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Abstract
Objective: Current and future estimates of the burden of diabetes for the Western Pacific (WP) region are among the highest in the world. Verifying Insulin Strategy and Initial Health Outcome Analysis (VISION) was an 18 month observational study that explored treatment approaches in patients with type 2 diabetes mellitus (T2DM) initiating insulin in the WP region.
Methods: A total of 1065 patients aged ≥18 years with T2DM initiating insulin therapy in normal clinical course were enrolled from Hong Kong, Malaysia, Philippines, Taiwan and Thailand. Participants’ data was recorded by the treating physicians. Patient-reported outcomes (PROs) were assessed using questionnaires completed by participants.
Results: The mean age of patients was 57.2 years with mean glycosylated hemoglobin (HbA1c) of 10.0%. About 66% of patients had an HbA1c ≥9.0% at insulin initiation despite 74% of them being on two or more oral antidiabetic agents at the time of insulin initiation. Basal insulin was initiated in 72% and premixed insulin in 27% of patients. Changes in insulin therapy was observed in 63% of patients and, by the end of study, 28% achieved HbA1c levels of <7.5%. The proportion of patients completely satisfied with their insulin treatment increased over the study course and the quality of life (QoL) score increased from baseline to the study end.
Conclusion: As high HbA1C levels indicate a delayed start of insulin therapy, timely initiation and early intensification of insulin therapy is necessary in the region to achieve adequate glycemic control in time and prevent diabetes complications. Data from PROs suggests that the insulin treatment improves QoL in most patients.
Transparency
Declaration of funding
This observational study was sponsored by Eli Lilly and Company, the manufacturer/licensee of Humalog (insulin lispro) and Humulin (human insulin).
Author contributions: A.J., S.M.B., T.L. and T.T. were involved in the development of the study concept and design. R.Q. performed statistical analyses. A.J., S.M.B., T.L., T.T. and R.Q. interpreted data. C.D., R.M., R.O., W.M. and W.S. were involved in the data acquisition. All authors critically revised and completed the manuscript. All authors have given final approval of the manuscript to be published and agree to be accountable for all aspects of the work.
Declaration of financial/other relationships
T.T., R.Q. and T.L. have disclosed that they are employees and stock- or share-holders of Eli Lilly and company. A.J. and S.M.B. have disclosed that they are former employees of Eli Lilly and Company. W.M. has disclosed that he received payments for clinical trials and lecture honoraria sponsored by Eli Lilly and company. W.S. has disclosed that he has served as advisor and/or speaker for AstraZeneca, Bayer HealthCare, Boehringer Ingelheim Pharmaceuticals, Daiichi-Sankyo, Eli Lilly and Company, Merck Sharp & Dohme, Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals, Novo Nordisk, Pfizer, Sanofi-Aventis and Takeda Pharmaceutical Company. R.M. has disclosed that he has participated at Advisory Boards for Eli Lilly and Company, Novo Nordisk, Astra Zeneca, Merck and Novartis. C.D. and R.O. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.
Acknowledgements
The authors would like to thank all study participants and the 26 investigators who enrolled patients. Medical writing assistance was provided by Doris Hummel PhD, Eli Lilly and Company.
