Comparison of Patient-Led and Physician-Led Insulin Titration in Japanese Type 2 Diabetes Mellitus Patients Based on Treatment Distress, Satisfaction, and Self-Efficacy: The COMMIT-Patient Study

Autor:	Yasuhiro Ono, Hitoshi Ishii, Yasunori Sato, Daigaku Uchida, Dai Shimono, Hiroki Nakajima, Nozomu Kamei, Daisuke Suzuki
Rok vydání:	2021
Předmět:	Quality of life medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism 030204 cardiovascular system & hematology Hypoglycemia 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Diabetes mellitus Internal medicine Self-management Internal Medicine Clinical endpoint Insulin Medicine Patient-reported outcome Original Research Glycemic Treatment satisfaction business.industry Patient-led insulin self-titration Type 2 Diabetes Mellitus medicine.disease Emotional distress Distress chemistry Physician-led insulin titration Glycated hemoglobin Self-efficacy business
Zdroj:	Diabetes Therapy
ISSN:	1869-6961 1869-6953
DOI:	10.1007/s13300-020-00995-8
Popis:	Introduction In Japan, patient-led insulin titration is rare in type 2 diabetes mellitus (T2DM) patients. Few studies have compared the effects of patient-led versus physician-led insulin titration on patient-reported outcomes in Japanese T2DM patients. This study aimed to compare the effects of patient-led and physician-led insulin titration in Japanese insulin-naïve T2DM patients on safety, glycemic control, and patient-reported outcomes (emotional distress, treatment satisfaction, and self-efficacy). Methods Ultimately, 125 insulin-naïve Japanese T2DM patients were randomly assigned to either a patient-led insulin self-titration group or a physician-led insulin titration group and monitored for 24 weeks. The primary endpoint was a change in emotional distress as measured using the Problem Areas in Diabetes scale (PAID). Secondary endpoints included treatment satisfaction, as measured with the Diabetes Treatment Satisfaction Questionnaire (DTSQ), self-efficacy as measured using the Insulin Therapy Self-Efficacy Scale (ITSS), glycated hemoglobin (HbA1c) levels, fasting plasma glucose levels, body weight, insulin daily dose, and frequency of hypoglycemia. Results There was no significant difference between the groups in PAID and DTSQ scores. The results for the primary endpoint should be interpreted taking account that the sample size for the power calculation was not reached. ITSS scores were significantly higher in the patient-led self-titration group. HbA1c and fasting plasma glucose levels were significantly decreased in both groups, but the decrease was significantly larger in the patient-led self-titration group. Although the insulin daily dose was significantly higher in the patient-led self-titration group, severe hypoglycemia did not occur in either group, and the frequency of hypoglycemia was similar in both groups. Conclusion Self-measurement of blood glucose and self-titration of insulin enhanced the patients’ self-efficacy without compromising their emotional distress or treatment satisfaction. Also, insulin self-titration was found to be safe and effective; it resulted in better glycemic control without severe hypoglycemia. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) (registration number: UMIN000020316). Supplementary Information The online version contains supplementary material available at 10.1007/s13300-020-00995-8.
Databáze:	OpenAIRE
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