Back to Journals » Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy » Volume 10

Challenges and unmet needs in basal insulin therapy: lessons from the Asian experience

Authors Chan WB, Chen JF, Goh SY, Vu TTH, Isip-Tan IT, Mudjanarko SW, Bajpai S, Mabunay MA, Bunnag P

Received 1 June 2017

Accepted for publication 6 October 2017

Published 15 December 2017 Volume 2017:10 Pages 521—532


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ming-Hui Zou

Wing Bun Chan,1 Jung Fu Chen,2 Su-Yen Goh,3 Thi Thanh Huyen Vu,4 Iris Thiele Isip-Tan,5 Sony Wibisono Mudjanarko,6 Shailendra Bajpai,7 Maria Aileen Mabunay,7 Pongamorn Bunnag8

1Qualigenics Diabetes Centre, Hong Kong SAR, People’s Republic of China; 2Division of Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Department of Endocrinology, Singapore General Hospital, Singapore; 4Out-patient Department and Department of Internal Medicine, National Geriatric Hospital, Hanoi Medical University, Hanoi, Vietnam; 5Section of Endocrinology, Diabetes and Metabolism, University of the Philippines–Philippine General Hospital, Manila, Philippines; 6Diabetes and Nutrition Centre, Dr. Soetomo Hospital, School of Medicine Airlangga University, Surabaya, Indonesia; 7Sanofi, Singapore; 8Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

Abstract: Basal insulin therapy can improve glycemic control in people with type 2 diabetes. However, timely initiation, optimal titration, and proper adherence to prescribed basal insulin regimens are necessary to achieve optimal glycemic control. Even so, glycemic control may remain suboptimal in a significant proportion of patients. Unique circumstances in Asia (eg, limited resources, management of diabetes primarily in nonspecialist settings, and patient populations that are predominantly less educated) coupled with the limitations of current basal insulin options (eg, risk of hypoglycemia and dosing time inflexibility) amplify the challenge of optimal basal insulin therapy in Asia. Significant progress has been made with long-acting insulin analogs (insulin glargine 100 units/mL and insulin detemir), which provide longer coverage and less risk of hypoglycemia over intermediate-acting insulin (Neutral Protamine Hagedorn insulin). Furthermore, recent clinical evidence suggests that newer long-acting insulin analogs, new insulin glargine 300 units/mL and insulin degludec, may address some of the unmet needs of current basal insulin options in terms of risk of hypoglycemia and dosing time inflexibility. Nevertheless, more can be done to overcome barriers to basal insulin therapy in Asia, through educating both patients and physicians, developing better patient support models, and improving accessibility to long-acting insulin analogs. In this study, we highlight the unique challenges associated with basal insulin therapy in Asia and, where possible, propose strategies to address the unmet needs by drawing on clinical experiences and perspectives in Asia.

Keywords: insulin titration, insulin detemir, insulin glargine, insulin degludec, patient education

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]