A prospective study in insulin regimen de-escalation from multiple daily injection in patients with poorly controlled Type 2 Diabetes Mellitus
https://doi.org/10.15605/jafes.041.S1
- Author:
Yik Hin Chin
1
;
Xun Ting Tiong
2
;
Noor Lita Adam
3
;
Subashini Rajoo
4
;
Chin Voon Tong
5
;
Miza Hiryanti Binti Zakaria
6
;
Daanisha Nayar
1
;
Sze Wei Lim
1
;
Siew Hui Foo
1
Author Information
1. Endocrine Unit, Hospital Selayang
2. Clinical Research Centre, Sarawak General Hospital, Institute for Clinical Research
3. Endocrine Unit, Hospital Tuanku Jaafar Seremban
4. Endocrine Unit, Hospital Kuala Lumpur
5. Endocrine Unit, Institut Endokrin, Hospital Putrajaya
6. Endocrine Unit, Hospital Sultanah Maliha
- Publication Type:Journal Article
- MeSH:
Diabetes Mellitus, Type 2;
Prospective Studies;
Insulins
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):5-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Multiple daily insulin injections, while effective for glycemic control, impose considerable costs on healthcare systems
and carry inherent risks including hypoglycemia, weight gain, and poor treatment adherence. This study evaluates the
glycemic effects of insulin regimen de-escalation from multiple daily injections in poorly controlled type 2 diabetes mellitus
(T2DM) patients and explores the predictors of successful insulin de-escalation.
Methodology:This is a multi-centred, prospective observational study of adult T2DM patients on multiple daily insulin injections
with hemoglobin A1c (HbA1c) 7–12% who underwent de-escalation to one or two injections. Patients were reassessed
at 3 months and 6 months. Primary endpoint was change in HbA1c from baseline. Secondary endpoints were changes in
body weight, hypoglycemia frequency, treatment adherence and predictors of successful insulin de-escalation defined
by at least a 0.3% reduction in HbA1c while on de-escalated regimen.
Results:A total of 80 patients were included. HbA1c improved from 9.23 to 8.52% (p <0.001) with total daily insulin dose reduction
from 0.81 + 0.35 units per kg to 0.46 + 0.24 units per kg. Symptomatic hypoglycemia decreased from 22.5 to 5.0%. Insulin
adherence improved from 50.0 to 92.3%. Body weight decreased by 1.4 kg. Forty-nine patients (61.3%) were successfully
de-intensified. Factors associated with successful insulin de-escalation included a high baseline HbA1c, high fasting blood
glucose and higher estimated glomerular filtration rate, while increased age, disease duration and being Indian were
associated with unsuccessful insulin de-escalation. After adjustment of the confounders, only HbA1c (OR 2.07, 95% CI
1.23–3.46, p = 0.006) and the status of being Indian (OR 0.21, 95% CI 0.05–0.94, p = 0.041) remained as significant positive
and negative predictors respectively for successful insulin de-intensification.
Conclusion:Insulin regimen de-escalation, when combined with optimized oral glucose-lowering agents, improved glycemic control
and treatment adherence while reducing hypoglycemia and body weight. These findings support insulin therapy deescalation as a safe, effective strategy for poorly controlled T2DM patients taking multiple daily insulin injections.
- Full text:202607280919342249OP_A005.pdf
