Chan Siew Pheng, Aamir Azizul Hasan, Bee Yong Mong, Deerochanawong Chaicharn, Paz-Pacheco Elizabeth, Tiu Fatma, Foo Siew Hui, Tan Kevin E K, Le Toan Q, Saraswati Made Ratna, Bunnag Pongamorn, Panusunan Sibarani Roy, Raza Syed Abbas, Tran Nam Quang
Subang Jaya Medical Centre, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Khyber Girls Medical College, Hayatabad Medical Complex, Peshawar, Pakistan.
Diabetes Ther. 2022 Aug;13(8):1511-1529. doi: 10.1007/s13300-022-01286-0. Epub 2022 Jun 29.
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.
糖尿病的全球健康负担正在上升，已影响全球超过5亿人，特别是在国际糖尿病联盟（IDF）的东南亚、北非、非洲以及西太平洋、中东和中南美地区。尽管有许多新的糖尿病治疗方法，但与世界其他地区相比，亚洲的血糖控制仍不理想。胰岛素起始治疗延迟和胰岛素滴定不足被认为是血糖控制不佳的一些重要原因。此外，与非亚洲人群相比，亚洲人群具有独特的表型，包括发病年龄较轻和血糖波动较大，提示β细胞功能较低。尽管有多个关于胰岛素起始治疗和滴定的本地和国际指南，但其中一些指南可能很复杂。对于2型糖尿病（T2DM）亚洲人群，迫切需要简化并定制基础胰岛素起始治疗和滴定的指南建议。统一的方法将增加初级保健和家庭医学医生对基础胰岛素起始治疗的采用，这反过来将有助于减少胰岛素起始治疗的惰性。在此背景下，与来自七个亚洲国家的14位专家举行了一次寻求共识的会议，以确定亚洲背景下胰岛素起始治疗和滴定的适当做法。关键目标是提出一种专门针对亚洲人群的简单胰岛素滴定算法，以改善血糖控制并优化T2DM患者基础胰岛素治疗的疗效。在详细回顾文献、当前指南以及胰岛素起始治疗和滴定的潜在障碍后，专家们提出了一种基于医生和患者主导成分的简化胰岛素滴定算法。本文总结了专家们关于基础胰岛素起始治疗和滴定的共识建议，以及为优化亚洲T2DM人群血糖控制而提出的滴定算法。
