Use of basal insulin in the management of adults with type 2 diabetes: An Asia-Pacific evidence-based clinical practice guideline |
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Authors: | Linong Ji Yingying Luo Yong Mong Bee Jun Xia Khue Thy Nguyen Weigang Zhao Liming Chen Siew Pheng Chan Chaicharn Deerochanawong Soo Lim Daisuke Yabe Margaret McGill Ketut Suastika Xiaoying Li Alice Pik Shan Kong Wei Chen Zhan Zhao Chenchen Xu Marisa Deodat Xiaomei Yao |
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Institution: | 1. Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China;2. Department of Endocrinology, Singapore General Hospital, Singapore, Singapore;3. Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Zhejiang, China;4. Ho Chi Minh University of Medicine and Pharmacy Medic Medical Center, Ho Chi Minh City, Vietnam;5. Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China;6. Chu Hsien-I Memorial (Metabolic Diseases) Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China;7. Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;8. College of Medicine, Rangsit University, Bangkok, Thailand;9. Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea;10. Departments of Diabetes, Endocrinology and Metabolism/Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu, Japan;11. Diabetes Centre, Royal Prince Alfred Hospital, Faculty of Medicine and Health University of Sydney, Sydney, Australia;12. Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Udayana University, Prof. IGNG Ngoerah Hospital, Denpasar, Indonesia;13. Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China;14. Division of Endocrinology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China;15. Department of Clinical Nutrition, Department of Health Medicine, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China;16. Tianjin Tiantian Biotechnology Co., Ltd, Tianjin, China;17. Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada;18. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada |
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Abstract: | The objective of this study was to provide recommendations regarding effectiveness, safety, optimal starting dose, optimal maintenance dose range, and target fasting plasma glucose of five basal insulins (glargine U-300, degludec U-100, glargine U-100, detemir, and insulin protamine Hagedorn) in insulin-naïve adult patients with type 2 diabetes in the Asia-Pacific region. Based on evidence from a systematic review, we developed an Asia-Pacific clinical practice guideline through comprehensive internal review and external review processes. We set up and used clinical thresholds of trivial, small, moderate, and large effects for different critical and important outcomes in the overall certainty of evidence assessment and balancing the magnitude of intervention effects when making recommendations, following GRADE methods (Grading of Recommendations, Assessment, Development, and Evaluation). The AGREE (Appraisal of Guidelines, Research and Evaluation) and RIGHT (Reporting Items for practice Guidelines in HealThcare) guideline reporting checklists were complied with. After the second-round vote by the working group members, all the recommendations and qualifying statements reached over 75% agreement rates. Among 44 contacted external reviewers, we received 33 clinicians' and one patient's comments. The overall response rate was 77%. To solve the four research questions, we made two strong recommendations, six conditional recommendations, and two qualifying statements. Although the intended users of this guideline focused on clinicians in the Asia-Pacific region, the eligible evidence was based on recent English publications. We believe that the recommendations and the clinical thresholds set up in the guideline can be references for clinicians who take care of patients with type 2 diabetes worldwide. |
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Keywords: | Asia-Pacific region basal insulin clinical thresholds evidence-based clinical practice guideline systematic review type 2 diabetes 亚太地区 基础胰岛素 临床阈值 循证临床实践指南 系统回顾 2型糖尿病 |
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