Insulin Initiation and Concomitant OHA (Oral Hypoglycaemic Agents) in Treatment of Diabetes Mellitus—Results of the Indian Human Insulin Registry (INHIRIT)

Abstract

INHIRIT is a multi-centric, prospective, open-label, single-arm, observational, naturalistic registry of diabetes mellitus patients in India with the aim of understanding the criteria for insulins initiation in day to day practice. Patients initiated on human insulin were included in the registry during which their glycaemic parameters and body weight was monitored. The commonly used oral antidiabetic drugs (OADs) used along with insulin therapy and the relevance of BMI as a criterion for insulin selection also was evaluated. Results: Of the total 668 patients with insulin initiation data, 62 were treatment-naïve. The mean total daily dose of insulin was 36.8 units/d. The daily insulin dose was higher for HbA1C between 7%-8% (42.03 units/d). The most commonly used OADs with insulin were the DPP-4 inhibitors (59.3%), sulfonylureas (50.6%) and metformin (42.7%). Other OADs used are alpha-glucosidase inhibitors (8.5%), thiazolidinedione’s (7.9%), SGLT inhibitors (1.3%) and other OADs (0.4%). Sulfonylureas used in the decreasing order glimepiride, gliclazide, glimepiride, glibenclamide and glipizide. Voglibose was the widely used alpha-glucosidase inhibitor and dapagliflozin was the commonly used SGLT inhibitor. There was found to be no preference of insulin type in underweight patients. However, more overweight and obese patients received human premix 30/70 compared to other insulin preparations. Conclusion: Our study illustrated the roles that different antidiabetic drugs play in the management of diabetes; chief among them was DPP-4 inhibitors, which represents almost 60% of prescriptions overlapping with insulin and the percentage use of sulfonylurea has decreased. Disclosure V. Karadi: None. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. S.: Employee; Self; Biocon. S. Bose: Employee; Self; Biocon. S.P. Wagh: None. K. Bhattacharjee: Employee; Self; Biocon. S. Anand: None.