Patterns and trends in insulin initiation and intensification among patients with type 2 diabetes mellitus in the Western Pacific region.

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.

CREED study: Hypoglycaemia during Ramadan in individuals with Type 2 diabetes mellitus from three continents.

AIMS: To describe diabetes treatment and hypoglycaemia in individuals with Type 2 diabetes mellitus during Ramadan. METHODS: A multi-country, retrospective, observational study with data captured before, during, and after Ramadan. We report on a cohort of people (N=3250) with Type 2 diabetes mellitus in four culturally distinct regions: Asia, North Africa, Europe, and the Middle East. RESULTS: During Ramadan, the proportion of participants on oral anti-diabetic medication alone ranged from 68.4% (Middle East) to 80.5% (Asia); the proportion on insulin alone ranged from 3.7% (Middle East) to 8.6% (Europe). The average number of days fasted for individuals with an American Diabetes Association (ADA) risk status of very high was 27 (Middle East), 25.7 (Asia), 25.4 (North Africa), and 21 (Europe). The incidence of hypoglycaemia according to an ADA risk status of very high was 5.6% (n=1/18, Europe), 6.1% (n=2/33, Middle East), 8.7% (n=4/46, Asia), and 38% (n=10/26, North Africa). The incidence of hypoglycaemia, during Ramadan, for the entire cohort was 16.8% with insulin treatment and 5.3% with oral anti-diabetic medication. Having an episode of hypoglycaemia before Ramadan was associated with hypoglycaemia during Ramadan (odds ratio 7.80; 95% confidence interval 5.31-11.45). CONCLUSIONS: Approaches to the management of Type 2 diabetes mellitus during Ramadan varied across regions. Episodes of hypoglycaemia and insulin therapy predicted risk of hypoglycaemia during Ramadan and identified individuals who required Ramadan-specific education.

Evaluating preferences for profiles of glucagon-like peptide-1 receptor agonists among injection-naive type 2 diabetes patients in Japan.

OBJECTIVE: The objective of this study was to use a discrete choice experiment (DCE) to estimate patients' preferences for the treatment features, safety, and efficacy of two specific glucagon-like peptide-1 receptor agonists, dulaglutide and liraglutide, among patients with type 2 diabetes mellitus (T2DM) in Japan. METHODS: In Japan, patients with self-reported T2DM and naive to treatment with self-injectable medications were administered a DCE through an in-person interview. The DCE examined the following six attributes of T2DM treatment, each described by two levels: "dosing frequency", "hemoglobin A1c change", "weight change", "type of delivery system", "frequency of nausea", and "frequency of hypoglycemia". Part-worth utilities were estimated using logit models and were used to calculate the relative importance (RI) of each attribute. A chi-square test was used to determine the differences in preferences for the dulaglutide versus liraglutide profiles. RESULTS: The final evaluable sample consisted of 182 participants (mean age: 58.9 [standard deviation =10.0] years; 64.3% male; mean body mass index: 26.1 [standard deviation =5.0] kg/m(2)). The RI values for the attributes in rank order were dosing frequency (44.1%), type of delivery system (26.3%), frequency of nausea (15.1%), frequency of hypoglycemia (7.4%), weight change (6.2%), and hemoglobin A1c change (1.0%). Significantly more participants preferred the dulaglutide profile (94.5%) compared to the liraglutide profile (5.5%; P<0.0001). CONCLUSION: This study elicited the preferences of Japanese T2DM patients for attributes and levels representing the actual characteristics of two existing glucagon-like peptide-1 receptor agonists. In this comparison, dosing frequency and type of delivery system were the two most important characteristics, accounting for >70% of the RI. These findings are similar to those of a previous UK study, providing information about patients' preferences that may be informative for patient-clinician treatment discussions.

Glycemic Control in Chinese Patients with Type 2 Diabetes Mellitus Receiving Oral Antihyperglycemic Medication-Only or Insulin-Only Treatment: A Cross-Sectional Survey.

INTRODUCTION: The primary aim of this analysis was to explore whether glycemic control (glycated hemoglobin [HbA1c] <7%) and the incidence of hypoglycemia are different between Chinese patients with type 2 diabetes mellitus (T2DM) receiving oral antihyperglycemic medication (OAM)-only or insulin-only regimens. METHODS: Physicians in nine Chinese cities completed surveys (Adelphi Real World Diabetes Disease Specific Programme) from October 2011 to March 2012. Key information collected included patients' demographic and clinical characteristics, HbA1c levels, and hypoglycemia incidence. Patients receiving OAM-only (n = 1077) or insulin-only (n = 292) regimens for ≥6 months who had most recent HbA1c results available and measured within 3 months of survey completion were included. The primary and secondary outcomes were glycemic control and the incidence of hypoglycemia. Primary (multivariate logistic regression analysis with adjustment for potential confounders) and sensitivity analyses (propensity score matching method) were performed. RESULTS: A higher proportion of patients in the insulin-only group achieved glycemic control than patients in the OAM-only group (41.8% vs 35.9%). Insulin-only treatment was associated with significantly (P = 0.013) better glycemic control than OAM-only treatment (odds ratio [95% confidence interval]: 1.48 [1.09, 2.01]). A higher proportion of patients in the insulin-only group experienced hypoglycemia (overall) than patients in the OAM-only group (33.3% vs 14.4%). Insulin-only treatment was associated with significantly (P < 0.001) increased overall hypoglycemia compared with OAM-only treatment (odds ratio [95% confidence interval]: 2.38 [1.72, 3.29]). Sensitivity analysis results were consistent with the primary analysis results. CONCLUSIONS: The results of this analysis provide important real-world information on glycemic control and hypoglycemia in Chinese patients with T2DM, which may be useful for guiding evidenced-based management. Notably, Chinese patients with T2DM receiving OAM-only had poorer glycemic control compared with those receiving insulin-only therapy, although patients receiving OAM-only were less likely to experience hypoglycemic events.

Increasing body mass index identifies Chinese patients with type 2 diabetes mellitus at risk of poor outcomes.

AIMS: Association between body mass index (BMI) and glycemic control, comorbidities/complications, and health-related quality of life (HRQoL) was assessed in Chinese patients with type 2 diabetes mellitus (T2DM) enrolled in the Diabetes Disease Specific Programme. METHODS: Surveys of 200 physicians and 2052 patients with T2DM captured demographic, clinical, and HRQoL information. Adjusted and unadjusted analyses were conducted across 3 BMI groups; normal (18.5-<24.0, n=998), overweight (24.0-<28.0, n=822), and obese (≥28.0, n=212). RESULTS: There were no between group differences in the achievement of glycated hemoglobin (HbA1c) <7.0% (48mmol/mol); however, compared with the normal BMI group, more obese patients had an HbA1c >9.0% (75mmol/mol; 4.3% vs 10.2%, P=0.002). More obese patients compared with normal BMI patients had hypertension (48.6% vs 35.3%, P<0.001), dyslipidemia (35.4% vs 18.8%, P<0.001), or both hypertension and dyslipidemia (24.1% vs 13.9%, P<0.001). Patients in the obese group reported worse HRQoL and greater effects of diabetes on their daily living. CONCLUSIONS: Obesity in Chinese patients with T2DM results in poor glycemic control, more comorbidities, and worse HRQoL. Management of these patients should include efforts to reduce weight. Selection of weight-neutral or weight-reducing anti-diabetic medications maybe useful in these patients.