Expert Opinion on Diabetes Management Challenges and Role of Basal Insulin/GLP-1 RA Fixed-Ratio Combination in People with Type 2 Diabetes from Indonesia

Abstract

Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.

Review of the Case Reports on Metformin, Sulfonylurea, and Thiazolidinedione Therapies in Type 2 Diabetes Mellitus Patients

“…The main side effects of sulfonylureas are a higher risk of hypoglycemia and weight gain [ 26 ]. The increase in BW is associated with the anabolic effect of higher insulin levels and the decrease in glycosuria [ 14 , 15 ]. Several cases of the use of sulfonylureas in DM patients are summarized in Table 1 .…”

“…T2DM is a metabolic and endocrine disorder initiated by complex interactions between genetic factors, unhealthy lifestyle, and pancreatic β-cell dysfunction, along with other endocrine abnormalities [ 10 , 11 , 12 ]. T2DM is always associated with IR, a condition whereby pancreatic β-cells fail to compensate for insulin [ 13 , 14 , 15 ], leading to a continuous increase in blood glucose; thus, the demand for more insulin release is needed [ 3 , 16 ]. The distorted function of insulin induces the elevation of lipogenesis but fails to inhibit gluconeogenesis [ 17 ].…”

Asuhan Keperawatan Pada Ny.N. dengan Gangguan Sistim Rndokrin: DM Tipe II di Ruang Perawatan St. Markus Rumah Sakit Santo Antonius Pontianak 2021

“…Studi kasus ditemukan bahwa klien mengalami diabetes mellitus tipe II. Sedangkan pada teori penyakit diabetes melitus dapat diklasifikasikan menjadi beberapa bagian, yakni: diabetes melitus tipe I, diabetes melitus tipe II, diabetes melitus tipe lain dan diabetes mellitus gestasional (Soelistijo, Novida, Rudijanto, Soewondo, Suastika, Manaf & Zufry, 2015). Tetapi dalam pengkajian di dapat bahwa pasien mengalami diagnosa medis tergolong diabetes melitus tipe II berdasarkan pengkajian anamnesa di dapat pasien mengatakan saya diusia 40 tahun lalu mempunyai riwayat penyakit diabetes.…”

Caring for Patients with Type II Diabetes Mellitus: A Nursing Case Report

“…In year 2015 Indonesian Endocrinology Association (PERKENI) diagnostic criteria for DM: blood glucose levels >200 mg/dl and/or fasting blood glucose values >126 mg/dl (Soelistijo et al, 2015). Glucose is formed in the liver from the food been consumed.…”

“…The detriment happens as insulin secretion is insuffcient due to injury to a little or bigger part of the β cells of the islets of Langerhans which act to make insulin, as a result insulin will suffer a drop and deficiency. High blood glucose levels then lead to a variety of health complications that impair the quality of life in those with DM (Soelistijo et al, 2015). Several signs and symptoms that can be observed in patients with DM are but not limited to: increased urine frequency (polyuria), excessive thirst (polydipsia), increased hunger (polyphagia), fatigue and drowsiness, and decreased body weight (Farrell & Dempsey, 2010).…”