Objective : Background: Insulin plays a key role in T2DM management but unfortunately most of the physicians treat with insulin as the last choice of treatment. Because many patients on insulin often have insulin related issues such as phobia of hypoglycemia, injection, weight gain and most importantly the cost. The purpose of the study was to assess insulin prescription pattern across Apollo Sugar Clinics of India
Methods : A cross-sectional observational retrospective prescription data analysis of T2DM patients initiated on insulin only or in combination with oral hypoglycemic agents screened from Jan 2016 to June 2018. Insulin type and dose information were obtained from the prescription data and glycaemic variables were assessed.
Results : Total 23832 patients on insulin were included in this analysis. Mean age was 55 years, 59% males and 41% females. The mean HbA1c at the time of insulin initiation was 9.4%, fasting blood glucose (FBG) 188mg/dL, post-prandial BG 246 mg/dL, and BMI was 27.7kg/m2. Mean follow-up duration of 116 days, 33% of the patients were adherent to insulin. Of these patients 78.7% of patients were on insulin along with oral hypoglycemic agents, 20.7% were only on insulin and 0.6% were in combination with injectables. Among these majority of the patients were initiated on premix insulin (51%) followed by basal (21%), basal+bolus (12.5%), bolus (10.9%), and ≤2% were other combination of insulins i.e., basal+premix, bolus+premix, and basal+bolus+premix.
Discussion : There was a significant reduction in HbA1c of 0.6%, FBG of 21mg/dL and PPBG of 27mg/dL, in an average duration of 86 days. Among different groups of insulin treatment high reduction in HbA1c was observed on in basal+bolus+premix (1.9%) and basal+premix (0.6%) combination, while in other groups the reduction was similar.
The current study highlights very high premix insulin usage compared to basal and bolus. The insulin treatment patterns reported here represents the real clinical practices followed for diabetes patients in India
Krishna Seshadri– Consultant Endocrinologist, Apollo Sugar Clinics, India
Sambit Das– Endocrinologist and Diabetologist, Apollo Sugar Clinic, Apollo Hospital, Bhubaneswar
Dwarakanath CS– Senior Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, India
Balaji Jaganmohan– Senior Consultant Diabetologist, Apollo Sugar Clinic, Bangalore, India
Venkataraman S– Senior Diabetologist, Apollo Sugar Clinic, Apollo Hospital, Chennai, India
Manikandan RM– Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Madhurai
Narayanan Nk– Endocrinologist, Apollo Sugar Clinic, Apollo Hospital, Chennai
Sanjiv Shah– Senior Endocrinologist, Apollo Sugar Clinics
Vamsi Kolukula– Head Clinical Excellence, Apollo Sugar Clinics Limited
Shashank Joshi– Senior Endocrinologist, Lilavati and Bhatia Hospital, Mumbai, Maharashtra, India
Apollo Sugar Clinics, India
Dr. Krishna Seshadri is a Internal Medicine and Endocrinologist in Adyar, Chennai and has an experience of 20 years in these fields. Dr. Krishna Seshadri practices at Fortis Malar Hospital in Adyar, Chennai,Apollo Speciality Hospital in Vanagaram, Chennai and Apollo Sugar Clinic in Vanagaram, Chennai. He completed MBBS from Madras Medical College, Chennai in 1989 and MD - Internal Medicine from Rush University, Illinosis, USA in 1998.
He is a member of American College of Physicians,American Endocrine Society,Indian Medical Association (IMA),Association of Physicians of India and Indian Endocrine Society. Some of the services provided by the doctor are: Circumcision, Peyronies Disease and Hypogonadism
Endocrinologist and Diabetologist
Apollo Sugar Clinic, Apollo Hospital
Dr. Sambit Das is an eminent Endocrinologist and Diabetologist in the state of Orissa, currently practising at Apollo Hospitals in Bhubaneswar, and at Dr.Sambit’s Centre of Diabetes and Endocrinology, N-4/18, IRC Village, Nayapali, Bhubaneswar.
Dr. Sambit Das excelled in academics right from his school days, and remained a topper during his medical studies as well, being awarded Gold Medals in several subjects during the MBBS programme and bagging the Best Graduate Award at the Final MBBS examination in 2001. Dr. Sambit Das went on to obtain the MD postgraduate degree in Internal Medicine in 2006, passing all the exams at first attempt. Then after completing a brief stint as Senior Resident in Endocrinology at SGPGI Lucknow in 2006, Dr. Das obtained the DM Endocrinology superspeciality degree from the prestigious PGIMER Chandigarh in 2009.
Dr. Sambit Das has been with Apollo Hospitals as Consultant Endocrinologist and Diabetologist since April 2010. He also received the adjunct title of Associate Professor in Endocrinology from Apollo Health and Educational Research Foundation (AHERF) Medvarsity in 2013. Dr. Das has been associated with several research projects, and his research papers have been published in reputed journals. He has delivered innumerable lectures and presentations at conferences in India and internationally, and is a regular invitee as Faculty at prominent events relating to his field of specialisation.
Apollo Sugar Clinic, Apollo Hospital, India
Dr. Dwarakanath C.S. is a Endocrinologist in Basavanagudi, Bangalore and has an experience of 31 years in this field. Dr. Dwarakanath C.S. practices at Surya Endocrine Diabetes Centre in Basavanagudi, Bangalore, Surya Endocrine Diabetes Centre in Nagarbhavi, Bangalore and Apollo Sugar Clinic in Bannerghatta Road, Bangalore. Completed MBBS from JJMMC, Davanagere in 1984,MD - Medicine from Mysore Medical College, Mysore in 1988 and DM - Endocrinology from All India Institutes of Medical Sciences, AIIMS, New Delhi in 1996. Member of Karnataka Medical Council and Indian Medical Association (IMA).
Senior Consultant Diabetologist
Apollo Sugar Clinic, Bangalore, India
Dr. Balaji Jagan Mohan is a Consultant Physician and Diabetologist at Apollo Sugar Clinic, Bangalore. He provides treatment for conditions such Diabetes Mellitus, Hypertension, Dyslipidemia, Obesity, Thyroid disorders, Screens and treats Microvascular and Macrovascular Complications of Diabetes like Diabetic neuropathy, nephropathy, retinopathy and Diabetic foot diseases. Apart from this, he has many publications and research work to his credit. He holds membership of associations and societies that are related to his field of practice. He is an enthusiastic learner and that is why he never misses a chance to attend any conference or seminar that take place within his reach. He completed MD in General Medicine from UMFT University, Romania, European Union and Postgraduate Diploma in Diabetes from Cardiff University (UK) and Fellowship in Diabetology from Dr. Mohans Diabetic Centre (Chennai).
Apollo Sugar Clinic, Apollo Hospital, Chennai, India
Dr. Venkatraman S is a General Physician and Diabetologist in Greams Road, Chennai and has an experience of 34 years in these fields. Dr. Venkatraman S practices at Apollo Sugar Clinic in Greams Road, Chennai. He completed MBBS from Madras University, Chenai, India in 1978 and MD - General Medicine from Madras University, Chenai, India in 1984.
He is a member of Tamilnadu Medical Council. Some of the services provided by the doctor are: Insulin Free Treatment,Head and Neck Infection Treatment,Filaria Treatment,Vaccination/ Immunization and Diabetes Management
Apollo Sugar Clinic, Apollo Hospital, Madhurai
Dr. R M Manikandan is a Endocrinologist and General Physician in Madurai East, Madurai and has an experience of 14 years in these fields. Dr. R M Manikandan practices at Apollo Hospital in Madurai East, Madurai and Apollo Sugar Clinic in KK Nagar, Madurai. He completed MBBS from Annamalai Universtiy in 2003,MRCP (UK) from Federation of Royal college of Physician of the United Kingdom in 2012 and MRCP - General Medicine from Royal Colleges Of Physicians,london, Uk in 2008.
Apollo Sugar Clinic, Apollo Hospital, Chennai
Dr. N.K.Narayanan is a General Physician and Endocrinologist in Greams Road, Chennai and has an experience of 20 years in these fields. Dr. N.K.Narayanan practices at Apollo Hospital in Greams Road, Chennai,Apollo First Med Hospitals in Kilpauk, Chennai and Apollo Sugar Clinic in Greams Road, Chennai. He completed MBBS from The Tamil Nadu Dr. M.G.R. Medical University (TNMGRMU) in 1999,FRCP - Endocrinology from UK in 2011 and MRCP (UK) from Wales College of Medicine, Cardiff University, UK in 2013.
He is a member of Indian Society for Pediatric and Adolescent Endocrinology (ISPAE). Some of the services provided by the doctor are: Insulin Treatment,Asthma Fever,General Illness Diabetes,Diabetes Management and Thyroid Disorder Treatment etc
Apollo Sugar Clinics
Dr. Sanjiv Shah is a Internal Medicine,General Physician and Diabetologist in Vileparle West, Mumbai and has an experience of 39 years in these fields. Dr. Sanjiv Shah practices at Nanavati Super Speciality Hospital in Vileparle West, Mumbai,Apollo Sugar Clinic in Kandivali West, Mumbai and Apollo Sugar Clinic in Vileparle West, Mumbai. He completed MBBS from University Of Bombay in 1980 and MD - Medicine from University Of Bombay in 1982.
He is a member of Association of Physicians of India (API),RESEARCH SOCIETY FOR STUDY OF DIABETES IN INDIA,Diabetic Association of India,Indian Society of Clinical Pharmacology and Therapeutics,American Diabetes Association (ADA),American Association of Clinical Endocrinologists (AACE) and European Association of Endocrinology Indian Medical Association. Some of the services provided by the doctor are: Allergy Treatment,Diabetic Ulcer Treatment,Foot infection,Diabetes Management and Diabetes in Children
Head Clinical Excellence
Apollo Sugar Clinics Limited
Dr Vamsi Krishna Kolukula, as a Physician, Researcher, Advisor, medical graduate with profound knowledge in pharmacology, medicine, molecular biology research and health care administration. Clinical and research experience in educational and pharmaceutical industries.
Lilavati and Bhatia Hospital
Mumbai, Maharashtra, India
Prof Shashank R. Joshi MD, DM, FACP, FACE, FRCP
Endocrinologist, Lilavati & Bhatia Hospital
Consultant and Advisor, Apollo Sugar Clinics
President, Indian Academy of Diabetes, Past President, Endocrine Society of India
Past President, Research Society for Study of Diabetes in India(RSSDI)
Past President, All India Association for Advancement of Research in Obesity Past President, Association of Physicians of India, Emeritus Editor, JAPI
Indian Chapter Chair, AACE
He was honored by the Government of India, in 2014, by bestowing on him the Padma Shri, the fourth highest civilian award, for his services to the field of medicine. He is also a recipient of the International Clinician Award, received at the 21st American Association of Clinical Endocrinologists (AACE) Annual Scientific and Clinical Congress, Philadelphia. This is an annual award given to practicing endocrinologists, outside the US