Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus
Issued Date
2022-08-01
Resource Type
ISSN
18696953
eISSN
18696961
Scopus ID
2-s2.0-85133156373
Journal Title
Diabetes Therapy
Volume
13
Issue
8
Start Page
1511
End Page
1529
Rights Holder(s)
SCOPUS
Bibliographic Citation
Diabetes Therapy Vol.13 No.8 (2022) , 1511-1529
Suggested Citation
Chan S.P., Aamir A.H., Bee Y.M., Deerochanawong C., Paz-Pacheco E., Tiu F., Foo S.H., Tan K.E.K., Le T.Q., Saraswati M.R., Bunnag P., Panusunan Sibarani R., Raza S.A., Tran N.Q. Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus. Diabetes Therapy Vol.13 No.8 (2022) , 1511-1529. 1529. doi:10.1007/s13300-022-01286-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85682
Title
Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus
Author's Affiliation
Ramathibodi Hospital
University of the Philippines Manila
University of Medicine and Pharmacy at HCMC
Vietnam National University Hanoi
Universitas Udayana
Shaukat Khanum Memorial Cancer Hospital and Research Centre
Khyber Medical College
Rangsit University
Singapore General Hospital
Mount Elizabeth Medical Centre
University of Malaya Medical Centre
Pertamedika Sentul City Hospital
Ateneo de Zamboanga University
Hospital Selayang
National Hospital of Endocrinology
University of the Philippines Manila
University of Medicine and Pharmacy at HCMC
Vietnam National University Hanoi
Universitas Udayana
Shaukat Khanum Memorial Cancer Hospital and Research Centre
Khyber Medical College
Rangsit University
Singapore General Hospital
Mount Elizabeth Medical Centre
University of Malaya Medical Centre
Pertamedika Sentul City Hospital
Ateneo de Zamboanga University
Hospital Selayang
National Hospital of Endocrinology
Other Contributor(s)
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.