title: Cross-National Variation in Glycemic Control and Diabetes-Related Distress Among East Asian Patients Using Insulin: Results from the MOSAIc Study.
abstract: BACKGROUND
  Guidelines recommend insulin progression for patients with type 2 diabetes (T2D) with inadequate glycemic control. The Multinational Observational Study Assessing Insulin use (MOSAIc [ClinicalTrials.gov identifier, NCT01400971]) study is a 2-year observational study, investigating factors that influence insulin progression in T2D patients. In this first of two reports, we describe baseline clinical and psychosocial characteristics of Chinese, Japanese, and South Korean patients who participated in MOSAIc. Insulin treatment, factors affecting progression, and outcomes will be reported separately.
  
  
  METHODS
  Patients with T2D using insulin for ≥3 months were eligible. Baseline demographic, clinical, and psychosocial data were collected from patients. Quality of life instruments, including the Diabetes Distress Scale (DDS), were used to assess patient's concerns about disease management, support, and emotional burden. The association between the DDS and the selected covariates was also assessed.
  
  
  RESULTS
  A total of 373 patients in China, 157 in Japan, and 141 in South Korea were enrolled from July 2011 to July 2013. Mean ± standard deviation duration (years) of T2D differed across countries (China 11.4 ± 7.5; Japan 13.8 ± 8.7; South Korea 15.7 ± 8.8; P < 0.0001). Japanese patients used more noninsulin anti-hyperglycemic agents than did Chinese or South Korean patients (P < 0.0001). Exclusive use of basal insulin was most common in Japan and South Korea compared with China, whereas approximately 66.8% of Chinese patients used mixed insulin. Covariates associated with the DDS were younger age [P = 0.044 (Japan)], higher incidence of monthly hypoglycemia [P = 0.036 [China]; P = 0.021 (South Korea)], and male gender [P = 0.037 (South Korea)].
  
  
  CONCLUSIONS
  There were significant differences amongst East Asian patients with T2D treated with insulin, including in quality of life scores. Results from the MOSAIc longitudinal analyses will further investigate trends of insulin intensification and barriers to insulin progression.
  
  
  BACKGROUND
  Eli Lilly and Company.
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan. ikuro@matsuba-web.com.
authors.forename: Ikuro
authors.initials: I
authors.lastname: Matsuba
authors.affiliation: Department of Internal Medicine, Kawasaki Saiwai Hospital, Kanagawa, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Sawa
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Kawata
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kanamori
authors.affiliation: Eli Lilly & Company, Indianapolis, IN, USA.
authors.forename: Dingfeng
authors.initials: D
authors.lastname: Jiang
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Machimura
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takeda
authors.affiliation: Lilly Korea Ltd, Seoul, Korea.
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Han
authors.affiliation: Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Eli Lilly Suzhou Pharmaceutical Company, Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Shen
authors.affiliation: Department of Diabetology, Kawasaki Saiwai Clinic, Kanagawa, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Ajima
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Kaneshiro
authors.affiliation: Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kim
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Umezawa
authors.affiliation: The Study Group of the Diabetes Committee, Kanagawa Physicians Association, Kanagawa, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Asakura
authors.affiliation: Eli Lilly Japan K.K., Kobe, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Seoyoung C
authors.initials: SC
authors.lastname: Kim
keywords: Asia; Diabetes Mellitus; Hypoglycemia; Insulin; Patient-reported outcomes; Type 2