A prospective, longitudinal, multicenter, observational study to assess insulin treatment patterns in diabetic patients in Thailand: Results from the TITAN study

Abstract

© 2014, Medical Association of Thailand. All rights reserved. Objective: To assess usage patterns, effectiveness, and safety of newly prescribed insulin treatment in patients with diabetes in Thailand. Material and Method: Type 1 or type 2 diabetes mellitus patients who failed achievement of HbA<inf>1c</inf> <7%, and were about to start or switch to a new insulin treatment were enrolled into this prospective, longitudinal, multicenter, observational study. Data regarding insulin usage pattern, HbA<inf>1c</inf>, fasting plasma glucose (FPG), and hypoglycemia were collected at enrollment, three and six-month. Results: Between July 2008 and February 2010, 751 patients were recruited. Mean (SD) age was 57.0 (12.8) years. Mean BMI was 26.1 (5.0) kg/m². At enrollment, 269 (35.8%), 241 (32.1%), 206 (27.4%), and 35 (4.7%) patients were prescribed neutral protamine Hagedorn (NPH) insulin, long-acting insulin analogues (LAA), premixed insulin (Premixed), and insulin combinations, respectively. Significant HbA<inf>1c</inf> and FPG reductions were noted at six-month (-1.4% and -56.2 mg/dl, respectively, p<0.01). After stratifying patients into three subgroups according to insulin, the patients could continue throughout six months (588 patients, 211 NPH-group, 201 LAA-group, and 176 Premixed-group). Patients in LAA-group attained higher rate of achievement HbA<inf>1c</inf> <7% without any hypoglycemia (18.9%) than NPH-group (7.1%) and Premixedgroup (6.3%; p<0.001). Mild-to-moderate hypoglycemic events were reported at 638 events (1.9 events/patient-year) while severe hypoglycemia was reported at 10 events (3.0 event/100 patient-year). Conclusion: In this observational study of real-life clinical practice in Thailand, most common newly prescribed insulin for patients having inadequate glycemic control was NPH, followed by LAA and premixed insulin. More patients on LAA achieved target HbA<inf>1c</inf> without hypoglycemic events than those on NPH and premixed insulin.