Choice of insulin in type 2 diabetes: A Southeast Asian perspective

Background:International guidelines recommend using local trimester-specific normative data for TSH (thyroid stimulating hormone). However, there are no unified Indian data for the same.Material and Methods:This review collates recently published data from various Indian centres and discusses the state of trimester-specific TSH ranges in the country.Results:The authors describe the strengths and limitations of available data, and support the need for pan-India data.Conclusion:To ensure effective screening and action, harmonized research is necessary to establish national normative data for TSH in India.

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“…One major area of research has the establishment of ethno-specific guidelines in diabetology and obesity. [ 2 3 ]…”

Section: E Thno -S Pecific E mentioning

confidence: 99%

Normative Trimester-Specific Thyroid Function Data from India: The State of the Nation

Kannan

Kalra

2018

Indian J Endocr Metab

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“…7 The Southeast Asia Region faces a diabetes epidemic, too. 10 Of the diabetic population, more than 85% suffer from type 2 diabetes mellitus (T2DM). 11 The prevalence of diabetes in South Asians is four times higher than in any other ethnic group owing to the individual susceptibility to T2DM.…”

Section: Introductionmentioning

confidence: 99%

International evidence-based guidelines on hypertension and type 2 diabetes mellitus: A systematic review

Melichová

Sivčo

Rusňák

et al. 2023

Journal of Public Health Research

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This systematic review provides a high-quality, comprehensive summary of recommendations on hypertension (HT) and type 2 diabetes mellitus (T2DM), accentuating patient blood pressure, HbA1c levels, patterns of drug treatment, management, and screening of these diseases. The overall objective of the review is to support adapting existing clinical practice guidelines in Indonesia, Vietnam, and Myanmar. The database PubMed and the web search engines Google and Google Scholar were searched from October to December 2019 for evidence-based guidelines covering the overall disease management in Europe, the United States of America, and low and middle-income countries (Indonesia, Vietnam, and Myanmar—IVM later on). Nine studies were selected for the review, seven concerning HT and five T2DM. Guidelines in IVM and Europe identified HT as increased blood pressure (BP; ≥140/90 mmHg). IVM guidelines also recommended commencing drug treatment if lifestyle interventions were not successful. Four international HT guidelines recommended monitoring BP every few months, and the other three guidelines gave recommendations based on the patient’s current BP levels. All five T2DM guidelines recommended target HbA1c levels below 7%–6.5%, but only IVM guidelines included re-examination every 3–6 months. Metformin was recommended as the first choice of medical treatment, if not contraindicated. Amid the guidelines’ recommendations, there were no major variations in the Class of recommendation and Level of evidence (except IVM guidelines where COR and LOE were missing). Revision and completion of IVM guidelines by this grading system would enhance evidence-based and informed decisions in clinical care.

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Giving Insulin Is Not a Guessing Game: Insulin Replacement Therapy in Type 2 Diabetes Mellitus

Luna¹,

Mercado-Asis²

2022

JMUST

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In 2021, 537 million adults were living with diabetes. Being a progressive disease, there would eventually be failure of oral hypoglycemic agents (OHA) to maintain good glycemic control and a majority will require insulin. However, optimal glycemic control has not been satisfactory in a significant proportion of patients who were on insulin therapy. Patient factors (eg, awareness, compliance, socioeconomic) have been identified but physician-related factors are as important. These include incorrect choice and inappropriate combination of insulin therapy which could be corrected by making the treatment physiologic. The purpose of this article is to improve management decisions in type 2 diabetes by reviewing its pathophysiology and identifying the optimum insulin regimen that could mimic such. Since eventual beta cell failure is central to its pathophysiology, it is but reasonable to replace insulin by mimicking its physiologic secretion. Hence, the term Insulin Replacement Therapy (IRT) should be utilized. This could be provided by the combination of premix insulin (ie, NPH + regular insulin) and rapid-acting insulin which has been reported to provide an initial 17.5% HbA1c reduction and even 18% reduction on 5-year follow-up providing sustainable control. A stepwise approach is an effective tool for insulin intensification. Hypoglycemia in insulin therapy could be prevented with an appropriate dietary regimen through automatic snacking. Keywords: Insulin replacement therapy, type 2 diabetes mellitus, pathophysiology

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Choice of insulin in type 2 diabetes: A Southeast Asian perspective

Cited by 3 publications

References 20 publications

Normative Trimester-Specific Thyroid Function Data from India: The State of the Nation

Normative Trimester-Specific Thyroid Function Data from India: The State of the Nation

International evidence-based guidelines on hypertension and type 2 diabetes mellitus: A systematic review

Giving Insulin Is Not a Guessing Game: Insulin Replacement Therapy in Type 2 Diabetes Mellitus

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