Safety and Efficacy of Insulin Detemir Among Adult Filipino Patients with Type 2 Diabetes: The Philippine Cohort of the Global A1chieve Study
Objective. To present the results from the Philippine cohort of the A1chieve study receiving insulin detemir (IDet) ± oral antidiabetic drugs.
Methodology. A1chieve is a multinational, 6-month, observational study of 66,726 people with type 2 diabetes mellitus (T2DM), both insulin users and non-insulin users, started on IDet, insulin aspart or biphasic insulin aspart in 28 countries across four continents. This subgroup analysis evaluates the safety and effectiveness of IDet in 988 subjects from the Philippines.
Results. At baseline the mean age, duration of diabetes and mean BMI were found to be 57±11.9 yrs, 6.9±5.3 yrs and 26±4.8 kg/m2 respectively. Majority of subjects were insulin-naive (84.3%) and glycemic control was poor in all the groups at baseline. At the end of 24 weeks, there were significant improvements following IDet initiation with a 2.1% reduction in mean HbA1c. The HbA1c target of <7% was achieved by 46.8% subjects at the study end. Although not statistically significant, there was a modest decrease in body weight in all the groups. There was no increase in the incidence of hypoglycemia among baseline insulin-naive subjects, while a significant reduction in hypoglycemia was seen among prior insulin users.
Conclusions. IDet appears to be an effective and safe option for individuals with T2DM in the Philippines. HbA1C was lowered to target, and there was no increase in incidence of hypoglycemia and body weight with IDet.
Soria ML, Sy RG, Vega BS et al. The incidence of type 2 diabetes mellitus in the Philippines: A 9-year cohort study. Diabetes Res Clin Pract. 2009; 86(2):130-3.
Baltazar JC, Ancheta CA, Aban IB, Fernando RE, Baquilod MM. Prevalence and correlates of diabetes mellitus and impaired glucose tolerance among adults in Luzon, Philippines. Diabetes Res Clin Pract. 2004; 64(2):107-15.
Sy RG, Morales DD, Dans AL et al. Prevalence of atherosclerosis-related risk factors and diseases in the Philippines. J Epidemiol. 2012; 22(5):440-7.
Higuchi M. Access to diabetes care and medicines in the Philippines. Asia Pac J Public Health. 2010; 22(3 Suppl):96S-102S.
John M. Basal insulin analogues--A review of recent data on efficacy and safety. J Assoc Physicians India. 2011; 59 Suppl:25-8.
Peyrot M, Rubin RR, Lauritzen T et al. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care. 2005; 28(11):2673-9.
Shah SN, Litwak L, Haddad J, Chakkarwar PN, Hajjaji I. The A1chieve study: A 60 000-person, global, prospective, observational study of basal, meal-time, and biphasic insulin analogs in daily clinical practice. Diabetes Res Clin Pract. 2010; 88 Suppl 1:S11-6.
Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycaemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012; 55(6):1577-96.
Home P, Naggar NE, Khamseh M et al. An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study. Diabetes Res Clin Pract. 2011; 94(3):352-63.
Philis-Tsimikas A. An update on the use of insulin detemir, with a focus on type 2 diabetes (drug evaluation update). Expert Opin Pharmacother. 2008; 9(12):2181-95.
Chapman TM, Perry CM. Insulin detemir: A review of its use in the management of type 1 and 2 diabetes mellitus. Drugs. 2004; 64(22):2577-95.
Yang W, Zilov A, Soewondo P, Bech OM, Sekkal F, Home PD. Observational studies: Going beyond the boundaries of randomized controlled trials. Diabetes Res Clin Pract. 2010; 88 Suppl 1:S3-9.
Home PD. How can observational trials inform and improve clinical practice? Diabetes Res Clin Pract. 2010; 88 Suppl 1:S1-2.
Stratton IM, Adler AI, Neil HA et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. BMJ. 2000; 321(7258):405–12.
Gough SC, Tibaldi J. Biphasic insulin aspart in type 2 diabetes mellitus: An evidence-based medicine review. Clin Drug Investig. 2007; 27(5):299-324.
Meneghini LF, Rosenberg KH, Koenen C, Merilainen MJ, Lüddeke HJ. Insulin detemir improves glycemic control with less hypoglycemia and no weight gain in patients with type 2 diabetes who were insulin-naive or treated with NPH or insulin glargine: Clinical practice experience from a German subgroup of the PREDICTIVE study. Diabetes Obes Metab. 2007; 9(3):418-27.
Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008; 51(3):408-16.
Swinnen SG, Dain MP, Aronson R et al. A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs. Diabetes Care. 2010; 33(6):1176-8.
Dornhorst A, Lüddeke HJ, Honka M et al. Safety and efficacy of insulin detemir basal-bolus therapy in type 1 diabetes patients: 14-week data from the European cohort of the PREDICTIVE study. Curr Med Res Opin. 2008; 24(2):369-76.
Sharma SK, Al-Mustafa M, Oh SJ et al. Biphasic insulin aspart 30 treatment in patients with type 2 diabetes poorly controlled on prior diabetes treatment: Results from the PRESENT study. Curr Med Res Opin. 2008; 24(3):645-52.
Noh RM, Graveling AJ, Frier BM. Medically minimising the impact of hypoglycemia in type 2 diabetes: A review. Expert Opin Pharmacother. 2011; 12(14):2161-75.
UK Hypoglycemia Study Group. Risk of hypoglycemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007; 50(6):1140-7.
Kontodimopoulos N, Pappa E, Chadjiapostolou Z, Arvanitaki E, Papadopoulos AA, Niakas D. Comparing the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetic complications. Eur J Health Econ. 2012; 13(1):111-20.
Shah S, Zilov A, Malek R, Soewondo P, Bech O, Litwak L. Improvements in quality of life associated with insulin analogue therapies in people with type 2 diabetes: Results from the A1chieve observational study. Diabetes Res Clin Pract. 2011; 94(3):364-70.
Dornhorst A, Lüddeke HJ, Koenen C et al. Transferring to insulin detemir from NPH insulin or insulin glargine in type 2 diabetes patients on basal-only therapy with oral antidiabetic drugs improves glycemic control and reduces weight gain and risk of hypoglycemia: 14-week follow-up data from PREDICTIVE. Diabetes Obes Metab. 2008; 10(1):75-81.
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