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Li L, Zhang X, Zhang T, Zeng L, Lin M, Li Y, Li W. Comparison of Efficacy and Adherence of Patient-Preferred (1 Unit Daily) and ADA/EASD Guideline-Recommended (2 Units Every 3 Days) Basal Insulin Titration Algorithms: Multicenter, Randomized, Clinical Study. Patient Prefer Adherence 2024; 18:687-694. [PMID: 38524199 PMCID: PMC10959243 DOI: 10.2147/ppa.s446855] [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: 10/27/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Aim Insulin titration often faces inertia, hindering glycemic control. A patient-centered approach empowers patients to overcome this inertia. This study aims to compare the effectiveness of patient-preferred and guideline-recommended self-titration algorithms in achieving glycemic targets and improving adherence. Methods Outpatients with type 2 diabetes (T2D) who did not respond to oral antihyperglycemic drugs (OAD) were assessed. They were randomly assigned to patient-preferred and guideline-recommended groups. In the patient-preferred group, individuals selected an algorithm to self-adjust their insulin glargine dosage by 2 units every 3 days if the mean fasting blood glucose (FBG) over the past 3 consecutive days was ≥7.0 mmol/L, or by 1 unit daily if the FBG on the same day was ≥7.0 mmol/L. In the guideline-recommended group, insulin glargine was titrated by 2 units every 3 days if the mean FBG over the past 3 consecutive days was ≥7.0 mmol/L. The FBG target was set below <7.0 mmol/L. Results Thirty-nine participants in the patient-preferred group and 42 in the guideline-recommended group completed the study. The cumulative rates of achieving the FBG target in the patient-preferred group compared to the guideline-recommended group were 69.2% vs 54.8% (χ²=1.792, p=0.181) in week 1, 89.7% vs 73.8% (χ²=3.403, p = 0.065) in week 2, 94.9% vs 76.2% (χ²=17.638, p=0.000) in week 3, and 100.0% vs 88.1% (χ²=4.405, p=0.036) in week 4. Adherence rates were significantly higher in the patient-preferred group (97.4%, 37/38) compared to the guideline-recommended group (66.7%, 28/42) (χ²=12.688, p=0.000). Insulin glargine dosage at FBG target achievement was 21.2±4.3 U in the patient-preferred group and 18.8±6.7 U in the guideline-recommended group (t=1.888, p=0.063). Hypoglycemia was reported in 1 patient in the guideline-recommended group, with no instances in the patient-preferred group. Conclusion The patient-preferred self-titration algorithm demonstrates a higher rate of reaching glucose targets and improved adherence. Trial Registration Number ChiCTR2100050805.
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Affiliation(s)
- Ling Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, People’s Republic of China
| | - Liankun Zeng
- Department of Endocrinology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Mingrun Lin
- Department of Endocrinology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yanli Li
- Department of Endocrinology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China
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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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Tasdemiroglu Y, Gourdie RG, He JQ. In vivo degradation forms, anti-degradation strategies, and clinical applications of therapeutic peptides in non-infectious chronic diseases. Eur J Pharmacol 2022; 932:175192. [PMID: 35981605 DOI: 10.1016/j.ejphar.2022.175192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
Current medicinal treatments for diseases comprise largely of two categories: small molecular (chemical) (e.g., aspirin) and larger molecular (peptides/proteins, e.g., insulin) drugs. Whilst both types of therapeutics can effectively treat different diseases, ranging from well-understood (in view of pathogenesis and treatment) examples (e.g., flu), to less-understood chronic diseases (e.g., diabetes), classical small molecule drugs often possess significant side-effects (a major cause of drug withdrawal from market) due to their low- or non-specific targeting. By contrast, therapeutic peptides, which comprise short sequences from naturally occurring peptides/proteins, commonly demonstrate high target specificity, well-characterized modes-of-action, and low or non-toxicity in vivo. Unfortunately, due to their small size, linear permutation, and lack of tertiary structure, peptidic drugs are easily subject to rapid degradation or loss in vivo through chemical and physical routines, thus resulting in a short half-life and reduced therapeutic efficacy, a major drawback that can reduce therapeutic efficiency. However, recent studies demonstrate that the short half-life of peptidic drugs can be significantly extended by various means, including use of enantiomeric or non-natural amino acids (AAs) (e.g., L-AAs replacement with D-AAs), chemical conjugation [e.g., with polyethylene glycol], and encapsulation (e.g., in exosomes). In this context, we provide an overview of the major in vivo degradation forms of small therapeutic peptides in the plasma and anti-degradation strategies. We also update on the progress of small peptide therapeutics that are either currently in clinical trials or are being successfully used in clinical therapies for patients with non-infectious diseases, such as diabetes, multiple sclerosis, and cancer.
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Affiliation(s)
- Yagmur Tasdemiroglu
- Department of Biomedical Sciences and Pathobiology, College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Robert G Gourdie
- Center for Vascular and Heart Research, Fralin Biomedical Research Institute, Virginia Tech, Roanoke, VA, 24016, USA
| | - Jia-Qiang He
- Department of Biomedical Sciences and Pathobiology, College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, 24061, USA.
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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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Lane W, Favaro E, Jódar E, Kelkar P, Oviedo A, Sivarathinasami R, Senior PA, Sesti G, Franek E. Effective Overall Glycaemic Control with Fast-Acting Insulin Aspart Across Patients with Different Baseline Characteristics: A Post Hoc Analysis of the Onset 9 Trial. Diabetes Ther 2022; 13:761-774. [PMID: 35290624 PMCID: PMC8991309 DOI: 10.1007/s13300-022-01213-3] [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: 07/15/2021] [Accepted: 01/27/2022] [Indexed: 11/03/2022] Open
Abstract
AIMS To investigate the efficacy and safety of fast-acting insulin aspart (faster aspart) compared with insulin aspart (IAsp) in participants with type 2 diabetes (T2D) across different subgroups. METHODS We report on a post hoc analysis of onset 9, a 16-week trial of participants with T2D randomised to faster aspart (n = 546) or IAsp (n = 545). Participants were grouped by baseline HbA1c (< 7.0%, ≥ 7.0%), meal test bolus insulin dose (≤ 10 units [U], > 10 U to ≤ 20 U, > 20 U), body mass index (< 30 kg/m2, ≥ 30 to < 35 kg/m2, ≥ 35 kg/m2), and age (< 65 years, ≥ 65 years). Outcomes assessed were change from baseline in HbA1c and in 1-h postprandial glucose (PPG) increment, and severe or blood glucose (BG)-confirmed hypoglycaemia. RESULTS Faster aspart provided reductions in HbA1c comparable to IAsp across all subgroups, with improved 1-h PPG control compared with IAsp in several subgroups. Faster aspart had comparable or improved rates of severe or BG-confirmed hypoglycaemia versus IAsp, particularly in participants with good glycaemic control (HbA1c < 7.0%), the elderly (≥ 65 years old), and those with insulin resistance (> 20 U meal test bolus insulin dose). CONCLUSIONS Faster aspart provides effective overall glycaemic control, with improved early PPG control compared with IAsp across a range of patient characteristics. CLINICAL TRIAL REGISTRATION NCT03268005.
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Affiliation(s)
- Wendy Lane
- Mountain Diabetes and Endocrine Centre, 1998 Hendersonville Rd, Bldg. 31, Asheville, NC, 28803, USA.
| | | | - Esteban Jódar
- University Hospital Quirón Salud Madrid, Universidad Europea, Madrid, Spain
| | | | - Alejandra Oviedo
- Santojanni Hospital and Cenudiab, Ciudad Autonoma de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - Edward Franek
- Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
- Centralny Szpital Kliniczny MSWiA, Warsaw, Poland
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Chawla M, Jain SM, Kesavadev J, Makkar BM, Viswanathan V, Tiwaskar M, Sosale AR, Negalur V, Modi KD, Gupta M, Kumar S, Ramakrishnan S, Deka N, Roy N. Insulinization in T2DM with Basal Analogues During COVID-19 Pandemic: Expert Opinion from an Indian Panel. Diabetes Ther 2021; 12:133-142. [PMID: 33314000 PMCID: PMC7733136 DOI: 10.1007/s13300-020-00979-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/26/2020] [Indexed: 11/26/2022] Open
Abstract
The ongoing global pandemic of the coronavirus disease 2019 (COVID-19) has placed a severe strain on the management of chronic conditions like diabetes. Optimal glycemic control is always important, but more so in the existing environment of COVID-19. In this context, timely insulinization to achieve optimal glycemic control assumes major significance. However, given the challenges associated with the pandemic like restrictions of movement and access to healthcare resources, a simple and easy way to initiate and optimize insulin therapy in people with uncontrolled diabetes is required. With this premise, a group of clinical experts comprising diabetologists and endocrinologists from India discussed the challenges and potential solutions for insulin initiation, titration, and optimization in type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic and how basal insulin can be a good option in this situation owing to its unique set of advantages like lower risk of hypoglycemia, ease of training, need for less monitoring, better adherence, flexibility of using oral antidiabetic drugs, and improved quality of life compared to other insulin regimens. The panel agreed that the existing challenges should not be a reason to delay insulin initiation in people with uncontrolled T2DM and provided recommendations, which included potential solutions for initiating insulin in the absence or restriction of in-person consultations; the dose of insulin at initiation; the type of insulin preferred for simplified regimen and best practices for optimal titration to achieve glycemic targets during the pandemic. Practical and easily implementable tips for patients and involvement of stakeholders (caregivers and healthcare providers) to facilitate insulin acceptance were also outlined by the expert panel. Simplified and convenient insulin regimens like basal insulin analogues are advised during and following the pandemic in order to achieve glycemic control in people with uncontrolled T2DM.
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Affiliation(s)
- Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, Maharashtra, India.
| | - Sunil M Jain
- TOTALL Diabetes and Hormone Institute, Indore, Madhya Pradesh, India
| | - Jothydev Kesavadev
- Department of Diabetes, Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | - Brij M Makkar
- Dr. Makkar's Diabetes and Obesity Centre, New Delhi, India
| | | | | | - Aravind R Sosale
- Diacon Hospital (Diabetes Care and Research Centre), Bangalore, India
| | - Vijay Negalur
- Dr. Negalur's Diabetes and Thyroid Specialities Center, Thane, India
| | | | | | - Surinder Kumar
- Department of Endocrinology, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Nirmalya Roy
- KPC Medical College and Hospital, Kolkata, India
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Mondal H, Mondal S. Usefulness of YouTube™ videos in training patients for blood glucose self-monitoring in current coronavirus disease-19 pandemic. INDIAN JOURNAL OF MEDICAL SCIENCES 2020. [PMCID: PMC7485635 DOI: 10.25259/ijms_150_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: During the coronavirus disease-19 pandemic, due to restricted health-care access, patients may not get hands-on training for self-monitoring of blood glucose (SMBG) from physicians. YouTube™ is a popular video-sharing web platform that can be used as a source of information for SMBG. This study aimed to assess the usefulness of YouTube™ videos on SMBG. Material and Methods: We searched the keywords “blood glucose self-monitoring,” “home blood glucose monitoring,” “blood glucose test,” and “blood sugar test” on YouTube™. The first 40 videos of each search were listed. After the two-stage screening, 49 videos were included for final data analysis. General characteristics and SMBG-specific characteristics (namely, strip handling, lancing device handling, measurement, and post- measurement action) were observed with pre-defined criteria having “yes” and “no” closed option. Data were tested statistically by the binomial test. Results: Average duration of 49 videos was 244.20 ± 72.61 s and those were online since 35.14 ± 20.52 months on YouTube™. Information about strip handling was mostly deficient, major being checking the expiry date (16.33% videos had the information). The handling of the lancing device was correct in the majority of the videos except for the disinfection of the tip of the lancing device (6.12% videos had the information). The measurement procedure was also correct in the majority of the videos except for the instruction to dry the hands (38.78% videos had the information) after washing. The post-measurement logbook entry was found in 48.98% videos. Conclusion: YouTube™ videos can be used as a potential source of information for patients’ education for SMBG. However, there are various levels of the incompleteness of the tutorials. Primary care physicians may suggest YouTube™ videos after exploring the videos and selecting the most appropriate one for their patients.
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Affiliation(s)
- Himel Mondal
- Department of Physiology, Bhima Bhoi Medical College and Hospital, Balangir, Odisha, India,
| | - Shaikat Mondal
- Department of Physiology, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India,
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