Knowledge, awareness, and practices with regard to diabetes management in south Asia are not known. This study aimed to determine current clinical practices with regard to managing diabetes in Nepal and India. Doctors attending conferences in Delhi, Guwahati, and Kathmandu were evaluated regarding their diabetes treatment preferences using a standardized questionnaire having 34 multiple-choice questions. The questionnaire evaluated doctor’s preferences on therapeutic lifestyle modification, pharmacotherapy, and insulin injection practices. From a total of 409 filled questionnaires which were collected, 261, 75, and 73 questionnaires from New Delhi, Guwahati, and Kathmandu, respectively, which fulfilled all criteria, were analyzed. The mean age of doctors was 42.26 ± 11.99 years. Low carbohydrate, high protein was the most frequently recommended diet plan. The use of carbohydrate counting in practice was non-existent. Self-monitoring of blood glucose (SMBG) is commonly used in practice with 1–2 times per day checking. The preferred second, third, and fourth oral agents after metformin were sulfonylureas (53.05%), glucosidase inhibitors (37.16%), and dipeptidyl-peptidase-4 inhibitors (DPP4i) (42.79%) respectively. Glimepiride (73.83%) and gliclazide (28.60%) were the most preferred sulfonylureas. Teneligliptin (31.54%), sitagliptin (23.71%), linagliptin (22.24%), and vildagliptin (16.38%) were the preferred DPP4i. Dapagliflozin (30.56%), empagliflozin (20.29%), and canagliflozin (8.85%) were the preferred sodium-glucose co-transporter-2 inhibitor (SGLT2i). Insulin use was delayed in type-2 diabetes, typically initiated only after glycemic control not adequate with five oral anti-diabetes agents (OADs) (50.36%). The most preferred insulin was basal insulin analogue (47.68%) followed by neutral protamine hagedorn (NPH) insulin (22.24%). Most patients received < 20 U of insulin/day (56.96%). The most commonly used short-acting insulin in pregnancy was lispro (204; 49.88%). The preferred long-acting insulin in pregnancy was NPH insulin (180; 44.01%). Lack of use of digital technology, less use of lifestyle modifications, delayed use of insulin, preference for multiple OADs, popularity of sulfonylureas and alpha-glucosidase inhibitors (AGIs), and late use of SGLT2i were some of the key highlights of diabetes practice in south Asia.
Diabetes therapy India Nepal Treatment practices Pattern Guidelines
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res. 2016;143:401–4.CrossRefGoogle Scholar
Dutta D, Mondal SA, Choudhuri S, Maisnam I, Hasanoor Reza AH, Bhattacharya B, et al. Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from Eastern India. Diabetes Res Clin Pract. 2014;103:e18–23.CrossRefGoogle Scholar
Dutta D, Choudhuri S, Mondal SA, Mukherjee S, Chowdhury S. Urinary albumin: creatinine ratio predicts prediabetes progression to diabetes and reversal to normoglycemia: role of associated insulin resistance, inflammatory cytokines and low vitamin D. J Diabetes. 2014;6:316–22.CrossRefGoogle Scholar
Dutta D, Choudhuri S, Mondal SA, Maisnam I, Reza AH, Ghosh S, et al. Tumor necrosis factor alpha 238G/A (rs 361525) gene polymorphism predicts progression to type-2 diabetes in an Eastern Indian population with prediabetes. Diabetes Res Clin Pract. 2013;99(3):e37–41.CrossRefGoogle Scholar
Kumar P, Khandelwal D, Mittal S, Dutta D, Kalra S, Katiyar P, et al. Knowledge, awareness, practices and adherence to treatment of patients with primary hypothyroidism in Delhi. Indian J Endocrinol Metab. 2017;21:429–33.CrossRefGoogle Scholar
Surana V, Aggarwal S, Khandelwal D, Singla R, Bhattacharya S, Chittawar S, et al. Society for Promotion of Education in Endocrinology and Diabetes Group, India. A 2016 clinical practice pattern in the management of primary hypothyroidism among doctors from different clinical specialties in New Delhi. Indian J Endocrinol Metab. 2017;21:165–77.CrossRefGoogle Scholar
Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S. Ketogenic diet in endocrine disorders: current perspectives. J Postgrad Med. 2017;63(4):242–51.CrossRefGoogle Scholar
Joshi SR, Bhansali A, Bajaj S, Banzal SS, Dharmalingam M, Gupta S, et al. Results from a dietary survey in an Indian T2DM population: a STARCH study. BMJ Open. 2014;4:e005138.CrossRefGoogle Scholar
Gupta L, Khandelwal D, Kalra S. Applied carbohydrate counting. J Pak Med Assoc. 2017;67:1456–7.PubMedGoogle Scholar
Selvan C, Thukral A, Dutta D, Ghosh S, Chowdhury S. Impact of self-monitoring of blood glucose log reliability on long-term glycemic outcomes in children with type 1 diabetes. Indian J Endocrinol Metab. 2017;21:382–6.CrossRefGoogle Scholar
Molugulu N, Yee LS, Ye YT, Khee TC, Nie LZ, Yee NJ, et al. Systematic review of metformin monotherapy and dual therapy with sodium glucose co-transporter 2 inhibitor (SGLT-2) in treatment of type 2 diabetes mellitus. Diabetes Res Clin Pract. 2017;132:157–68.CrossRefGoogle Scholar
Dutta D, Kalra S. Sodium glucose transporter 2 (sglt2) inhibitors: current status in clinical practice. J Pak Med Assoc. 2014;64:1203–6.PubMedGoogle Scholar
Dutta D, Khandelwal D. Sodium glucose transporter 2 inhibition, euglycemic ketosis and bone mineral loss: refining clinical practices. Indian J Endocrinol Metab. 2015;19:854–5.CrossRefGoogle Scholar
Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American association of clinical endocrinologists and American college of endocrinology on the comprehensive type 2 diabetes management algorithms - 2018 executive summary. Endocr Pract. 2018;24:91–120.CrossRefGoogle Scholar
Baruah MP, Kalra S, Bose S, Deka J. An audit of insulin usage and insulin injection practices in a large Indian cohort. Indian J Endocrinol Metab. 2017;21:443–52.CrossRefGoogle Scholar
Kalra S, Chandalia HB, Chawla M, Munshi N, Poojary A, Varaiya A, et al. Forum for injection technique 2.0 addendum 1: insulin use in indoor settings. Indian J Endocrinol Metab. 2016;20:863–5.CrossRefGoogle Scholar