Nearly 12% of adults in China have type-2 diabetes, and fewer than half of them have it well-managed. That makes them good candidates for insulin therapy, especially a type known as basal insulin, which uses long- or intermediate-acting insulin to keep blood sugar levels stable throughout the day. But it hasn’t been clear how useful that treatment is under real-world conditions. Now, a recently completed observational trial in China finds that the therapy successfully lowers blood sugar, although dosing challenges remain.
Researchers recruited nearly 20,000 patients from across China who had been on oral diabetes medications, and were willing to try basal insulin to better control their disease. Because the team wanted to see how well the therapy could work in a realistic setting, each patient worked with his or her own doctor to come up with a personalized plan. Participants were then followed-up at three and six months.
Compared to baseline, patients’ long-term average blood sugar fell by nearly 30% -- without triggering significant weight gain or dangerous drops in blood sugar. This is a huge improvement, and suggests that basal insulin can radically improve how well someone’s diabetes is managed, ultimately reducing the risk of complications like heart and kidney disease or eye problems.
But the study also identified practical concerns that could prevent a person from fully benefiting from the approach. For one, adhering to basal insulin was difficult for about a fifth of people. Many patients found it too taxing to do so many injections, or found it too inconvenient or expensive. Insulin therapy in China is usually only offered at larger medical centers, which are not accessible to much of the population. Glucose monitoring, which is necessary to properly administer insulin, is also pricey, and many Chinese patients are saddled with high out-of-pocket costs.
Finally, even though many patients improved on basal insulin, a majority still did not get to a target blood glucose level, possibly because dosing can be so tricky. Future work on optimizing dosing may make the therapy more effective and attractive for the hundreds of millions suffering from type-2 diabetes in China.