RSSDI consensus recommendations on insulin therapy in the management of diabetes

Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review

“…Facilitators in this dimension are related to the political and health system level, and include national regulations for medication purchasing, the definition of an essential list of medicines, evidence-based national strategies for control of chronic diseases, national drug policies, and the strengthening of health information systems, which make it possible to link health risks with the availability of drugs, efficient procurement, increased national supply of generic drugs, and distribution systems for pharmaceuticals and regular monitoring of medicine stocks [4,9,39,44,55,56,63,65,72,73,77,80,99,102,123,124,[128][129][130]. Other aspects that facilitate availability are providing education, competencies, and training to health professionals [22,35,86,102,107,111,[131][132][133][134]; easilyaccessible medication dispensing facilities (people's pharmacies, medicine delivered to home, mobile pharmacies in rural settings) [36,43,94,99,113,[134][135][136], and integrated health care programs, which optimize the resources allocated for private health care, to benefit other programs [122,137]. Finally, medical innovation provides more individualized treatment options and treatments adapted to patients…”

“…Is the relationship between price of medicines and the ability of patients to pay. This dimension was divided into five areas: 1) costs of medicines, in which the high price of medicines represents a barrier to access [9, 15, 21-23, 25, 35, 36, 43, 44 implying the postponement of the treatment initiation, interruption/ discontinuity, the use of lower doses or only a part of the prescribed medicines [47,74,89,113,133,150,[188][189][190][191]. 2) Out-of-pocket expenditure, understood as the direct payment for the medicines [4, 9, 21, 37, 41, 42, 44-46, 49, 51, 63, 65, 67, 68, 70, 71, 79, 86-88, 91, 93, 94, 100, 106, 109, 115, 117, 119, 120, 124, 129, 131, 136, 141, 142, 144, 147, 161, 163, 169, 192-203], which is associated with the ability of households to pay for those medicines; therefore, a lack of money is relevant in this context [43,60,69,96,146,172,186,[204][205][206][207], especially considering that paying for medicine can lead households to borrow, sell assets, disregard needs, or even fall into poverty [56,61,72,138,139,189,208,209].…”

“…4) Lack of financial coverage by the health system or private health insurance, which implies that the person must cover the full cost of the required medicines [7, 9, 15, 22, 25, 26, 35, 42, 43, 54, 57, 62, 64, 65, 69, 72, 81, 86, 99, 117, 119-122, 134, 136, 139, 141, 143-145, 157, 158, 160, 161, 164, 166-169, 172, 180, 186, 189, 199, 205, 209-218]. 5) Other considers: cost of elements required for administering the prescribed medicine (e.g., glucometers, strips, syringes) [56,63,74,93,127,132,219], lack of drug price regulation policies and inefficient purchasing by the public sector [35,66,97,99,112,128], cost of consultation or check-up with doctors and specialists [86,91,113,171,191,213], cost of travel time [36,96], sociodemographic characteristics that make it more difficult to afford medications (socioeconomic status, unemployment, age, disability, ethnicity, food insecurity) [65,115,122,133,135,140,172,180,186,195,202,212], among others [9,58,105,121,149,166,218,…”

Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus

“…Insulin is to be initiated at 0.1–0.2 U/kg/day depending on age, comorbidities, and blood glucose levels. Dosage should be adjusted by 2–4 U once or twice weekly, or as clinically indicated, until the FPG target is reached RSSDI [ 46 ] Basal insulin dosage is estimated on the basis of weight and is normally initiated at 10 U or 0.1–0.2 U/kg/day and then uptitrated on the basis of glycemic value, with typical doses ranging from 0.2 to 1.0 U/kg/day ADA American Diabetes Association, FPG fasting plasma glucose, Hb A1c glycated hemoglobin, IDF International Diabetes Federation, OAD oral antidiabetic drug, SGLT2 sodium-glucose cotransporter 2, T2DM type 2 diabetes mellitus, RSSDI Research Society for the Study of Diabetes in India …”

Safety of Insulin Degludec/Insulin Aspart in Patients with Diabetes Mellitus over a Period of 1 Year during Routine Clinical Care in India: SMART (Study of Management of Diabetes with Ryzodeg™ Treatment)

“…Insulin is the mainstay of therapy against type 1 DM (T1DM) and is also necessary for people with type 2 DM (T2DM) under certain circumstances at the diagnosis of T2DM, and particularly following the inability of oral anti-diabetic drugs (OADs) to maintain glycemic control [ 2 , 3 ]. The joint RSSDI-ESI (Research Society for the Study of Diabetes in India—Endocrine Society of India) clinical practice recommendations 2020 suggest that insulin initiation with once-daily co-formulation/premix or basal insulin should be considered if the glycosylated hemoglobin (HbA1c) value is not on target despite three OADs [ 4 ].…”