Review of insulin‐associated hypoglycemia and its impact on the management of diabetes in Southeast Asian countries

Abstract

Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin‐associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin‐associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations.

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

“…Second, the hypoglycaemia assessment in the JADE Register did not capture data on nocturnal hypoglycaemia, or adjustments of insulin dosages and/or regimens during Ramadan fasting. In view of different clinical needs in this special population, a separate study that focuses on the effects of Ramadan fasting is warranted. Third, given that the present study aimed to quantify the impacts of different types of insulin regimens on glycaemic control, we did not compare the effects of human vs analogue insulin.…”

<p>Dipeptidyl peptidase-4 inhibitors as add-on therapy to insulin in patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials</p>

“…Currently, multiple regimens of insulin injections are applied in clinical practice, such as basal insulin treatment, basal and premeal bolus insulin injections, and premix insulin treatments, and with which, satisfying glycemic control can be achieved in most T2DM patients 8–10. However, insulin treatment is associated with adverse events including gain of body weight (BW) and hypoglycemia, which are related to the increase of the daily insulin dose 11,12. Therefore, exploring an optimized add-on therapy to insulin is of clinical significance for the improvement of glycemic control and reducing the risk of adverse events in T2DM patients with insulin injections.…”

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

“…A suboptimal titration of basal insulins was also shown, as Asian patients with diabetes might have delayed insulin initiation and a higher risk of hypoglycemia. Such ethnic and genetic differences between Asians and Caucasians pose a clinical challenge to deal with the dose adjustment for different insulin needs.…”