Current insulinization trends in India

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.

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.

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.

This survey outlines an urgent need of reducing the clinical inertia against insulin initialization in Indian settings.