Diabetes & Metabolism Journal

Original Article

Clinical Care/Education
Comparison of Antidiabetic Regimens in Patients with Type 2 Diabetes Uncontrolled by Combination Therapy of Sulfonylurea and Metformin: Results of the MOHAS Disease Registry in Korea: Sung Hee Choi, Tae Jung Oh, Hak Chul Jang; Diabetes Metab J. 2017;41(3):170-178. Published online May 11, 2017; DOI: https://doi.org/10.4093/dmj.2017.41.3.170

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Background

The aim of this study was to investigate the glucose-lowering efficacy of antidiabetic treatments in patients with type 2 diabetes mellitus (T2DM) uncontrolled by sulfonylurea plus metformin.

Methods

This open-label, multicenter, prospective, observational study was conducted in 144 centers in Korea, from June 2008 to July 2010, and included patients with T2DM who had received sulfonylurea and metformin for at least 3 months and had levels of glycosylated hemoglobin (HbA1c) >7.0% in the last month. Data of clinical and biochemical characteristics were collected at baseline and 6 months after treatment. The treatment option was decided at the physician's discretion. Subjects were classified into the following three groups: intensifying oral hypoglycemic agents (group A), adding basal insulin (group B), or starting intensified insulin therapy (group C).

Results

Of 2,995 patients enrolled, 2,901 patients were evaluated, and 504 (17.4%), 2,316 (79.8%), and 81 patients (2.8%) were classified into groups A, B, and C, respectively. Subjects in group C showed relatively higher baseline levels of HbA1c and longer duration of diabetes. The mean decrease in HbA1c level was higher in the insulin treated groups (−0.9%±1.3%, −1.6%±1.3%, and −2.4%±2.3% in groups A, B, and C, respectively, P=0.042). The proportion of patients who achieved target HbA1c <7.0% was comparable among the groups; however, intensified insulin therapy seemed to be the most effective in achieving the target HbA1c of 6.5%.

Conclusion

These findings suggest that insulin-based therapy will be an important option in the improved management of Korean patients with T2DM whose glycemic control is not sufficient with sulfonylurea and metformin.

Citations

Citations to this article as recorded by

Metformin-Insulin versus Metformin-Sulfonylurea Combination Therapies in Type 2 Diabetes: A Comparative Study of Glycemic Control and Risk of Cardiovascular Diseases in Addis Ababa, Ethiopia
Desye Gebrie, Tsegahun Manyazewal, Dawit A Ejigu, Eyasu Makonnen
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy.2021; Volume 14: 3345. CrossRef
Insulin Therapy for Adult Patients with Type 2 Diabetes Mellitus: A Position Statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu-Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
Diabetes & Metabolism Journal.2017; 41(5): 367. CrossRef
Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
The Korean Journal of Internal Medicine.2017; 32(6): 947. CrossRef
Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
The Korean Journal of Internal Medicine.2017; 32(6): 967. CrossRef
Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
Diabetes & Metabolism Journal.2017; 41(5): 337. CrossRef
Insulin

Reactions Weekly.2017; 1665(1): 159. CrossRef

Review

Dose Adjustment for Normal Eating: A Role for the Expert Patient?: Harold David McIntyre; Diabetes Metab J. 2014;38(2):87-91. Published online April 18, 2014; DOI: https://doi.org/10.4093/dmj.2014.38.2.87

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Abstract PDF PubReader

The Dose Adjustment for Normal Eating (DAFNE) programme of intensive insulin therapy for type 1 diabetes provides a structured educational intervention to improve glycemic control, reduce hypoglycemia and improve quality of life. Enhancement of self-management skills is a key element of DAFNE and patients acquire detailed skills in insulin dose adjustment. Following DAFNE training, patients report improved confidence in their ability to manage their own insulin dosing, but generally still seek and require the assistance of health professionals when making substantial changes to their insulin regimens. Some DAFNE trained patients may be able to assist their peers in aspects of diabetes management within a group environment, but widespread introduction of the expert patient/peer educator role in the self-management of type 1 diabetes, in particular related to insulin dose management, would require formal and detailed evaluation, preferably in randomized controlled clinical trials, before being introduced into routine clinical practice.

Citations

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Factors Associated With Resilience During Long-Term Hemodialysis
Pedro García-Martínez, Rafa Ballester-Arnal, Kavita Gandhi-Morar, María D. Temprado-Albalat, Eladio Collado-Boira, Carlos Saus-Ortega, Jesús Castro-Calvo
Nursing Research.2023; 72(1): 58. CrossRef
Association Between Management of Continuous Subcutaneous Basal Insulin Administration and HbA1C
Harry Rubin-Falcone, Ian Fox, Emily Hirschfeld, Lynn Ang, Rodica Pop-Busui, Joyce M. Lee, Jenna Wiens
Journal of Diabetes Science and Technology.2022; 16(5): 1120. CrossRef
Perceived Stress in Relation to Quality of Life and Resilience in Patients with Advanced Chronic Kidney Disease Undergoing Hemodialysis
Pedro García-Martínez, Rafael Ballester-Arnal, Kavita Gandhi-Morar, Jesús Castro-Calvo, Vicente Gea-Caballero, Raúl Juárez-Vela, Carlos Saus-Ortega, Raimunda Montejano-Lozoya, Eva María Sosa-Palanca, María del Rosario Gómez-Romero, Eladio Collado-Boira
International Journal of Environmental Research and Public Health.2021; 18(2): 536. CrossRef
Determinants of blood glucose control among people with Type 2 diabetes in a regional hospital in Ghana
Sampson Kafui Djonor, Ignatius Terence Ako-Nnubeng, Ewurama Ampadu Owusu, Kwadwo Owusu Akuffo, Pricillia Nortey, Eldad Agyei-Manu, Anthony Danso-Appiah, Lakshmi Pulakat
PLOS ONE.2021; 16(12): e0261455. CrossRef
Recent advances in type 1 diabetes
Mervyn Kyi, John M Wentworth, Alison J Nankervis, Spiros Fourlanos, Peter G Colman
Medical Journal of Australia.2015; 203(7): 290. CrossRef

Original Article

A Study on Resistance in Type 2 Diabetic Patient Against Commencement of Insulin Treatment.: Sun Hwa Hong, Mi Jin Kim, Sung Gab Noh, Dae Won Suh, Suk Jung Youn, Kwan Woo Lee, Ho Chae Lee, Yang Soo Chung, Hong Ryang Chung, Hyuk Sang Kwon, Bong Yun Cha, Ho Young Son, Kun Ho Yoon; Korean Diabetes J. 2008;32(3):269-279. Published online June 1, 2008; DOI: https://doi.org/10.4093/kdj.2008.32.3.269

2,351 View
48 Download
8 Crossref

Abstract PDF

BACKGROUND
To achieve tight glycemic control in the poorly controlled type 2 diabetic patients with oral hypoglycemic agent, it maybe beneficial to initiate insulin treatment at the early stage. Many patients with type 2 diabetes are often reluctant to begin insulin therapy despite poor glycemic control with oral hypoglycemic agents, this little known phenomenon, often termed 'psychological insulin resistance (PIR)'. This study investigates psychological insulin resistance in Korean patients with type 2 diabetes. METHOD: This study examined a total of 76 type 2 diabetic patients with poor glycemic control during period of April to July 2006. Through questionnaire and telephone survey, total 24 questions were asked about various attitudes on insulin therapy including psychological barriers and patients' acceptance of this treatment. Subjects were asked to allocate points in 5-point scale (from 5 points for 'very true' to 1 point for 'very untrue'). RESULTS: The means of psychological rejection, injection-related anxiety and fear of insulin side effects such as hypoglycemia and weight gain were 3.65 +/- 0.92, 3.17 +/- 0.98 and 2.8 +/- 1.02, respectively. Unwillingness was common in insulin therapy, 67% of patient rejected or was unwilling to take insulin. Main reasons of patients most frequently endorsed beginning insulin indicate that disease is worsening, permanence (once you start insulin you can never quit) and sense of personal failure. Furthermore, study indicates that patients' reasons for avoiding insulin therapy were mainly psychological rejection, which extended far beyond a simple injection related anxiety. CONCLUSION: PIR was psychological reluctance rather than injection related anxiety. To overcome these psychological barriers to insulin treatment, it is necessary to address appropriate diabetes education including training and counseling with excellent interactive communications between patients and clinicians.

Citations

Citations to this article as recorded by

Using Motivational Interviewing to Overcome Psychological Insulin Resistance
Sung-Chul Lim
The Journal of Korean Diabetes.2023; 24(4): 227. CrossRef
Psychological Insulin Resistance: Key Factors and Intervention
Yeon Jeong Jang
The Journal of Korean Diabetes.2021; 22(3): 192. CrossRef
Factors influencing psychological insulin resistance in type 2 diabetes patients
Ji Hyeon Yu, Hye Young Kim, Sung Reul Kim, Eun Ko, Heung Yong Jin
International Journal of Nursing Practice.2019;[Epub] CrossRef
Development of a Psychological Insulin Resistance Scale for Korean Patients with Diabetes
Youngshin Song, Younghee Jeon, Jeonghwa Cho, Bohyun Kim
Journal of Korean Academy of Nursing.2016; 46(6): 813. CrossRef
Patients' perspectives on taking insulin in diabetes - Perspectives of convergence
Youngshin Song, Eunkyong Ah
Journal of Digital Convergence.2016; 14(12): 283. CrossRef
Concept Analysis for Psychological Insulin Resistance in Korean People with Diabetes
Youngshin Song
Journal of Korean Academy of Nursing.2016; 46(3): 443. CrossRef
New Insulin Injection Recommendations
Min Jeong Gu
The Journal of Korean Diabetes.2016; 17(4): 261. CrossRef
Glucose, Blood Pressure, and Lipid Control in Korean Adults with Diagnosed Diabetes
Sun-Joo Boo
Korean Journal of Adult Nursing.2012; 24(4): 406. CrossRef

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