Abstract

KALWEIT, K L; VAN ZYL, D G  and  RHEEDER, P. Titrating insulin in patients with type 2 diabetes using a structured self-monitoring blood glucose regimen. SAMJ, S. Afr. med. j. [online]. 2018, vol.108, n.8, pp.654-659. ISSN 2078-5135.  http://dx.doi.org/10.7196/samj.2018.v108i8.12801.

BACKGROUND: Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia, but there is currently no standardised approach to utilising these data to improve glycaemic control in patients with type 2 diabetes OBJECTIVES: To assess the improvement in glycaemic control when an insulin titration algorithm was used in combination with SMBG in patients with poorly controlled, insulin-treated type 2 diabetes METHODS: This 6-month prospective study recruited 39 poorly controlled (glycated haemoglobin (HbAlc) >8.5%; 69.4 mmol/mol) type 2 diabetes subjects using twice-daily biphasic insulin from two state hospitals in Tshwane, South Africa. Patients were asked to perform structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using an algorithm guided by the data collected. The primary endpoint was the trend in HbA1c measured at baseline and 3 and 6 months RESULTS: Mean HbAlc decreased over the study period by 1.89% (95% confidence interval (CI) -2.46 - -1.33; p<0.001). The hypoglycaemic event rate (<4.0 mmol/L) was 33.08 events per patient year. Total daily insulin use increased by a mean of 40.12 units over the study period (standard error 7.7; p<0.001) and weight increased by an average of 3.98 kg (95% CI 2.56 - 5.41; p<0.001 CONCLUSIONS: Monthly algorithmic insulin titration guided by structured SMBG can markedly improve glycaemic control in patients with type 2 diabetes by aggressively increasing insulin doses not previously expected in this population, with moderate hypoglycaemic events and weight gain observed

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