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01-11-2009 | Diabetes | Article

Self-titration of insulin effective for glycemic control in Type 2 diabetics


Free abstract

MedWire News: Previously insulin-naïve Type 2 diabetes patients can effectively control their glycated hemoglobin (HbA1c) by self-titration of an insulin analog premix with minimal dietary counseling, report researchers.

The findings suggest patients can be educated and empowered to self-titrate insulin dosage and achieve good glycemic control in a primary care setting, say the authors who explain that there are now too few diabetes specialists available to treat the burgeoning number of children and adults with poorly controlled diabetes.

For this study, Oyer and team recruited 4875 insulin-naïve patients with an HbA1c of 8% or above to take part in a 24-week trial of twice-daily biphasic insulin aspart 70/30 called the INITIATEplus trial.

All participants were given instructions by their physician on how to self-titrate the level of insulin according to self-measured blood glucose values, but were randomly assigned to receive different levels of support from a trained dietician during the study. This took the form of three (n=1626), one (n=1624), or no (standard treatment; n=1625), telephone counseling sessions.

The average baseline HbA1c of the participants was 9.9%. After 24 weeks, HbA1c had decreased to 7.49%, 7.48%, and 7.44% in the standard treatment, one, and three counseling session groups, respectively, amounting to an average decrease of 2.5%.

The counseling sessions did not influence the efficacy of self-titration for successful glycemic control, but reduced rates of minor and major hypoglycemias in these patients.

The rates of minor hypoglycemia were 54, 50, and 45 episodes per 100 patient-years in the standard treatment, one, and three counseling session groups, respectively, and corresponding rates for major hypoglycemia were 9, 6, and 4 episodes per 100 patient-years.

In addition, all groups had increased weight at 24 weeks, but the increase was smaller in the group which received three counseling sessions, at 2.88 kg, than in the standard treatment and one counseling session groups, at 3.13 kg and 3.40 kg, respectively.

Writing in the American Journal of Medicine, the team concludes that “the INITIATEplus study is highly relevant for primary care physicians who treat the majority of patients with Type 2 diabetes, demonstrating that biphasic insulin aspart is a viable option for initiating insulin therapy in those patients who have difficulty meeting glycemic goals with oral agents alone.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

By Helen Albert