New study details PWT2D experiments with basal insulin titration


A new multinational study presented at the Metabolic Institute of America (TMIOA) World Congress 2021 Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) suggested that new tools and strategies be implemented in clinical settings to empower diabetes patients to type 2 (T2D) and allow efficient titration of basal insulin (IB).

This suggestion was in response to only 1/3 of the T2DM patients who achieved fasting blood sugar (FBG) after initiating IB in the study.

For patients with T2DM on BI treatment, optimal titration of their dose may help achieve glycemic control. However, many of them remain uncontrolled for reasons linked to a lack of knowledge of BI titration.

As such, researchers led by Stewart Harris, MD, MPH, Schulich School of Medicine & Dentistry, The University of Western Ontario, Canada, assessed the outlook and experiences of BI titration in people with T2DM initiating the assay. .

The methods

Stewart and investigators identified recent initiators of BI through registration, medical and pharmaceutical records in the Optum research database.

Inclusion criteria including 2 years or more of medical claims with a diagnosis of T2DM 30 days apart during the 12 month sample identification period, which ended in March 2021 for wave 1 and in April 2021 for wave 2.

In addition, ≥ 1 pharmacy reimbursement request for IB (insulin glargine 100 U / mL, insulin glargine 300 U / mL, insulin degludec or insulin detemir) in the most recent month of drug data was also required, any such as being 18 years of age and over on the indexation date and 12 months of continuous registration for medical and pharmaceutical benefits before the indexation date.

From there, all identified BI initiators were tasked with responding to a survey, which included questions about the BI titration experience involving titration resources, interactions with healthcare providers (HCPs), self-management of titration, clinical information, titration status and achievement of goals.

A total of 416 BI initiators were included in the study.

Of these 416 survey respondents, 51% were men, 71% were Caucasian, the average age was 70, and the average BMI in kg / m2. The mean age at diagnosis was 51 years and 72% of responders had T2D for more than a decade.

The results

Harris and colleagues reported that most respondents (74%) had the BI titration explained by their provider, and the majority (67%) were very / extremely satisfied with the support they received. Only 5% were not at all satisfied.

Regarding glycemic control and hypoglycemia, most responders documented the dose of IB (89%) and fasting blood sugar (FBG; 80%) daily.

Aside from the 35% of responders who achieved FBG goals, 58% had not achieved FGB and were still titrating while 7% had stopped using BI.

Only half (204, 49%) of participants experienced hypoglycemia during titration.

The mean total score on the Diabetes Treatment Satisfaction Questionnaire (DTSQ) was 28 (range 0-36; higher score indicates greater satisfaction), while the mean total score on the measure of patient activation (PAM) was 65.

The PAM score measured a patient’s knowledge, ability, and confidence in managing their own health, on a 100-point scale, with higher scores indicating higher levels of activation.

Patients were classified into 1 of 4 activation levels based on their overall PAM score, and only 6% were classified as “disengaged and overwhelmed.”

Investigators felt that the study addressed the lack of understanding of the patient’s experience with the BI titration.

“While many people with T2DM initiating BI had received titration training / support, only a third achieved the FBG target, suggesting new tools and strategies to empower patients and enable effective BI titration. The team wrote.

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