A Prospective, Longitudinal, Multicenter, Observational
Study to Assess Insulin Treatment Patterns in Diabetic
Patients in Thailand: Results from the TITAN Study
Petch Rawdaree MD*, Veerasak Sarinnapakorn MD**,
Somchai Pattanaungkul MD***, Weerapan Khovidhunkit MD, PhD****,
Poj Tannirandorn MD*****, Thavatchai Peerapatdit MD******
Affiliation :
* Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
** Diabetes and Endocrinology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine,
Rangsit University, Bangkok, Thailand
*** Division of Endocrinology and Metabolism, Department of Internal Medicine,
Phramongkutklao Hospital, Bangkok, Thailand
**** Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine,
Chulalongkorn University, Bangkok, Thailand
***** Endocrinology Unit, Department of Medicine, Police General Hospital, Bangkok, Thailand
****** Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Objective : To assess usage patterns, effectiveness, and safety of newly prescribed insulin treatment in patients with diabetes
in Thailand.
Material and Method: Type 1 or type 2 diabetes mellitus patients who failed achievement of HbA1c <7%, and were about
to start or switch to a new insulin treatment were enrolled into this prospective, longitudinal, multicenter, observational
study. Data regarding insulin usage pattern, HbA1c, fasting plasma glucose (FPG), and hypoglycemia were collected at
enrollment, three and six-month.
Results : Between July 2008 and February 2010, 751 patients were recruited. Mean (SD) age was 57.0 (12.8) years. Mean
BMI was 26.1 (5.0) kg/m2. At enrollment, 269 (35.8%), 241 (32.1%), 206 (27.4%), and 35 (4.7%) patients were prescribed
neutral protamine Hagedorn (NPH) insulin, long-acting insulin analogues (LAA), premixed insulin (Premixed), and insulin
combinations, respectively. Significant HbA1c and FPG reductions were noted at six-month (-1.4% and -56.2 mg/dl,
respectively, p<0.01). After stratifying patients into three subgroups according to insulin, the patients could continue
throughout six months (588 patients, 211 NPH-group, 201 LAA-group, and 176 Premixed-group). Patients in LAA-group
attained higher rate of achievement HbA1c <7% without any hypoglycemia (18.9%) than NPH-group (7.1%) and Premixed-
group (6.3%; p<0.001). Mild-to-moderate hypoglycemic events were reported at 638 events (1.9 events/patient-year) while
severe hypoglycemia was reported at 10 events (3.0 event/100 patient-year).
Conclusion : In this observational study of real-life clinical practice in Thailand, most common newly prescribed insulin
for patients having inadequate glycemic control was NPH, followed by LAA and premixed insulin. More patients on LAA
achieved target HbA1c without hypoglycemic events than those on NPH and premixed insulin.
Keywords : Hemoglobin A1c, Isophane insulin, Glycemic control, Insulin, Long-acting insulin, Management, Hypoglycemia,
Thailand
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