Insulin Initiation in Insulin-Naïve Korean Type 2 Diabetic Patients Inadequately Controlled on Oral Antidiabetic Drugs in Real-World Practice: The Modality of Insulin Treatment Evaluation Study

Abstract

BackgroundThe Modality of Insulin Treatment Evaluation (MOTIV) study was performed to provide real-world data concerning insulin initiation in Korean type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with oral hypoglycemic agents (OHAs).MethodsThis multicenter, non-interventional, prospective, observational study enrolled T2DM patients with inadequate glycemic control (glycosylated hemoglobin [HbA1c] ≥7.0%) who had been on OHAs for ≥3 months and were already decided to introduce basal insulin by their physician prior to the start of the study. All treatment decisions were at the physician's discretion to reflect real-world practice.ResultsA total of 9,196 patients were enrolled, and 8,636 patients were included in the analysis (mean duration of diabetes, 8.9 years; mean HbA1c, 9.2%). Basal insulin plus one OHA was the most frequently (51.0%) used regimen. After 6 months of basal insulin treatment, HbA1c decreased to 7.4% and 44.5% of patients reached HbA1c <7%. Body weight increased from 65.2 kg to 65.5 kg, which was not significant. Meanwhile, there was significant increase in the mean daily insulin dose from 16.9 IU at baseline to 24.5 IU at month 6 (P<0.001). Overall, 17.6% of patients experienced at least one hypoglycemic event.ConclusionIn a real-world setting, the initiation of basal insulin is an effective and well-tolerated treatment option in Korean patients with T2DM who are failing to meet targets with OHA therapy.

Effectiveness of Vildagliptin in Clinical Practice: Pooled Analysis of Three Korean Observational Studies (the VICTORY Study)

“…In the present study, patients with better baseline HbA1c and aged < 65 years exhibited better glycemic target achievement at 24 weeks; this could be explained by the shorter duration of diabetes, better self-management, and remaining β -cell function in this group [ 18 , 19 ]. In addition, a larger proportion of patients treated at hospitals achieved the glycemic target compared with those treated at clinics; this may be owing to the comprehensive management by an endocrinology team (including an endocrinologist, nurse, and dietitian) in hospital settings, which was also cited in another Korean study [ 20 ].…”

Proportion and characteristics of patients with Type 2 diabetes mellitus initiating basal insulin therapy using a basal-bolus regimen

“…One study by Kim et al reported that basal-bolus insulin only accounted for 1.6% when initiating BI, (13) whilst another study by Patrick et al reported 13% patients using basal-bolus as the BI initiation regimen. (14) In comparison, patients in the current study had a higher average HbA1c level (9.6%) than Kim et al's study (9.2%), (13) whilst Chinese guidelines recommend initiating BI when HbA1c ≥ 7% after 3 months of OAD treatment. (8) Nevertheless, our study observed a mean diabetes duration of 6.4 years, which was shorter than previous studies ranging from 8.9 to 11.7 years.…”

Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017

“…The progressive nature of T2DM in the deterioration of pancreatic β-cell function was such that after 3 years, approximately 50% of patients could attain glycosylated hemoglobin (HbA1c) below 7% with monotherapy, and by 9 years, this declined to approximately 25% [ 1 ]. Early intensive insulin therapy in patients with newly diagnosed T2DM has favorable outcomes on the recovery and maintenance of β-cell function and protracted glycemic remission compared to treatment with oral hypoglycemic agents (OHAs) [ 3 4 5 6 ]; thus, supporting the rationale for the initiation of insulin therapy in subjects with T2DM whose glycemic targets cannot be achieved with lifestyle modifications and OHAs [ 7 8 ]. The Korean Diabetes Association recommends insulin therapy in two circumstances: timely initial treatment after the diagnosis of T2DM and in cases of OHA failure.…”