Practical Guidance on Basal Insulin Initiation and Titration in Asia: A Delphi-Based Consensus

Area of Science:

• Endocrinology
• Metabolic Diseases
• Pharmacology

Background:

• Diabetes mellitus poses a significant global health challenge, with suboptimal glycemic control persisting in Asian populations despite available treatments.
• Delayed insulin initiation and inadequate titration are key contributors to poor glycemic control in type 2 diabetes mellitus (T2DM).
• Asian patients with T2DM exhibit unique characteristics, including earlier onset and greater glycemic variability, suggesting distinct pathophysiological differences.

Purpose of the Study:

• To develop a simplified, customized basal insulin initiation and titration algorithm for Asian individuals with T2DM.
• To address the complexity of existing guidelines and promote wider adoption by primary care physicians.
• To overcome inertia in insulin initiation and improve therapeutic outcomes in the Asian T2DM population.

Main Methods:

• A consensus-seeking meeting involving 14 experts from seven Asian countries.
• A comprehensive review of existing literature and international/local guidelines on insulin therapy.
• Development of a simplified insulin titration algorithm incorporating physician- and patient-led components.

Main Results:

• A simplified basal insulin titration algorithm tailored for the Asian population with T2DM was proposed.
• The algorithm aims to enhance glycemic control and optimize treatment outcomes.
• Consensus recommendations for basal insulin initiation and titration in the Asian context were established.

Conclusions:

• The proposed simplified algorithm offers a practical approach to basal insulin management for Asian patients with T2DM.
• Customizing insulin titration strategies for the Asian population is crucial for improving glycemic control.
• This unified approach seeks to increase physician confidence and patient engagement in insulin therapy, ultimately reducing treatment inertia.