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Matsuba I, Kawata T, Ajima M, Umezawa S, Kaneshiro M, Asakura T, Machimura H, Sawa T, Tanaka K, Takeda H, Imaoka T, Kanamori A. Multinational Observational Study to Understand Insulin Treatment Intensification: Japanese Subgroup Analysis of the MOSAIc Study. Diabetes Ther 2022; 13:265-274. [PMID: 34988917 PMCID: PMC8873337 DOI: 10.1007/s13300-021-01195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION MOSAIc was a multinational, non-interventional, prospective, observational cohort study designed to provide an understanding of the specific challenges associated with intensification of initial insulin therapy in patients with type 2 diabetes mellitus (T2DM). We present a sub-analysis of Japanese patients from MOSAIc, with data analyzed longitudinally over 2 years, to provide insight on how T2DM treatment is intensified. METHODS Japanese patients with T2DM receiving any insulin therapy for at least 3 months were eligible for study inclusion. Baseline and clinical data were collected during an initial baseline visit and during four subsequent prospective visit windows (within ± 3 months) at 6, 12, 18, and 24 months. Treatment intensification was defined as addition of new insulin, increase in insulin dosage (1-unit change or 10% compared with the previous visit), increase in insulin injection frequency, and/or addition of non-insulin antihyperglycemic agents. RESULTS Of 116 Japanese patients who completed the study, 50.0% (n = 58) received treatment intensification. Baseline characteristics of patients with treatment intensification included a longer duration of diabetes, higher incidence of baseline microvascular complications, and higher HbA1c compared to those without intensification. There was no significant difference in HbA1c change from baseline between the two groups at any post-baseline visit. Insulin intensification accounted for 61.2% of treatment changes, with non-insulin-related intensification accounting for 36.2% of treatment changes. An increase in insulin dose was the most frequent treatment change (51.7%), followed by the addition of new insulin (22.4%), and an increase in insulin injection frequency (6.9%). CONCLUSION Real-world data from Japanese patients with T2DM who received treatment intensification showed that an increase in insulin dose and the addition of new insulin were the most frequent treatment intensification methods. HbA1c was maintained through 2 years of treatment. TRIAL REGISTRATION NCT01400971, ClinicalTrials.gov.
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Affiliation(s)
- Ikuro Matsuba
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Takehiro Kawata
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Miho Ajima
- Department of Diabetology, Kawasaki Saiwai Clinic, Kanagawa, Japan
| | - Shinichi Umezawa
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Mizuki Kaneshiro
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Taro Asakura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hideo Machimura
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Tasuku Sawa
- Sawa Internal Medicine and Diabetes Clinic, Kanagawa, Japan
| | - Keiji Tanaka
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Hiroshi Takeda
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
| | - Takeshi Imaoka
- Japan Drug Development and Medical Affairs, Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-ku, Kobe, Hyogo, 651-0086, Japan.
| | - Akira Kanamori
- The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan
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Masyuko S, Ngongo CJ, Smith C, Nugent R. Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review. PLoS One 2021; 16:e0245269. [PMID: 33449968 PMCID: PMC7810280 DOI: 10.1371/journal.pone.0245269] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/26/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs. METHODS We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting. RESULTS Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7). CONCLUSION PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.
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Affiliation(s)
- Sarah Masyuko
- RTI International, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Ministry of Health, Nairobi, Kenya
| | - Carrie J. Ngongo
- RTI International, Seattle, Washington, United States of America
- * E-mail:
| | - Carole Smith
- RTI International, Seattle, Washington, United States of America
- Department of Neurology, University of Washington, Seattle, Washington, United States of America
| | - Rachel Nugent
- RTI International, Seattle, Washington, United States of America
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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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Kadowaki T, Kondo K, Sasaki N, Miyayama K, Yokota S, Terata R, Gouda M. Efficacy and safety of teneligliptin add-on to insulin monotherapy in Japanese patients with type 2 diabetes mellitus: a 16-week, randomized, double-blind, placebo-controlled trial with an open-label period. Expert Opin Pharmacother 2017; 18:1291-1300. [DOI: 10.1080/14656566.2017.1359259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Takashi Kadowaki
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Kazuoki Kondo
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
| | - Noriyuki Sasaki
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
| | - Kyoko Miyayama
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
| | - Shoko Yokota
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
| | - Ryuji Terata
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
| | - Maki Gouda
- Integrated Value Development, Mitsubishi Tanabe Pharma Corporation , Tokyo, Japan
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Kalra S, Thai HQ, Deerochanawong C, Su-Yen G, Mohamed M, Latt TS, Aye TT, Latif ZA, Katulanda P, Khun T, Satha S, Vongvandy V. Choice of Insulin in Type 2 Diabetes: A Southeast Asian Perspective. Indian J Endocrinol Metab 2017; 21:478-481. [PMID: 28553609 PMCID: PMC5434737 DOI: 10.4103/ijem.ijem_82_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Southeast Asia faces a diabetes epidemic, which has created significant challenges for health care. The unique Asian diabetes phenotype, coupled with peculiar lifestyle, diet, and healthcare-seeking behavior, makes it imperative to develop clinical pathways and guidelines which address local needs and requirements. From an insulin-centric viewpoint, the preparations prescribed in such pathways should be effective, safe, well tolerated, nonintrusive, and suitable for the use in multiple clinical situations including initiation and intensification. This brief communication describes the utility of premixed or dual action insulin in such clinical pathways and guidelines.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Hong Quang Thai
- Vietnamese Association of Diabetes and Endocrinology, Vietnam
| | - Chaicharn Deerochanawong
- Rajavithi Hospital, College of Medicine, Rangsit University, Ministry of Public Health, Bangkok, Thailand
| | - Goh Su-Yen
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Mafauzy Mohamed
- Universiti Sains Malaysia,, Health Campus in Kelantan, Kelantan, Malaysia
| | | | - Than Than Aye
- Department of Medicine, University of Medicine 2, Yangon, Myanmar
| | | | - Prasad Katulanda
- Department of Clinical Medicine, Diabetes Research Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Touch Khun
- Diabetology Unit, Preah Kossamak Hospital, Phnom Penh, Cambodia
| | - Sum Satha
- Department of Medicine, Calmette Hospital, Phnom Penh, Cambodia
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