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

05 January 2020


Alice P. S. Kong, Thomas Lew, Eric S. H. Lau, Lee‐Ling Lim, Jothydev Kesavadev, Weiping Jia, Wayne H.‐H. Sheu, Leorino Sobrepena, Alexander T. B. Tan, Thy Khue Nguyen, Kun‐Ho Yoon, Ke Wang, Kamlanathan Kodiappan, Tamás Treuer, Juliana C. N. Chan, and on behalf of the JADE Collaborative Study Group

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Abstract

Aims

To explore the pattern of insulin use and glycaemic control in Asian people with type 2 diabetes, stratified by gender, young-onset diabetes (YOD; diagnosed before age 40 years), and diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73m2).

Materials and methods

We conducted a cross-sectional analysis of 97 852 patients from 11 Asian countries/regions (2007–2017) included in the prospective Joint Asia Diabetes Evaluation (JADE) Register.

Results

Among 18 998 insulin users (47% women, mean ± SD age 59.2 ± 11.7 years, diabetes duration 13.2 ± 8.3 years, glycated haemoglobin [HbA1c] 72 ± 21.4 mmol/mol [8.74 ± 1.95%], median total daily insulin dose [TDD] 0.27–0.82 units/kg), 25% and 29.5% had YOD and DKD, respectively. Premixed (44%) and basal-only (42%) insulin were the most common regimens. Despite being more commonly treated with these two regimens with higher insulin dosages, patients with YOD had worse HbA1c levels than their late-onset peers (73 ± 20.5 vs. 71 ± 21.2 mmol/mol [8.82 ± 1.87% vs. 8.66 ± 1.94%]; P < 0.001). Fewer women than men attained an HbA1c level < 53 mmol/mol (7%; 15.7% vs 17.1%; P = 0.018). Adjusting for age, diabetes duration, TDD, HbA1c, eGFR, and use of oral glucose-lowering drugs at baseline, the odds of self-reported hypoglycaemia were higher in women (vs. men: adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.05–1.28) and in patients with DKD treated with a premixed regimen (1.81 [95% CI 1.54–2.13] vs. 1.34 [95% CI 1.16–1.54] in non-DKD; Pinteraction < 0.001). Compared to basal-only regimens, premixed and basal-bolus regimens had similar HbA1c reductions but were independently associated with increased odds of hypoglycaemia (1.65 [95% CI 1.45–1.88] and 1.88 [95% CI 1.58–2.23], respectively).

Conclusions

In this Asian population, there were varying patterns of insulin regimens with suboptimal glycaemic control, despite relatively high TDDs, which were influenced by gender, DKD, and YOD status.

Reference

  1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium: International Diabetes Federation; 2019.
  2. Ohn JH, Kwak SH, Cho YM, et al. 10-year trajectory of beta-cell function and insulin sensitivity in the development of type 2 diabetes: a community-based prospective cohort study. Lancet Diabetes Endocrinol. 2016;4:27–34.
  3. Chan WB, Tong PC, Chow CC, et al. The associations of body mass index, C-peptide and metabolic status in Chinese Type 2 diabetic patients. Diabet Med. 2004;21:349–353.
  4. Yoon KH, Ko SH, Cho JH, et al. Selective beta-cell loss and alpha-cell expansion in patients with type 2 diabetes mellitus in Korea. J Clin Endocrinol Metab. 2003;88:2300–2308.
  5. Yeung RO, Zhang Y, Luk A, et al. Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (JADE programme). Lancet Diabetes Endocrinol. 2014;2:935–943.
  6. Yang C, Lee HK, Kong APS, et al. Early-life exposure to endocrine disrupting chemicals and childhood obesity. Ann Pediatr Endocrinol Metab. 2018;23:182–195.
  7. Chow E, Chan JC. Explaining high prevalence of young-onset diabetes among Asians. Med J Aust. 2017;207:331–332.
  8. Ke C, Lau E, Shah BR, et al. Mental illness and hospitalization in young-onset T2DM. Ann Intern Med. 2019;170(3):145–154.
  9. Ting RZ, Nan H, Yu MW, et al. Diabetes-related distress in Chinese T2DM patients. Diabetes Care. 2011;34:1094–1096.
  10. Chan JC, Lau ES, Luk AO, et al. Premature mortality in young-onset diabetes. Am J Med. 2014;127:616–624.
  11. Huo L, Magliano DJ, Rancière F, et al. Age at diagnosis and mortality in T2DM. Diabetologia. 2018;61:1055–1063.
  12. Zoungas S, Woodward M, Li Q, et al. Age, duration of diabetes and complications risk. Diabetologia. 2014;57:2465–2474.
  13. Luk AO, Li X, Zhang Y, et al. Diabetic kidney disease care in Asia (JADE Registry). Diabet Med. 2016;33:1230–1239.
  14. Kong AP, Xu G, Brown N, et al. Diabetes and comorbidities in East-West populations. Nat Rev Endocrinol. 2013;9:537–547.
  15. Wang J, Zhang L, Tang SC, et al. Chronic kidney disease burden in Asia. Kidney Int. 2018;94:22–25.
  16. Leung CB, Cheung WL, Li PK. Hong Kong renal registry overview. Kidney Int Suppl. 2015;5:33–38.
  17. Tuttle KR, Bakris GL, Bilous RW, et al. Diabetic kidney disease consensus. Diabetes Care. 2014;37:2864–2883.
  18. Chan JCN, Lim LL, Luk AOY, et al. JADE to RAMP-DM program evolution. Diabetes Care. 2019;42:2022–2031.
  19. Davies MJ, D’Alessio DA, Fradkin J, et al. ADA/EASD hyperglycemia consensus. Diabetes Care. 2018;41:2669–2701.
  20. Levey AS, Stevens LA, Schmid CH, et al. eGFR equation. Ann Intern Med. 2009;150:604–612.
  21. Holman RR. Alpha-glucosidase inhibitors in prediabetes. Diabetes Res Clin Pract. 1998;40(Suppl):S21–S25.
  22. Li C, Ford ES, Zhao G, et al. Insulin use trends in US adults. J Diabetes Complications. 2012;26:17–22.
  23. Koye DN, Shaw JE, Reid CM, et al. CKD incidence in diabetes. Diabet Med. 2017;34:887–901.
  24. Kodama K, Tojjar D, Yamada S, et al. Ethnic insulin sensitivity differences. Diabetes Care. 2013;36:1789–1796.
  25. Chantelot JM, Gagliardino JJ, Ilkova H, et al. Insulin discontinuation reasons (IDMPS). EASD Meeting 2018.
  26. Lim LL, Lau ESH, Kong APS, et al. Multicomponent care in diabetes outcomes. Diabetes Care. 2018;41:1312–1320.
  27. Russell-Jones D, Pouwer F, Khunti K. Barriers to insulin therapy. Diabetes Obes Metab. 2018;20:488–496.
  28. Cefalu WT, Dawes DE, Gavlak G, et al. Insulin access and affordability. Diabetes Care. 2018;41:1299–1311.
  29. Tien KJ, Hung YJ, Chen JF, et al. Basal insulin unmet needs in Asia. J Diabetes Investig. 2019;10:560–570.
  30. Kong AP, Yang X, Luk A, et al. Severe hypoglycemia and mortality risk. Diabetes Care. 2014;37:1024–1031.
  31. Zoungas S, Patel A, Chalmers J, et al. Severe hypoglycemia outcomes. N Engl J Med. 2010;363:1410–1418.
  32. Higgins V, Piercy J, Roughley A, et al. Medication trends in T2DM. Diabetes Metab Syndr Obes. 2016;9:371–380.
  33. Arai K, Takai M, Hirao K, et al. Insulin therapy in Japan survey. J Diabetes Investig. 2012;3:396–401.
  34. Snoek FJ, Bremmer MA, Hermanns N. Depression and distress in diabetes. Lancet Diabetes Endocrinol. 2015;3:450–460.
  35. Zhang Y, Ting RZ, Yang W, et al. Depression and adherence in T2DM. J Diabetes. 2015;7:800–808.
  36. Chan JCN, Bunnag P, Chan SP, et al. Insulin glargine response in Asians. Diabetes Res Clin Pract. 2018;135:199–205.
  37. Goh S-Y, Hussein Z, Rudijanto A. Hypoglycemia in Southeast Asia. J Diabetes Investig. 2017;8:635–645.

Cite

Kong APS, Lew T, Lau ESH, et al. Real-world data reveal unmet clinical needs in insulin treatment in Asian people with type 2 diabetes: the Joint Asia Diabetes Evaluation (JADE) Register. Diabetes Obes Metab. 2020;22:669–679. https://doi.org/10.1111/dom.13950

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