Basal insulin therapy: Unmet medical needs in Asia and the new insulin glargine in diabetes treatment

Abstract

Diabetes remains a global epidemic and a tremendous health challenge, especially in the Asian population. Dramatic increases in the prevalence of diabetes across different countries or areas in Asia have been reported in recent epidemiological studies. Although clinical guidelines have strengthened appropriate antihyperglycemic medications and lifestyle modifications for optimal diabetes management, inadequate glycemic control still occurs in many patients with an increased risk of developing microvascular and macrovascular complications. Insulin administration is the main therapy for diabetes in response to the inability to secrete insulin, and is recommended in current guidelines to treat patients with type 2 diabetes after failure of oral antidiabetic drugs. Clinical studies have shown that long‐acting insulin analogs improve basal glycemic control with reduced risk of hypoglycemia. In the present review, we discuss previous challenges with basal insulin therapy in Asia, the pharmacological development of insulin analogs to overcome the unmet medical needs and recent clinical studies of the new ultra‐long‐acting insulin analog, insulin glargine U300. Furthermore, relevant findings of current real‐world evidence are also included for the comparison of the efficacy and safety of different insulin formulations. Based on the accumulating evidence showing a low incidence of hypoglycemia and technical benefits of dose titration, treatment with glargine U300 can be a promising strategy for Asian diabetes patients to achieve glycemic targets with favorable safety.

Efficacy and safety of insulin glargine 300 U/mL versus insulin glargine 100 U/mL in Asia Pacific insulin‐naïve people with type 2 diabetes: The EDITION AP randomized controlled trial

“…Fear of hypoglycaemia is a barrier to insulin initiation and optimal titration in insulin‐naïve people with T2D . Delay in insulin initiation, suboptimal titration and poor glucose control are issues in the treatment of diabetes in Asia as in other regions . The ORBIT real‐world evidence study showed that ~50% of patients did not have their insulin dose up‐titrated within the first 3 months after starting insulin therapy .…”

“…29 Delay in insulin initiation, suboptimal titration and poor glucose control are issues in the treatment of diabetes in Asia as in other regions. 11 The ORBIT real-world evidence study showed that 50% of patients did not have their insulin dose up-titrated within the first 3 months after starting insulin therapy. 12 Early glycaemic control increases the likelihood of achieving targets in the longer term, 28 and promotes improved glycaemic outcomes in the longer term.…”

“…However, some people delay initiating insulin therapy because of a variety of patient and physician barriers, including fear of hypoglycaemia, burdensome regimens, and insufficient access and/or communication with a general practitioner . The majority of people with T2D in China delayed initiation of basal insulin, and had at initiation a mean HbA1c of 9.6% (81 mmol/mol) . Barriers can also cause individuals to discontinue basal insulin treatment regimens .…”

Real‐world data reveal unmet clinical needs in insulin treatment in Asian people with type 2 diabetes: the Joint Asia Diabetes Evaluation (JADE) Register

“…19 We reported that only 10% of patients were treated with a basal-bolus regimen, probably for reasons of patients' acceptability to multiple injections, patients' fear of hypoglycaemia, lack of support systems, and high treatment costs, especially if the treatment is paid out-of-pocket. [27][28][29] The high treatment cost is in part due to the complexity of pricing, procurement, and supply chain of insulin. 28 F I G U R E 3 Modifying effects of gender, young-onset diabetes (YOD), and diabetic kidney disease (DKD) at baseline on the impact of intensive insulin regimens in the entire cohort For each subgroup, the respective reference groups were: premixed -DKD -; basal-bolus -, YOD -; and basal-bolus -, women.…”

“…However, existing evidence has consistently reported a similar efficacy in HbA1c reduction, but with a lower risk of hypoglycaemia with the use of analogues insulin compared to human insulin. 29 Last, we acknowledge limitations inherent in crosssectional surveys that precluded causal inference.…”