Efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes: A meta-analysis of randomized controlled trials

Marco Castellana, Filippo Procino, Rodolfo Sardone, Pierpaolo Trimboli, Gianluigi Giannelli

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Insulin is the most effective antihyperglycemic treatment and basal insulin is the preferred initial formulation in patients with type 2 diabetes. However, its effects are dose-dependent, so adequate titration is necessary to reach targets. We performed a meta-analysis to compare the efficacy and safety of patient-led versus physician-led titration of basal insulin in patients with uncontrolled type 2 diabetes. Research design and methods Four databases were searched from database inception through March 2020. Randomized controlled studies with at least 12 weeks of follow-up of patients with type 2 diabetes allocated to patient-led versus physician-led titration of basal insulin were selected. Data on glycemic endpoints (hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), hypoglycemia) and other outcomes (insulin dose, body weight, patient-reported outcomes, adverse events, rescue medication, discontinuation) were extracted. Data were pooled using a random-effects model. Results Six studies evaluating 12 409 patients were finally included. Compared with the physician-led performance, patient-led titration was associated with a statistically significant higher basal insulin dose (+6 IU/day), leading to benefits on HbA1c (-0.1%) and FPG (-5 mg/dL), despite a higher risk of any level hypoglycemia (relative risk=1.1) and a slight increase in body weight (+0.2 kg). No difference was found for the other outcomes. Conclusions The present study showed that patient-led titration of basal insulin was not inferior to physician-led titration in patients with uncontrolled type 2 diabetes. Therefore, diabetes self-management education and support programs on basal insulin should be widely adopted in clinical practice and patients provided with tools to self-adjust their dose when necessary.

Original languageEnglish
Article numbere001477
JournalBMJ Open Diabetes Research and Care
Volume8
Issue number1
DOIs
Publication statusPublished - Jul 6 2020

Keywords

  • diabetes mellitus
  • insulin
  • meta-analysis
  • type 2

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

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