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Comparative Study
. 2018 Feb;20(2):301-308.
doi: 10.1111/dom.13064. Epub 2017 Sep 12.

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Lori Berard  1 , Mireille Bonnemaire  2 , Marie Mical  2 , Steve Edelman  3
Affiliations
Comparative Study

Insights into optimal basal insulin titration in type 2 diabetes: Results of a quantitative survey

Lori Berard et al. Diabetes Obes Metab. 2018 Feb.

Abstract

Aims: Basal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such "clinical inertia" results in poor glycaemic control and high risk of long-term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration.

Methods: An online survey (July-August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months.

Results: Participants comprised 386 HCPs and 318 people with T2DM. While >75% of HCPs reported discussing titration at the initiation visit, only 16% to 28% of patients remembered such discussions, many (32%-42%) were unaware of the need to titrate BI, and only 28% to 39% recalled mention of the time needed to reach glycaemic goals. Most HCPs and patients agreed that more effective support tools to assist BI initiation/titration are needed; patients indicated that provision of such tools would increase confidence in self-titration. HCPs identified fear of hypoglycaemia, failure to titrate in the absence of symptoms, and low patient motivation as important titration barriers. In contrast, patients identified weight gain, the perception that titration meant worsening disease, frustration over the time to reach HbA1c goals and fear of hypoglycaemia as major factors.

Conclusion: A disconnect exists between HCP- and patient-perceived barriers to effective BI titration. To optimize titration, strategies should be targeted to improve HCP-patient communication, and provide support and educational tools.

Keywords: basal insulin; insulin analogues; insulin therapy; type 2 diabetes.

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Conflict of interest statement

L. B. has served on an advisory panel for Abbott, AstraZeneca, BD, Eli Lilly, Janssen, Lifescan, Novo Nordisk, Sanofi; has been a consultant to Abbott, AstraZeneca, Bayer, BD, Boehringer Ingelheim, Eli Lilly, Janssen, Lifescan, Merck, Novo Nordisk, Sanofi; and has served on a speakers bureau for Abbott, AstraZeneca, Bayer, BD, Boehringer Ingelheim, Eli Lilly, Janssen, Lifescan, Merck, Novo Nordisk, Sanofi. M. B. and M. M. are employees of Sanofi. S. E. has no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Information on basal insulin titration shared by HCPs with all patients. Abbreviations: BG, blood glucose; HCP, healthcare professional; SMPG, self‐monitored plasma glucose
Figure 2
Figure 2
Barriers to self‐titration identified by HCPs and patients. The top 9 of 14 potential response options are shown for HCPs, with the corresponding response options shown for patients. BI, basal insulin; HCP, healthcare professional
Figure 3
Figure 3
Provision of information on titration factors: factors recalled by patients as being discussed with HCPs, and those factors patients consider would increase confidence in self‐titration. HCP, healthcare professional
See this image and copyright information in PMC

References

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