Development and implementation of signs- and symptoms-based insulin adjustment algorithm

Lee, Joyce Yu‐Chia; Wong, Sabrina

doi:10.2146/ajhp100032

Cited by 7 publications

(12 citation statements)

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“…Poor glucose control is often due to inappropriate drug usage and lack of close follow‐up; hence, closer monitoring by clinical pharmacist provided timely drug optimization . In addition, the clinical pharmacists in our study were trained to use the SIGN algorithm specifically designed for Asian patients who refuse to use a glucose meter, and active insulin titration was still carried out despite low adherence rates of SMBG. Due to these interventions of the clinical pharmacists, patients in the multidisciplinary collaborative care arm benefitted from glycaemic improvement as any degree of improvement in HbA1c would lower the risk of diabetes‐related complications …”

Section: Discussionmentioning

confidence: 99%

“…Upon signing the informed consent forms, patients were randomized into the intervention (multidisciplinary collaborative care) or control (usual care) arms. In the intervention arm, physicians referred their patients to the diabetes nurse educators or dietitians as needed, while clinical pharmacists followed up regularly with all patients every four to 6 weeks via face‐to‐face visits or phone calls, following an established protocol . Each face‐to‐face session with the clinical pharmacists, diabetes nurse educators and dietitians lasted between 20 and 30 minutes (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…Today, the impact of this form of care in a much‐challenged patient population in Asia is yet to be elucidated. In this population, treatment is often complicated by cultural beliefs, religious practices, polypharmacy, limited formulary and poor adherence to self‐monitoring of blood glucose (SMBG) . Furthermore, evidence on its impact on quality of life and cost savings for this high‐risk group of patients is not available.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

et al. 2017

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SummaryWhat is known and objective: With the increasing prevalence of diabetes, the physician-centred model is challenged to deliver holistic care in Asia. Diabetes may be managed effectively within a multidisciplinary collaborative care model; however, evidence on its effectiveness in Asian patients is lacking. Therefore, the primary objective was to evaluate the clinical outcomes of multidisciplinary collaborative care vs physician-centred care in diabetes. The secondary objectives were to evaluate humanistic and economic outcomes among the two types of care.Methods: This 6-month prospective, open-label, parallel-arm, randomized, controlled study was conducted at four outpatient healthcare institutions. High-risk patients aged ≥21 years with uncontrolled type 2 diabetes, polypharmacy and comorbidities were included. Patients with type 1 diabetes or those who were unable to communicate independently were excluded. The control arm received usual care with referrals to nurses and dietitians as needed. The intervention arm (multidisciplinary collaborative care) was followed up with pharmacists regularly, in addition to receiving the usual care. The primary outcomes included HbA1c, systolic blood pressure, low-density lipoprotein and triglycerides. The secondary outcomes included scores from the Problem Areas in Diabetes (PAID) and the Diabetes Treatment Satisfaction Questionnaires (DTSQ), and diabetes-related health service utilization rates and costs.Results and discussion: Of 411 eligible patients, 214 and 197 patients were randomized into the intervention and control arms, respectively. At 6 months, 141 patients in the intervention arm (65.9%) and 189 patients in the control arm (95.9%) completed the study. Mean HbA1c reduced from 8.6%±1.5% at baseline to 8.1%±1.3% at 6 months in the intervention arm (P=.04), with up to mean HbA1c improvement of 0.8% in patients with greater levels of uncontrolled glycemia. Whereas the mean HbA1c in the control arm remained unchanged (8.5%±1.4%) throughout the 6-month period. Improvements in PAID and DTSQ scores, reduction in physician workload and an average cost savings of US$91.01 per patient were observed in the intervention arm over 6 months.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

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Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

et al. 2017

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“…7 The algorithm was subsequently revised and updated in 2010, incorporating all rapid-, short-, and long-acting insulin products as well as the premixed insulin products (Fig. 1).…”

Section: Development Of Sign Algorithmmentioning

confidence: 99%

“…7 In this pilot study, we report the clinical outcome and safety in the use of our SIGN algorithm to manage patients with uncontrolled type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

“Symptom-based Insulin adjustment for Glucose Normalization” (SIGN) Algorithm: A Pilot Study

Lee

Tsou²,

Lim³

et al. 2012

Diabetes Technology & Therapeutics

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Background: Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a ''Symptom-based Insulin adjustment for Glucose Normalization'' (SIGN) algorithm was developed to guide clinicians in caring for patients with uncontrolled type 2 diabetes who have few to no SMBG records. This study examined the clinical outcome and safety of the SIGN algorithm. Subjects and Methods: Glycated hemoglobin (HbA1c), insulin usage, and insulin-related adverse effects of a total of 114 patients with uncontrolled type 2 diabetes who refused to use SMBG or performed SMBG once a day for less than three times per week were studied 3 months prior to the implementation of the algorithm and prospectively at every 3-month interval for a total of 6 months after the algorithm implementation. Patients with type 1 diabetes, nonadherence to diabetes medications, or who were not on insulin therapy at any time during the study period were excluded from this study. Results: Mean HbA1c improved by 0.29% at 3 months (P = 0.015) and 0.41% at 6 months (P = 0.006) after algorithm implementation. A slight increase in HbA1c was observed when the algorithm was not implemented. There were no major hypoglycemic episodes. The number of minor hypoglycemic episodes was minimal with the majority of the cases due to irregular meal habits. Conclusions: The SIGN algorithm appeared to offer a viable and safe approach when managing uncontrolled patients with type 2 diabetes who have few to no SMBG records.

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Cost-effectiveness of multidisciplinary collaborative care versus usual care in the management of high-risk patients with diabetes in Singapore: Short-term results from a randomized controlled trial

Siaw

Malone

et al. 2018

J Clin Pharm Ther

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Development and implementation of signs- and symptoms-based insulin adjustment algorithm

Cited by 7 publications

References 14 publications

Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

“Symptom-based Insulin adjustment for Glucose Normalization” (SIGN) Algorithm: A Pilot Study

Cost-effectiveness of multidisciplinary collaborative care versus usual care in the management of high-risk patients with diabetes in Singapore: Short-term results from a randomized controlled trial

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