Patient Preference and Adherence (Mar 2024)
Comparison of Efficacy and Adherence of Patient-Preferred (1 Unit Daily) and ADA/EASD Guideline-Recommended (2 Units Every 3 Days) Basal Insulin Titration Algorithms: Multicenter, Randomized, Clinical Study
Abstract
Ling Li,1 Xiaodan Zhang,1 Tong Zhang,2 Liankun Zeng,3 Mingrun Lin,4 Yanli Li,4 Wangen Li1 1Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Endocrinology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China; 4Department of Endocrinology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of ChinaCorrespondence: Wangen Li; Yanli Li, Email [email protected]; [email protected]: Insulin titration often faces inertia, hindering glycemic control. A patient-centered approach empowers patients to overcome this inertia. This study aims to compare the effectiveness of patient-preferred and guideline-recommended self-titration algorithms in achieving glycemic targets and improving adherence.Methods: Outpatients with type 2 diabetes (T2D) who did not respond to oral antihyperglycemic drugs (OAD) were assessed. They were randomly assigned to patient-preferred and guideline-recommended groups. In the patient-preferred group, individuals selected an algorithm to self-adjust their insulin glargine dosage by 2 units every 3 days if the mean fasting blood glucose (FBG) over the past 3 consecutive days was ≥ 7.0 mmol/L, or by 1 unit daily if the FBG on the same day was ≥ 7.0 mmol/L. In the guideline-recommended group, insulin glargine was titrated by 2 units every 3 days if the mean FBG over the past 3 consecutive days was ≥ 7.0 mmol/L. The FBG target was set below < 7.0 mmol/L.Results: Thirty-nine participants in the patient-preferred group and 42 in the guideline-recommended group completed the study. The cumulative rates of achieving the FBG target in the patient-preferred group compared to the guideline-recommended group were 69.2% vs 54.8% (χ²=1.792, p=0.181) in week 1, 89.7% vs 73.8% (χ²=3.403, p = 0.065) in week 2, 94.9% vs 76.2% (χ²=17.638, p=0.000) in week 3, and 100.0% vs 88.1% (χ²=4.405, p=0.036) in week 4. Adherence rates were significantly higher in the patient-preferred group (97.4%, 37/38) compared to the guideline-recommended group (66.7%, 28/42) (χ²=12.688, p=0.000). Insulin glargine dosage at FBG target achievement was 21.2± 4.3 U in the patient-preferred group and 18.8± 6.7 U in the guideline-recommended group (t=1.888, p=0.063). Hypoglycemia was reported in 1 patient in the guideline-recommended group, with no instances in the patient-preferred group.Conclusion: The patient-preferred self-titration algorithm demonstrates a higher rate of reaching glucose targets and improved adherence.Trial Registration Number: ChiCTR2100050805.Keywords: type 2 diabetes, glargine, self-titration, adherence, preference
