Support for self-managed Gla-300 titration in type 2 diabetes
medwireNews: Findings from the TAKE CONTROL study suggest that self-managed titration of insulin glargine (Gla)-300 may achieve better glycemic control than physician-managed titration among individuals with type 2 diabetes.
As reported at the 54th EASD Annual Meeting in Berlin, Germany, 631 patients aged an average of 63.3 years with mean baseline glycated hemoglobin (HbA1c) levels of 8.4% were randomly assigned to undergo a 24-week self- or physician-managed Gla-300 titration regimen. The titration algorithm involved a dose increase of 3 U for patients with fasting self-monitored blood glucose (SMBG) levels above 7.2 mmol/L, a 3 U decrease for those with levels below 4.4 mmol/L, and no change in dosing when SMBG levels were within the target range of 4.4–7.2 mmol/L .
Although patients in both groups experienced an improvement in HbA1c levels from baseline to week 24, those in the self-managed titration arm experienced significantly greater decreases than those who underwent physician-managed titration, with a least squares mean difference of 0.13% (1.4 mmol/L).
Moreover, participants in the self-management arm were significantly more likely to achieve an HbA1c level below 7% and to meet the composite target of fasting SMBG levels of 4.4–7.2 mmol/L without confirmed or severe hypoglycemia than those in the physician-managed group, said David Russell-Jones (Royal Surrey County Hospital, Guildford, UK).
Indeed, the incidence of hypoglycemia was comparable in both the self-managed and physician-managed groups, with rates of 32.2% and 32.9%, respectively, and severe hypoglycemic events were “rare” (two and one events, respectively), he remarked.
Self-management of Gla-300 titration did not influence diabetes distress, Russell-Jones added, with similar reductions in Diabetes Distress Scale scores occurring in both groups from baseline to week 24. However, a significantly lower proportion of participants in the self-management group reported having high distress at week 24, at 13.1% versus 19.7%.“I think this study shows that [Gla-300] is very suitable for self-management of diabetes in people with type 2 diabetes,” concluded Russell-Jones.
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