Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data

Background: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). Methods: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. Results: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). Conclusion: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers.Centro de Endocrinología Experimental y Aplicad

Challenges associated with insulin therapy progression among patients with type 2 diabetes: Latin American MOSAIc study baseline data

Background: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). Methods: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. Results: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). Conclusion: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers.Centro de Endocrinología Experimental y Aplicad

Comparison of homeostasis model analysis with insulin tolerance test in the assessment of insulin resistance in healthy young people

The aim of this paper was to compare homeostasis model analysis and insulin tolerance test in the assessment of insulin resistance in healthy young people. A cross-sectional study was carried out in 129 healthy non-obese young volunteers. Fasting glucose and serum insulin were measured, homeostasis model analysis calculated and an insulin tolerance test performed. The constant for the rate of serum glucose disappearance calculated with insulin tolerance test was of 4.7 � 0.9%/min and insulin resistance obtained with homeostasis model analysis was of 1.8 � 0.9. Results did not show significant correlation between homeostasis model analysis and insulin tolerance test in the estimation of insulin resistance. In conclusion, the assessment of insulin resistance with homeostasis model analysis was not comparable to that obtained with insulin tolerance test in healthy young people. However, we recommend the use of ITT as a method for estimating insulin resistance in healthy people based on the particular characteristics of this technique

Comparison of homeostasis model analysis with insulin tolerance test in the assessment of insulin resistance in healthy young people

The aim of this paper was to compare homeostasis model analysis and insulin tolerance test in the assessment of insulin resistance in healthy young people. A cross-sectional study was carried out in 129 healthy non-obese young volunteers. Fasting glucose and serum insulin were measured, homeostasis model analysis calculated and an insulin tolerance test performed. The constant for the rate of serum glucose disappearance calculated with insulin tolerance test was of 4.7 ± 0.9%/min and insulin resistance obtained with homeostasis model analysis was of 1.8 ± 0.9. Results did not show significant correlation between homeostasis model analysis and insulin tolerance test in the estimation of insulin resistance. In conclusion, the assessment of insulin resistance with homeostasis model analysis was not comparable to that obtained with insulin tolerance test in healthy young people. However, we recommend the use of ITT as a method for estimating insulin resistance in healthy people based on the particular characteristics of this technique

An algorithm for the treatment of type 2 diabetes in Latin America

Diabetes is a principal and growing health concern in Latin America, accounting for significant mortality and morbidities. Large, randomized, prospective trials of various interventional therapies in patients with both type 1 and type 2 diabetes have demonstrated that reductions in hyperglycaemia and management of diabetes-related risk factors can significantly reduce the micro- and macrovascular complications of diabetes. Therefore, patients with type 2 diabetes will benefit from more aggressive treatment regimens to help decrease the occurrence and rate of progression of diabetic complications. Given the many complexities of diabetes management, it is often difficult for general practice physicians to stay abreast of emerging treatment strategies and therapies. Owing to the high prevalence of type 2 diabetes in Latin America, the majority of patients with diabetes are treated by generalists rather than specialists. This article was intended to assist physicians and other healthcare professionals in developing and using effective treatment strategies to stem the growing epidemic of diabetes and its complications in Latin America.Univ Texas, Med City Dallas Hosp, SW Med Sch, Endocrine & Diabet Associates Texas, Dallas, TX 75230 USAUniversidade Federal de São Paulo, São Paulo, BrazilUniv Chile, Hosp San Juan Dios, Santiago, ChileMexican Inst Social Secur, Guadalajara, Jalisco, MexicoHosp Italiano Buenos Aires, Buenos Aires, DF, ArgentinaUniv So Calif, Los Angeles, CA USAUniv Peruana Cayetano Heredia, Lima, PeruCtr Univ, Fac Med Tampico, Tampico, MexicoUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc