| Popis: |
Ling Li,1 Xiaodan Zhang,1 Tong Zhang,2 Liankun Zeng,3 Mingrun Lin,4 Yanli Li,4 Wangen Li1 1Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China; 2Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 3Department of Endocrinology, The Fourth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of China; 4Department of Endocrinology, The Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, People’s Republic of ChinaCorrespondence: Wangen Li; Yanli Li, Email liwg660@126.com; liyanli0735@163.comAim: Insulin titration often faces inertia, hindering glycemic control. A patient-centered approach empowers patients to overcome this inertia. This study aims to compare the effectiveness of patient-preferred and guideline-recommended self-titration algorithms in achieving glycemic targets and improving adherence.Methods: Outpatients with type 2 diabetes (T2D) who did not respond to oral antihyperglycemic drugs (OAD) were assessed. They were randomly assigned to patient-preferred and guideline-recommended groups. In the patient-preferred group, individuals selected an algorithm to self-adjust their insulin glargine dosage by 2 units every 3 days if the mean fasting blood glucose (FBG) over the past 3 consecutive days was ≥ 7.0 mmol/L, or by 1 unit daily if the FBG on the same day was ≥ 7.0 mmol/L. In the guideline-recommended group, insulin glargine was titrated by 2 units every 3 days if the mean FBG over the past 3 consecutive days was ≥ 7.0 mmol/L. The FBG target was set below < 7.0 mmol/L.Results: Thirty-nine participants in the patient-preferred group and 42 in the guideline-recommended group completed the study. The cumulative rates of achieving the FBG target in the patient-preferred group compared to the guideline-recommended group were 69.2% vs 54.8% (χ²=1.792, p=0.181) in week 1, 89.7% vs 73.8% (χ²=3.403, p = 0.065) in week 2, 94.9% vs 76.2% (χ²=17.638, p=0.000) in week 3, and 100.0% vs 88.1% (χ²=4.405, p=0.036) in week 4. Adherence rates were significantly higher in the patient-preferred group (97.4%, 37/38) compared to the guideline-recommended group (66.7%, 28/42) (χ²=12.688, p=0.000). Insulin glargine dosage at FBG target achievement was 21.2± 4.3 U in the patient-preferred group and 18.8± 6.7 U in the guideline-recommended group (t=1.888, p=0.063). Hypoglycemia was reported in 1 patient in the guideline-recommended group, with no instances in the patient-preferred group.Conclusion: The patient-preferred self-titration algorithm demonstrates a higher rate of reaching glucose targets and improved adherence.Trial Registration Number: ChiCTR2100050805.Keywords: type 2 diabetes, glargine, self-titration, adherence, preference |
