Automatic insulin titration improves glycemic control in type 2 diabetes
medwireNews: Insulin-dependent patients with type 2 diabetes using the d-Nav® system improve their glycemic control over and above that achieved with intensive healthcare professional (HCP) support, research shows.
Previous research showed that patients achieved significant reductions in their glycated hemoglobin (HbA1c) levels when using the d-Nav® Insulin Guidance Service (Hygieia, Livonia, Michigan, USA), which is a handheld device that calculates the optimal insulin dose according to patients’ glucose levels.
However, presenting the latest findings at the ADA’s 78th Scientific Sessions in Orlando, Florida, USA, Israel Hodish (University of Michigan, Ann Arbor) noted that patients also received intensive HCP support to help them follow the device’s recommendations, leaving open the question of whether the support alone would be sufficient.
All patients in this follow-up multicenter study received the same level of HCP support, amounting to seven interactions over 6 months, but 93 patients were randomly assigned to also receive the titration device, whereas the other 88 received HCP support only. They were approximately 60 years of age and had a diabetes duration of 15–16 years.
Starting HbA1c levels were 8.7% and 8.5% in the device and HCP groups, respectively, and over the subsequent 6 months these fell by a corresponding 1.0% and 0.3%, with the difference between the two groups being statistically significant. Average daily insulin dose rose markedly in the device group, from 0.77 to 1.24 U/kg, compared with 0.71 to 0.76 U/kg in the HCP group.
From previous experience with the d-Nav® system, the team anticipates that insulin doses will continue to increase – and HbA1c levels to decline – for a further few months before stabilizing, said Hodish.
Despite the large overall increase in insulin dose, he said that one in every six titrations made by the device was a dose reduction. He noted that an individual’s insulin requirement is “very dynamic and you need to chase it with frequent titrations,” with insulin manufacturers advising weekly dose adjustments, which is hard to achieve in clinical practice. The device often titrated it more frequently, however.
The increased insulin dose and lower HbA1c did not result in more hypoglycemia, with both groups having 0.29 episodes of minor hypoglycemia (≤54 mg/dL) per patient–month and two severe hypoglycemic events during the 6-month study.
The team also presented a poster of their research showing that the device is cost-saving.
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