Current insulinization trends in India

Background: Hyperglycemia-associated micro- and macro-vascular complications remain the leading cause of premature morbidity and mortality among the diabetic population worldwide. Poor glycemic control due to clinical inertia towards insulin treatment is a major cause behind the development of diabetic complications. In this paper, we analyze different strategies of insulin treatment initialization and titration practiced in India. Methods: The response of 367 healthcare professionals (HCPs) across the country was recorded based on a survey on demographics, treatment regimens, and patient behavior. For analysis, the responses from HCPs were segregated into six regions, north, south, east, west, and central, covering the entire country. Results: The survey revealed that 59.1% HCPs preferred using three oral anti-diabetic drugs (OADs) before starting insulin therapy while 12.5% initiated insulin as the last option after trying all available OADs. Besides, 61% HCPs across India considered initiating insulin in type 2 diabetes mellitus (T2DM) patients when the patients (i) failed to achieve glycemic targets with current OADs, or (ii) could not tolerate OADs, or (iii) required a more flexible therapy. In T2DM patients, 52.9% HCPs chose basal only insulin during initiation. In comparison, 63.8% HCPs used basal bolus while initiating insulin in type 1 DM (T1DM) patients. Pan-India, 53.4% HCPs preferred analogue premix while 46.6% HCPs opted for human premix. Next, 98.9% HCPs counselled patients about the risk of hypoglycemia upon initiation of insulin. Conclusion: This survey outlines an urgent need of reducing the clinical inertia against insulin initialization in Indian settings.