Self-Managed Titration of Insulin Glargine Superior to Physician Management

For patients with inadequately controlled type 2 diabetes, self-managed titration of insulin glargine 300 U/mL (Gla-300) is superior to physician-managed titration, according to study results published in Diabetes, Obesity and Metabolism.

The results indicated that self-managed titration results in better glycated hemoglobin (HbA1c) reduction.

The study included insulin-naïve and pretreated participants who were randomly assigned 1:1 to a self- or physician-managed titration of Gla-300. The fasting self-monitored plasma glucose target was set to 4.4 to 7.2 mmol/L. The study’s primary outcome was noninferiority of glycemic control measured by HbA1c change from baseline to week 24, and secondary outcomes included self-monitored plasma glucose target achievement without hypoglycemia, hypoglycemia incidence, adverse events, and participant-reported outcomes.

In the self-managed group, the least squares mean HbA1c reduction was 0.97% (10.6 mmol/mol) at 24 weeks. In the physician-managed group, it was 0.84% (9.2 mmol/mol). The groups had a least squares mean difference of -0.13%, demonstrating noninferiority (P <.0001) and superiority (P =.0247) of self-managed titration compared with physician-managed titration.

The results indicated that significantly more participants in the self-managed group achieved the self-monitored plasma glucose target without hypoglycemia compared with the physician-managed group (67.3% vs 58.3%; P =.0187).

Participants did not report any safety concerns during the study period. The researchers observed similar participant-reported outcome improvements in both groups for distress related to diabetes disease burden and confidence in diabetes self-management. Both groups had similar rates of hypoglycemia.

“Encouragement and support of self-titration in appropriate target groups may help to improve outcomes and provide a sense of empowerment in people with [type 2 diabetes], without increasing distress,” the researchers wrote.

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Reference

Russell-Jones D, Dauchy A, Delgado E, et al. Take control: a randomized trial evaluating the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL in patients with uncontrolled type 2 diabetes [published online March 8, 2019]. Diabetes Obes Metab. doi:10.1111/dom.13697