patients. Asian patients had less weight gain than non-Asian patients (+1.3 vs. +1.9 kg, respectively, P = .013). CONCLUSIONS In our post hoc meta-analysis, Gla-100 effectively lowers HbA1c and FPG in Asian patients with T2D uncontrolled on OADs with similar incidence of hypoglycaemia and less absolute weight gain compared with non-Asian patients. At a similar FPG reduction, fewer Asian patients achieved HbA1c target <7.0%, suggesting that prandial glucose needs to be addressed.
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Affiliation(s)
- Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
| | | | - Siew P Chan
- University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Iris T I Tan
- University of The Philippines, Manila, Philippines
| | | | - Ling Gao
- Analysta Inc., Somerset, NJ, USA
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14
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Chan WB, Chen JF, Goh SY, Vu TTH, Isip-Tan IT, Mudjanarko SW, Bajpai S, Mabunay MA, Bunnag P. Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience. Diabetes Metab Syndr Obes 2017; 10:521-532. [PMID: 29276400 PMCID: PMC5733912 DOI: 10.2147/dmso.s143046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.
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Affiliation(s)
- Wing Bun Chan
- Qualigenics Diabetes Centre, Hong Kong SAR, People’s Republic of China
| | - Jung Fu Chen
- Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Thi Thanh Huyen Vu
- Out-patient Department and Department of Internal Medicine, National Geriatric Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Iris Thiele Isip-Tan
- Section of Endocrinology, Diabetes and Metabolism, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Sony Wibisono Mudjanarko
- Diabetes and Nutrition Centre, Dr. Soetomo Hospital, School of Medicine Airlangga University, Surabaya, Indonesia
| | | | | | - Pongamorn Bunnag
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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15
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Deerochanawong C, Bajpai S, Dwipayana IMP, Hussein Z, Mabunay MA, Rosales R, Tsai ST, Tsang MW. Optimizing Glycemic Control Through Titration of Insulin Glargine 100 U/mL: A Review of Current and Future Approaches with a Focus on Asian Populations. Diabetes Ther 2017; 8:1197-1214. [PMID: 29094298 PMCID: PMC5688987 DOI: 10.1007/s13300-017-0322-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 01/25/2023] Open
Abstract
Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulin-an issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors' clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizing the dose of basal insulin, enabling a larger number of patients in Asia to reach their target glycemic goals with improved outcomes.
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