Expert Opinion on Addressing the Gap in Injection Technique and Needle Reuse for People with Diabetes in Indonesia.

The use of insulin for patients with diabetes mellitus in Indonesia appears to be under expectation; moreover, there are gaps in knowledge regarding the proper injection technique and pen needle reuse by both healthcare professionals (HCPs) and patients. To address these issues, a scientific expert meeting was held with the participation of endocrinologists and public health specialist from many different organizations in Indonesia to identify the challenges and problem related to injection technique, high pen needle reuse rate, and the need of all stakeholders. The experts agreed that it is necessary to ensure physicians to start the initiation phase as early as indicated, continue optimizing its dosage to reach targeted blood sugar based on guideline, and involve all relevant stakeholders to improve insulin distribution and patient access in every primary care facility in order to optimize the use of insulin or other injectable diabetes medications in Indonesia. Additionally, the experts believed that education on proper injection technique and improved reuse rate of pen needle is necessary. To date, Indonesian Diabetes Educators Association (IDEA/PEDI) has established guideline on injection technique. There are also recommendations on injection technique and needle reuse from Indonesian Society of Endocrinology (PERKENI) and Forum for Injection Technique & Therapy: Expert Recommendations (FITTER); however, this guideline/recommendation should be disseminated more widely among HCPs. In addition, cost-effectiveness studies based on local data are needed to propose and convince the Payors and other stakeholders. This article can be used as a guidance for HCPs and policymakers to improve current practice on injection technique, pen needle reuse, needle prescription and reimbursement policy in Indonesia and elsewhere.

Clinical experience with insulin detemir: results from the Indonesian cohort of the international A1chieve study.

AIM: To determine the safety and efficacy of insulin detemir in Indonesian patients with type 2 diabetes (T2D) as a sub-analysis of the 24-week, prospective, multinational, non-interventional A1chieve study. METHODS: This study included 477 Indonesian T2D patients starting insulin detemir at the discretion of their physicians. Safety and efficacy was measured in routine clinical practice at baseline, interim (around 12 weeks from baseline) and final (around 24 weeks from baseline) visit. RESULTS: At baseline the mean age, duration of diabetes and mean BMI were 55.3 ± 8.5 years, 5.9 ± 4.0 years and 24 ± 3.6 kg/m(2), respectively. Of these patients, 78% were insulin-naive and 22% were prior insulin users. Glycaemic control was poor at baseline. After 24 weeks, significant reductions were observed in mean HbA1c (2.2%, p < 0.001), fasting plasma glucose (90.0 mg/dL, p < 0.001) and postprandial plasma glucose (115.4 mg/dL, p < 0.001) levels, in the entire cohort. Similar significant reductions were also seen in insulin-naive patients and prior insulin users. In the entire cohort, 32.5% patients achieved HbA1c levels <7.0% while 32.0% insulin-naive patients and 33.9% prior insulin users achieved this target after 24 weeks. No hypoglycaemic events were reported in the entire cohort. Modest increase in body weight was noted in the insulin-naive group, while mean body weight decreased in prior insulin users after 24 weeks of insulin detemir therapy. CONCLUSION: This sub-analysis suggests that insulin detemir can be a safe and effective option for initiating insulin therapy in people with T2D in Indonesia.

Clinical experience with BIAsp 30: results from the Indonesian cohort of the international A1chieve study.

AIM: To evaluate the safety and effectiveness of biphasic insulin aspart 30 (BIAsp 30) in Indonesian patients with type 2 diabetes (T2D) as part of the 24-week, international, prospective, non-interventional A1chieve study. METHODS: Indonesian patients who started BIAsp 30 were included. Safety and efficacy was measured as part of routine clinical practice at baseline, Week 12 and Week 24. RESULTS: Overall, 1324 patients having a mean ± SD age, duration of diabetes and body mass index of 55.2 ± 9.9 yrs, 6.8 ± 5.2 yrs and 24.1 ± 3.6 kg/m(2), respectively, were enrolled. 67% of patients were insulin-naive and 33% were prior insulin users. Glycaemic control was poor at baseline. After 24 weeks, significant reductions from baseline were observed in the mean glycated haemoglobin A1c (HbA1c) (-2.6%), fasting plasma glucose (-93.8 mg/dL) and postprandial plasma glucose (-134.8 mg/dL) levels in the entire cohort (p < 0.001). Significant reductions were also seen in insulin-naive patients and prior insulin users. At Week 24, 29.9% of patients in the entire cohort achieved target HbA1c level of <7.0%, while 26.7% and 39.2% achieved this target among insulin-naive patients and prior insulin users, respectively. The proportion of patients reporting overall hypoglycaemia significantly decreased in the entire cohort after 24 weeks of BIAsp 30 therapy. A small significant increase in body weight was noted in the entire cohort, insulin-naive patients and prior insulin users. CONCLUSION: The current study suggests that BIAsp 30 can be considered as a safe and effective option for initiating as well as intensifying insulin therapy in Indonesian patients with T2D.

Leptin, adiponectin and resistin concentration in obesity class I and II at Sardjito Hospital Yogyakarta.

AIM: to determine the level of different concentration of leptin, adiponectin and resistin among obesity class I and class II population. METHODS: cross sectional study was conducted from June 2006 until January 2007 on 57 patients with obese diabetic and non diabetic Native Javanese. They were divided into obese class I (body mass index [BMI] >25 kg/m2 to <30 kg/m2) and obese class II (BMI >30 kg/m2). Leptin, adiponectin and resistin level concentration were measured. RESULTS: leptin concentration in obese class I was 13.998 +/- 13.486 ng/ml; adiponectin was 3.98 +/- 1.78 microg/ml; resistin were 25.676 +/- 13.434 ng/ml. Leptin concentration in obese class II 31,074 +/- 26,158 ng/ml; adiponectin 4.75 +/- 1.88 microg/ml; resistin 25.46 +/- 12.26 ng/ml. Leptin concentration was significantly higher in obese class II than obese class I (p=0,002) and there was a positive weak correlation between BMI and leptin level, with Spearman correlation {coefficient correlation 0.363 (p=0.006)}. Adiponectin and resistin concentration was not significantly higher in obese class II than obese class I (p=0.156 and p=0.956). CONCLUSION: leptin concentration in obese class II was significantly higher than in obese class I but adiponectin and resistin were not different.

ACE gene insertion/deletion polymorphism among patients with type 2 diabetes, and its relationship with metabolic syndrome at Sardjito Hospital Yogyakarta, Indonesia.

AIM: To know the frequencies of insertion/deletion polymorphism in the angiotensin-converting enzyme (ACE) gene among patients with type 2 diabetes and its relationship with metabolic syndrome at Sardjito Hospital Yogyakarta. METHODS: We examined 69 patients with type 2 diabetes at Sardjito Hospital Yogyakarta, divided 2 groups based on ATP III criteria of metabolic syndrome. To determine the ACE genotype of the patients, a genomic DNA fragment on intron 16 of the ACE gene was amplified by polymerase chain reaction (PCR) using a forward primer 5'-CTG GAG ACC ACT CCC ATC CTT TCT-3' and reverse primer 5'-GAT GTG GCC ATC ACA RTC GTC AGA T-3'. II genotype 1 band on 490 bp (homozigot), DD genotype 1 band on 190 bp (homozigot) and ID genotype 2 band (heteroduplex) on 490 bp and 190 bp were separately detected on a 3% agarose gel containing ethidium bromide. RESULTS: Of 69 patients with type 2 diabetes, there were 51 females (73.91%) and 18 males (26.09%). Subjects with metabolic syndrome were 49 patients (71.02%) while without metabolic syndrome were 20 patients (28.98%). Subjects with II, DD, ID genotype were 57.97%, 23.19% and 18.84% respectively. The male subjects with II, DD, ID genotype were 55.56%, 27.78% and 16.67% respectively, and the female subject II, DD ID genotype were 58.82%, 21.57% and 19.61% respectively. The association between ACE I/D polymorphism and metabolic syndrome in type 2 diabetes, was not significant (p=0.204). CONCLUSION: The frequency of ACE I/D polymorphism among type 2 diabetes are 57.97% II, 23.19% DD, 18.84% ID. There is no association between metabolic syndrome and the component of metabolic syndrome and varians of the ACE gene among the type 2 diabetes patients.