ImageHeralding a new dawn in diabetes management, Indian guidelines on insulin therapy for primary care physicians (PCPs) was launched on the sidelines of APICON 2009 at Greater Noida.

This guideline is the first-of-its-kind insulin therapy guideline formulated by 27 experts (Indian National Consensus Group) comprising diabetologists, physicians and endocrinologists across India, and is part of the special issue of JAPI (Journal of Associations of Physicians in India) 2009.

Till date, there were no specific guidelines in insulin therapy for the Indian diaspora. The western guidelines (the only ones that are in force) rarely get implemented in countries like India and China. Hence, the panel of experts on the Indian National Consensus Group discussed and defined the problem of insulin usage in primary care in India.

A recommendation was then made based on evidences and clinical experience following which a primary draft was shared with 250 diabetologists and physicians across the country for their review, before arriving at the final guideline. Some of the key opinion leaders who played an important role in drafting the guidelines include Dr Ashok Kumar Das, Dr A K Jhingan, Dr Seshiah and Dr Shashank Joshi.

Majority of patients in India are dealt and cared by primary care physicians (PCPs), and making insulin therapy more user friendly to PCPs is imperative to contain diabetes in the country. Premix insulin stands out as the most suitable and effective regimen as it addresses the condition in a simple and efficient way (controls both post prandial and fasting plasma glucose). The premix guideline will now arm a primary care physician with a simple algorithm that can be implemented. NovoMix 30 from Novo Nordisk is the leading modern premix insulin in India.

The guideline aims to give insights in to insulin therapy – premix insulin as the optimal choice; rationale for using premix insulin therapy in India; evidences supporting premix insulin – initiation and titration of premix insulin; evaluation of modern premix insulin and human premix; and premix insulin in special situations, etc.

These much-needed guidelines will empower physicians with a simple and doable algorithm for starting and treating with insulin therapy," said Dr A.K. Das, Medical Superintendent, JIPMER and one of the members of The National Consensus Group.

"The insulin guideline will immensely help in reducing the huge burden of moratlity and morbidity caused by uncontrolled hyperglycaemia," commented Dr A K Jhingan, Chairman, Delhi Diabetes Research Centres.

The guidelines have been published in the Journal of Associations of Physicians in India (JAPI, January 2009 issue). On the occasion of the release of special issue of JAPI, Dr Shashank Joshi, Endocrinologist at Lilavati Hospital and Bhatia Hospital, Mumbai, raised concerns on the use of biosimilars and said, "There are concerns about safety, efficacy and quality of biosimilars due to the absence of stringent guidelines for evaluating these products in our regulatory system. It was imperative to have these guidelines for the efficient management of diabetes in India."