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Kalra S, Das AK, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Bajaj S, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel. J Family Med Prim Care 2020; 9:5450-5457. [PMID: 33532378 PMCID: PMC7842427 DOI: 10.4103/jfmpc.jfmpc_843_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Mohali, India
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - S Chandrasekaran
- Department of Endocrinology and Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Nepal
| | - T Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital, Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Galle, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology and Diabetes, Dr. Wiam Clinic, Royal Hospital, Awali Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, UAE
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Kalra S, Ghosh S, Das AK, Nair T, Bajaj S, Priya G, Mehrotra RN, Das S, Shah P, Deshmukh V, Chawla M, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel. Indian Heart J 2020; 72:7-13. [PMID: 32423565 PMCID: PMC7231843 DOI: 10.1016/j.ihj.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022] Open
Abstract
AIM The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.
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Affiliation(s)
- S Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - S Ghosh
- Department of Endocrinology and Metabolism, IPGMER, Kolkata, West Bengal, India
| | - A K Das
- Department of Endocrinology & Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - T Nair
- Dept. of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - S Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - G Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, India
| | - S Das
- Department of Endocrinology, Apollo Hospitals in Bhubaneswar, India
| | - P Shah
- Department of Endocrinology and Diabetes Gujarat Endocrine Centre, Ahmedabad, India
| | - V Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra
| | - M Chawla
- Department of Diabetology, Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | - D Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal
| | - S Chandrasekaran
- Department of Endocrinology & Diabetes, Dr. Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - D Khandelwal
- Department of Endocrinology & Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - A Joshi
- Department of Endocrinology & Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, India
| | - F Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - H Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | - P K Shrestha
- Department of Internal Medicine, Tribhuwan University Teaching Hospital, Kathmandu, Nepal
| | - D Shrestha
- Department of Endocrinologist, Norvic International Hospital Kathmandu, Nepal
| | - S Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Sri Lanka
| | - M Sumanathilaka
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - A Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | - A A Rahim
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - A Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - A Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - W Hussein
- Department of Endocrinology & Diabetes, Royal Hospital, Bahrain
| | - D Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi
| | - K Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Kalra S, Bajaj S, Sharma SK, Priya G, Baruah MP, Sanyal D, Das S, Chaudhury T, Gangopadhyay KK, Das AK, Sethi B, Ayyar V, Shaikh S, Shah P, Jindal S, Deshmukh V, Dave J, Amod A, Joshi A, Pokharel S, Pathan F, Afsana F, Prasad I, Murad M, Soelistijo SA, Purwoto J, Hussein Z, Horn LC, Sahay R, Somasundaram N, Antonypillai C, Sumanathilaka M, Bulugahapitiya U. A Practitioner's Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel. Diabetes Ther 2020; 11:585-606. [PMID: 31981212 PMCID: PMC7048897 DOI: 10.1007/s13300-020-00764-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 11/13/2022] Open
Abstract
AIM To develop an evidence-based expert group opinion on the role of insulin motivation to overcome insulin distress during different stages of insulin therapy and to propose a practitioner's toolkit for insulin motivation in the management of diabetes mellitus (DM). BACKGROUND Insulin distress, an emotional response of the patient to the suggested use of insulin, acts as a major barrier to insulin therapy in the management of DM. Addressing patient-, physician- and drug-related factors is important to overcome insulin distress. Strengthening of communication between physicians and patients with diabetes and enhancing the patients' coping skills are prerequisites to create a sense of comfort with the use of insulin. Insulin motivation is key to achieving targeted goals in diabetes care. A group of endocrinologists came together at an international meeting held in India to develop tool kits that would aid a practitioner in implementing insulin motivation strategies at different stages of the journey through insulin therapy, including pre-initiation, initiation, titration and intensification. During the meeting, emphasis was placed on the challenges and limitations faced by both physicians and patients with diabetes during each stage of the journey through insulinization. REVIEW RESULTS After review of evidence and discussions, the expert group provided recommendations on strategies for improved insulin acceptance, empowering behavior change in patients with DM, approaches for motivating patients to initiate and maintain insulin therapy and best practices for insulin motivation at the pre-initiation, initiation, titration and intensification stages of insulin therapy. CONCLUSIONS In the management of DM, bringing in positive behavioral change by motivating the patient to improve treatment adherence helps overcome insulin distress and achieve treatment goals.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - Sarita Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Surendra Kumar Sharma
- Diabetes, Thyroid and Endocrine Centre, Galaxy Specialty Centre, Jaipur, Rajasthan, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Manash P Baruah
- Department of Endocrinology, Excel Hospital, Guwahati, Assam, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - Tirthankar Chaudhury
- Department of Diabetes and Endocrinology, Apollo Gleneagles Hospital, Kolkata, India
| | - Kalyan Kumar Gangopadhyay
- Department of Diabetology and Endocrinology, Peerless Hospital and B K Roy Research Centre, Kolkata, West Bengal, India
| | - Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Bipin Sethi
- Department of Endocrinology, CARE Hospitals, Hyderabad, Telangana, India
| | - Vageesh Ayyar
- Department of Endocrinology, St John Hospital, Bangalore, Karnataka, India
| | - Shehla Shaikh
- Department of Endocrinology, KGN Institute of Diabetes and Endocrinology, Mumbai, Maharashtra, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Sushil Jindal
- Department of Endocrinology, Peoples Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - Joel Dave
- Department of Endocrinology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Aslam Amod
- Department of Endocrinology, Life Chatsmed Garden Hospital, Durban, South Africa
| | - Ansumali Joshi
- Department of Endocrinology, Kathmandu Diabetes and Thyroid Centre, Kathmandu, Nepal
| | - Sunil Pokharel
- Department of Endocrinology, Alka Hospital, Kathmandu, Nepal
| | - Faruque Pathan
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | - Faria Afsana
- Department of Endocrinology, Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
| | | | - Moosa Murad
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives
| | | | - Johanes Purwoto
- Department of Endocrinology, MRCCC Siloam Hospitals, Jakarta, Indonesia
| | - Zanariah Hussein
- Department of Endocrinology, Putrajaya Hospital, Putrajaya, Malaysia
| | - Lee Chung Horn
- Department of Diabetes and Endocrinology, Gleneagles Medical Centre, Singapore, Singapore
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - Noel Somasundaram
- Department of Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Kalra S, Das AK, Bajaj S, Priya G, Ghosh S, Mehrotra RN, Das S, Shah P, Deshmukh V, Sanyal D, Chandrasekaran S, Khandelwal D, Joshi A, Nair T, Eliana F, Permana H, Fariduddin MD, Shrestha PK, Shrestha D, Kahandawa S, Sumanathilaka M, Shaheed A, Rahim AAA, Orabi A, Al-Ani A, Hussein W, Kumar D, Shaikh K. Utility of Precision Medicine in the Management of Diabetes: Expert Opinion from an International Panel. Diabetes Ther 2020; 11:411-422. [PMID: 31916214 PMCID: PMC6995789 DOI: 10.1007/s13300-019-00753-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 12/16/2022] Open
Abstract
AIM The primary objective of this review is to develop a practice-based expert group opinion on the role of precision medicine with a specific focus on sulfonylureas (SUs) in diabetes management. BACKGROUND The clinical etiology, presentation and complications of diabetes vary from one patient to another, making the management of the disease challenging. The pre-eminent feature of diabetes mellitus (DM) are chronically elevated blood glucose concentrations; however, in clinical practice, the exclusion of autoimmunity, pregnancy, pancreatic disease or injury and rare genetic forms of diabetes is crucial. Within this framework, precision medicine provides unique insights into the risk factors and natural history of DM. Precision medicine goes beyond genomics and encompasses patient-centered care, molecular technologies and data sharing. Precision medicine has evolved in the field of diabetology. It has helped improve the efficacy of SUs, a class of drugs, which have been effectively used in the management of diabetes mellitus for decades, and it has enabled the expansion of SUs use in diabetes patients with genetic mutations. REVIEW RESULTS After due discussions, the expert group analyzed studies that focused on the use of SUs in diabetes patients with genomic variations and rare mutations. The expert group opined that SUs are important glucose-lowering drugs and that precision medicine helps in improving the efficacy of SUs by matching them to those patients who will benefit most. CONCLUSION Precision medicine opens new vistas for the effective use of SUs in unexpected patient populations, such as those with genetic mutations.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
| | - A K Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sarita Bajaj
- Department of Endocrinology, MLN Medical College, Allahabad, Uttar Pradesh, India
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh, Punjab, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Post-Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - R N Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Research Centre, Pune, Maharashtra, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Sruti Chandrasekaran
- Department of Endocrinology and Diabetes, Dr Rela Institute of Medical Science (RIMC), Chennai, Tamil Nadu, India
| | - Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, New Delhi, India
| | - Amaya Joshi
- Department of Endocrinology and Diabetes, Bhaktivedanta Hospital and Research Institute, Mumbai, Maharashtra, India
| | - Tiny Nair
- Department of Cardiology, PRS Hospital, Trivandrum, Kerala, India
| | - Fatimah Eliana
- Department of Internal Medicine, Faculty of Medicine, YARSI University, Jakarta, Indonesia
| | - Hikmat Permana
- Department of Internal Medicine, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - M D Fariduddin
- Department of Endocrinology of Bangabandhu Sheikh, Mujib Medical University, Dhaka, Bangladesh
| | | | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Shayaminda Kahandawa
- Department of Endocrinology, Teaching Hospital Karapitiya, Karapitiya, Galle, Sri Lanka
| | | | - Ahamed Shaheed
- Department of Internal Medicine, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | | | - Abbas Orabi
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Al-Ani
- Department of Internal Medicine, Hamad General Hospital, Doha, Qatar
| | - Wiam Hussein
- Department of Endocrinology and Diabetes, Royal Hospital, Manama, Bahrain
| | - Dinesh Kumar
- Department of Endocrinology, NMC Specialty Hospital, Abu Dhabi, United Arab Emirates
| | - Khalid Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
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Bajaj S, Das AK, Kalra S, Sahay R, Saboo B, Das S, Shunmugavelu M, Jacob J, Priya G, Khandelwal D, Dutta D, Chawla M, Surana V, Tiwaskar M, Joshi A, Shrestha PK, Bhattarai J, Bhowmik B, Latt TS, Aye TT, Vijayakumar G, Baruah M, Jawad F, Unnikrishnan AG, Chowdhury S, Pathan MF, Somasundaram N, Sumanathilaka M, Raza A, Bahendeka SK, Coetzee A, Ruder S, Ramaiya K, Lamptey R, Bavuma C, Shaikh K, Uloko A, Chaudhary S, Abdela AA, Akanov Z, Rodrìguez-Saldaña J, Faradji R, Tiago A, Reja A, Czupryniak L. BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion. Diabetes Ther 2019; 10:1189-1204. [PMID: 31102253 PMCID: PMC6612329 DOI: 10.1007/s13300-019-0629-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.
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Affiliation(s)
- Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, India
| | - A K Das
- Department of Medicine, JIPMER, Puducherry, India
| | - Sanjay Kalra
- Department of Diabetes and Endocrinology, Bharti Hospital, Karnal, India.
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, India
| | - Banshi Saboo
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - M Shunmugavelu
- Trichy Diabetes Speciality Centre (P) Ltd., Trichy, India
| | - Jubbin Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College and Hospital, Ludhiana, India
| | | | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | | | | | - Ameya Joshi
- Bhaktivedanta Hospital and Research Institute, Thane, India
| | | | | | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Than Than Aye
- University of Medicine 2, Myanmar Society of Endocrinology and Metabolism (MSEM), Yangon, Myanmar
| | - G Vijayakumar
- Apollo Specialty Hospital and Diabetes Medicare Centre, Chennai, India
| | | | - Fatema Jawad
- Journal of Pakistan Medical Association, Karachi, Pakistan
| | | | | | - Md Faruqe Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Manilka Sumanathilaka
- National Hospital of Sri Lanka, Sri Lanka College of Endocrinologists, Colombo, Sri Lanka
| | - Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Silver K Bahendeka
- Mother Kevin Postgraduate Medical School, Martyrs University, St. Francis Hospital, Kampala, Uganda
| | - Ankia Coetzee
- Division of Endocrinology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Society for Endocrinology, Diabetes and Metabolism, Cape Town, South Africa
| | - Sundeep Ruder
- Life Fourways Hospital, University of the Witwatersrand, Cape Town, South Africa
| | | | - Roberta Lamptey
- Korle Bu Teaching Hospital, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Charlotte Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Khalid Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Andrew Uloko
- College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Abdurezak Ahmed Abdela
- Department of Internal Medicine, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zhanay Akanov
- Kazakh Society for Study of Diabetes, Almaty, Kazakhstan
| | | | - Raquel Faradji
- Clinica EnDi, RENACED Diabetes Tipo 1, Escuela de Medicina, TEC-ABC, Centro Médico ABC, Sociedad Mexicana de Nutrición y Endocrinología, Mexico City, Mexico
| | - Armindo Tiago
- Mozambican Diabetic Association, Maputo Central Hospital, Maputo, Mozambique
| | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Central University Hospital, Warsaw Medical University, Warsaw, Poland
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