Common Standards of Basal Insulin Titration in T2DM

Arnolds, Sabine; Heise, Tim; Flacke, Frank; Sieber, Jochen

doi:10.1177/193229681300700323

Cited by 46 publications

(47 citation statements)

References 70 publications

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“…Patients were found to be as good as physicians in titration. 8 Our standard TA has been shown to be superior to other algorithms with respect to hypoglycemia risk in a recent study comparing clinical outcomes using 3 initiation and TAs for insulin glargine in 1380 insulin-naive patients with T2DM receiving both metformin and sulfonylurea (SU) at baseline. 12 In our trial, we directly compared dose titration decisions for normalizing FBG values with insulin glargine in a BOT regimen, when made by an individually selected dose TA or by the responsible physician on a daily basis over 28 days.…”

Section: Discussionmentioning

confidence: 99%

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Real-World Data Collection Regarding Titration Algorithms for Insulin Glargine in Patients With Type 2 Diabetes Mellitus

Pfützner¹,

Stratmann

Funke³

et al. 2016

J Diabetes Sci Technol

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The primary objective of this study was to collect data regarding the effectiveness of different dose titration algorithms (TAs) for optimization or initiation of basal insulin supported oral therapy (BOT) in patients with type 2 diabetes. A total of 50 patients were enrolled in this trial (17 women, 33 men, age 63 ± 8 years, HbA1c 7.9 ± 0.8%). The investigator decided on an individual basis to apply any of 4 standard TAs: standard (S: fasting glucose target 90-130 mg/dL, n = 39), standard-fast titration (S-FT: 90-130 mg/dL, larger dose increments at FBG < 180 mg/dl, n = 1), less tight (LT: 110-150 mg/dL, n = 5), and tight (T: 70-100 mg/dL, n = 5). During the next 30 days daily contacts were used to adapt the insulin dose. The majority of all patients (70%) achieved a stable insulin glargine dose within 5 ± 6 days after initiation of the dose titration. HbA1c improved from 7.9 ± 0.8% to 7.5 ± 0.7% (P < .001). In total, 1300 dose decisions were made (1192 according to the TA and 108 by the physicians independently from the TA in 29 patients [58% of study population]). Reasons for TA-overruling dosing decisions were hypoglycemic events (14 mild/4 moderate) in 9 patients. In the majority of these cases (89.8%), the physician recommended continuation of the previous dose or a higher dose. The majority of FBG values were within the respective target range after 4 weeks. In conclusion, the insulin glargine TAs delivered safe dose recommendations with a low risk of hypoglycemia, which successfully led to a stable dose in the vast majority of patients.

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Section: Discussionmentioning

confidence: 99%

“…The development of the TAs was based on the current literature on basal insulin titration as summarized in Arnolds et al 8 and recent guidelines for insulin treatment of type 2 diabetes. …”

mentioning

confidence: 99%

Real-World Data Collection Regarding Titration Algorithms for Insulin Glargine in Patients With Type 2 Diabetes Mellitus

Pfützner¹,

Stratmann

Funke³

et al. 2016

J Diabetes Sci Technol

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“…The lower targets are based on the recommendations from international and domestic guidelines, and previous study results [9, 10, 26], whereas the 7.0 mmol/L target is within the range recommended by 2014 Chinese diabetes guidelines (4.4–7.0 mmol/L) [24] and widely accepted by Chinese physicians.…”

Section: Discussionmentioning

confidence: 99%

“…However, only a limited number of studies have investigated the efficacy of insulin glargine-based treatment in Chinese patients with T2DM to date. Moreover, these studies were unable to identify a clear and consistent FPG target that would suggest appropriate glycemic control [25, 26]. Data are needed to elucidate the contribution of FPG to HbA1c in Chinese patients with T2DM.…”

Section: Introductionmentioning

confidence: 99%

Assessment of three fasting plasma glucose targets for insulin glargine-based therapy in people with type 2 diabetes mellitus in China: study protocol for a randomized controlled trial

Yang

Zhao³

et al. 2016

Trials

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BackgroundA large proportion of patients with T2DM in China do not meet accepted HbA1c targets despite the availability of guidelines that describe a treatment pathway for achieving glycemic control. The aim of this study is to identify the fasting plasma glucose (FPG) target that will provide the highest control rate of HbA1c <7 % in Chinese patients with T2DM treated with an insulin glargine-based regimen as an adjunct to an established OAD regimen. This information will support improvements in diabetes care management in China.MethodsApproximately 934 men and women aged ≥18 to ≤65 years with poorly controlled T2DM will be enrolled and randomized to one of three FPG target groups; ≤5.6 mmol/L, ≤6.1 mmol/L, or ≤7.0 mmol/L. They will be initiated on daily insulin glargine (Lantus®) in addition to their usual OAD regimen for 24 weeks. Patients will self-monitor fasting blood glucose (SM-FBG), and the study physician will titrate the basal insulin dose according to the SM-FBG results. In addition, HbA1c and safety will be recorded. We plan to statistically derive the optimal FPG target for an HbA1c of <7 %.DiscussionIn China, treatment strategies that would achieve an optimum balance between glycemic control (as per HbA1c) and hypoglycemia are imperative to ensure improvements in the management of T2DM. Furthermore, elucidating the contribution of FPG to HbA1c in Chinese patients with T2DM and identifying a predictable relationship between FPG and HbA1c would be a valuable tool for patient self-management of diabetes.Trial registrationNCT02545842. Registered on 8 September 2015.

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“…1 Of these, the majority has type 2 diabetes. 4,5 Treat-to-target titration trials have helped define the initiation and titration of basal insulin analogues contingent on achieving fasting plasma glucose (FPG) targets. 2 The introduction of basal insulin analogues more than a decade ago has made it easier for primary care physicians to engage in the treatment of insulin-requiring patients and to intensify insulin therapy, with lower rates of hypoglycaemia achieved compared with non-modified human insulins.…”

Section: Introductionmentioning

confidence: 99%

When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

Umpiérrez

Skolnik

Dex

et al. 2019

Diabetes Obesity Metabolism

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Aims A post‐hoc analysis to assess the impact in people with type 2 diabetes, of increasing doses of basal insulin on glycaemic measures, body weight and hypoglycaemia. Research Design and Methods We included data from prospective, randomized controlled treat‐to‐target trials of ≥24 weeks' duration in people with type 2 diabetes, uncontrolled on metformin and sulphonylureas, and treated with insulin glargine 100 units/mL (U100), who had at least six fasting plasma glucose (FPG) measurements. The impact of insulin dose on glycated haemoglobin (HbA1c) values, FPG, hypoglycaemia incidence (<3.9 mmol/L [70 mg/dL]), and body weight was analysed. A total of 458 participants from three eligible trials were included. Results The observed relationship between higher basal insulin doses and glycaemic control was non‐linear, with increasing insulin dose leading to smaller reductions in FPG and HbA1c for doses >0.3 IU/kg/d, with a plateauing effect at 0.5 IU/kg/d. Total daily dose of insulin >0.5 IU/kg/d resulted in greater weight gain, but without higher rates of hypoglycaemia, compared with insulin doses ≤0.5 IU/kg/d. Conclusions This analysis indicates that basal insulin doses >0.5 IU/kg/d have diminishing additional impact on improving glycaemic measures, with the disadvantage of additional weight gain. Clinicians should consider anti‐hyperglycaemic treatment intensification at doses approaching 0.5 IU/kg/d.

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Common Standards of Basal Insulin Titration in T2DM

Cited by 46 publications

References 70 publications

Real-World Data Collection Regarding Titration Algorithms for Insulin Glargine in Patients With Type 2 Diabetes Mellitus

Real-World Data Collection Regarding Titration Algorithms for Insulin Glargine in Patients With Type 2 Diabetes Mellitus

Assessment of three fasting plasma glucose targets for insulin glargine-based therapy in people with type 2 diabetes mellitus in China: study protocol for a randomized controlled trial

When basal insulin is not enough: A dose–response relationship between insulin glargine 100 units/mL and glycaemic control

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