Abstract
Background:The First Basal Insulin Evaluation (FINE) Asia study is a multinational, prospective, observational study of insulin-naïve Type 2 diabetes mellitus (T2DM) patients in Asia, uncontrolled (A1c ≥ 8%) on oral hypoglycemic agents, designed to evaluate the impact of basal insulin initiation.Methods:Basal insulin was initiated with or without concomitant oral therapy and doses were adjusted individually. All treatment choices, including the decision to initiate insulin, were at the physician's discretion to reflect real-life practice.Results:Patients (n= 2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3 ± 6.5 years; weight 68.1 ± 12.7 kg; A1c 9.8 ± 1.6%). After 6 months of basal insulin (NPH insulin, insulin glargine, or insulin detemir), A1c decreased to 7.7 ± 1.4%; 33.7% patients reached A1c <7%. Fasting blood glucose (FBG) decreased from 11.7 ± 3.6 to 7.2 ± 2.5 mmol/L and 36.8% of patients reached FBG <6.1 mmol/L. The mean daily insulin dose prescribed increased marginally from 0.18 to 0.23 U/kg per day at baseline to 0.22–0.24 U/kg per day at Month 6. Mean changes in body weight and reported rates of hypoglycemia were low over the duration of the study.Conclusions:Initiation of insulin therapy is still being delayed by approximately 9 years, resulting in many Asian patients developing severe hyperglycemia. Initiating insulin treatment with basal insulin was effective and safe in Asian T2DM patients in a real-world setting, but insulin needs may differ from those in Western countries.
Highlights
The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide, but the rate of increase is rapid in Asian countries
There were some differences in patient characteristics among groups of patients according to insulin prescribed, including diabetes duration, duration of oral hypoglycemic agents (OHAs) treatment, and Fasting blood glucose (FBG) levels (Table 2), but age and body mass index (BMI) were comparable
The mean (±SD) doses of insulin at baseline were 0.20 ± 0.09 U ⁄ kg for insulin glargine, 0.18 ± 0.11 U ⁄ kg for NPH insulin and 0.23 ± 0.10 U ⁄ kg for a 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd insulin detemir; the type and doses of insulin remained stable at Months 3 and 6 (Table 3)
Summary
The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide, but the rate of increase is rapid in Asian countries. First basal insulinization in Asians repeated across the Asian continent with three- to fivefold increases in the prevalence of T2DM over the past 30 years reported in India, Indonesia, Korea, and Thailand.[4]. Results: Patients (n 1⁄4 2679) from 11 Asian countries were enrolled (mean [±SD] duration of diabetes 9.3 ± 6.5 years; weight 68.1 ± 12.7 kg; A1c 9.8 ± 1.6%). Conclusions: Initiation of insulin therapy is still being delayed by approximately 9 years, resulting in many Asian patients developing severe hyperglycemia. Initiating insulin treatment with basal insulin was effective and safe in Asian T2DM patients in a real-world setting, but insulin needs may differ from those in Western countries
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