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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, Obesity and Metabolism ( IF 5.8 ) Pub Date : 2020-01-05 , DOI: 10.1111/dom.13950 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,
Diabetes, Obesity and Metabolism ( IF 5.8 ) Pub Date : 2020-01-05 , DOI: 10.1111/dom.13950 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,
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.
中文翻译:
实际数据揭示了亚洲2型糖尿病患者胰岛素治疗的临床需求未得到满足:《亚洲糖尿病联合评估》(JADE)注册。
目的探讨按性别,新发糖尿病(YOD; 40岁之前诊断)和糖尿病肾病(DKD;估计的肾小球滤过率[eGFR]分层的亚洲2型糖尿病患者的胰岛素使用和血糖控制模式] <60 mL / min / 1.73m2)。材料和方法我们对11个亚洲国家/地区(2007-2017年)的97 852名患者进行了横断面分析,该研究纳入了预期的“亚洲糖尿病联合评估”(JADE)登记册。结果在18 998名胰岛素使用者中(47%为女性,平均±SD年龄为59.2±11.7岁,糖尿病持续时间为13.2±8.3年,糖化血红蛋白[HbA1c] 72±21.4 mmol / mol [8.74±1.95%],平均每日总胰岛素剂量[TDD] 0.27-0.82单位/ kg),YOD和DKD分别为25%和29.5%。预混合胰岛素(44%)和仅基础胰岛素(42%)是最常见的治疗方案。尽管这两种方案均以较高的胰岛素剂量进行更普遍的治疗,但YOD患者的HbA1c水平较迟发的同行患者差(73±20.5 vs. 71±21.2 mmol / mol [8.82±1.87%vs. 8.66±1.94% ]; P <0.001)。HbA1c水平低于53 mmol / mol的女性人数少于男性(7%; 15.7%vs 17.1%; P = 0.018)。调整年龄,糖尿病病程,TDD,HbA1c,eGFR以及在基线时使用口服降糖药后,女性自我报告的低血糖的几率较高(与男性相比:调整后的几率[aOR] 1.16,95%)置信区间[CI] 1.05-1.28)和采用预混合方案治疗的DKD患者(非DKD患者为1.81 [95%CI 1.54-2.13]对比1.34 [95%CI 1.16-1.54];交互作用<0.001)。与仅基础疗法相比,预混和基础推注方案的HbA1c降低量相似,但分别与低血糖几率增加相关(分别为1.65 [95%CI 1.45-1.88]和1.88 [95%CI 1.58-2.23])。结论在这一亚洲人群中,尽管TDDs相对较高,但受性别,DKD和YOD状态的影响,血糖控制欠佳的胰岛素治疗方案存在多种模式。
更新日期:2020-02-04
中文翻译:
实际数据揭示了亚洲2型糖尿病患者胰岛素治疗的临床需求未得到满足:《亚洲糖尿病联合评估》(JADE)注册。
目的探讨按性别,新发糖尿病(YOD; 40岁之前诊断)和糖尿病肾病(DKD;估计的肾小球滤过率[eGFR]分层的亚洲2型糖尿病患者的胰岛素使用和血糖控制模式] <60 mL / min / 1.73m2)。材料和方法我们对11个亚洲国家/地区(2007-2017年)的97 852名患者进行了横断面分析,该研究纳入了预期的“亚洲糖尿病联合评估”(JADE)登记册。结果在18 998名胰岛素使用者中(47%为女性,平均±SD年龄为59.2±11.7岁,糖尿病持续时间为13.2±8.3年,糖化血红蛋白[HbA1c] 72±21.4 mmol / mol [8.74±1.95%],平均每日总胰岛素剂量[TDD] 0.27-0.82单位/ kg),YOD和DKD分别为25%和29.5%。预混合胰岛素(44%)和仅基础胰岛素(42%)是最常见的治疗方案。尽管这两种方案均以较高的胰岛素剂量进行更普遍的治疗,但YOD患者的HbA1c水平较迟发的同行患者差(73±20.5 vs. 71±21.2 mmol / mol [8.82±1.87%vs. 8.66±1.94% ]; P <0.001)。HbA1c水平低于53 mmol / mol的女性人数少于男性(7%; 15.7%vs 17.1%; P = 0.018)。调整年龄,糖尿病病程,TDD,HbA1c,eGFR以及在基线时使用口服降糖药后,女性自我报告的低血糖的几率较高(与男性相比:调整后的几率[aOR] 1.16,95%)置信区间[CI] 1.05-1.28)和采用预混合方案治疗的DKD患者(非DKD患者为1.81 [95%CI 1.54-2.13]对比1.34 [95%CI 1.16-1.54];交互作用<0.001)。与仅基础疗法相比,预混和基础推注方案的HbA1c降低量相似,但分别与低血糖几率增加相关(分别为1.65 [95%CI 1.45-1.88]和1.88 [95%CI 1.58-2.23])。结论在这一亚洲人群中,尽管TDDs相对较高,但受性别,DKD和YOD状态的影响,血糖控制欠佳的胰岛素治疗方案存在多种模式。