Simplified Self-Titration of Basal Insulin Injection in Type 2 Diabetes

Abstract

Plasma glucose of many patients with type 2 diabetes remains poorly controlled even with high doses of oral hypoglycemic agents. Initiation of basal insulin injection daily and self-titration of insulin doses based on self-monitoring of blood glucose (SMBG) may improve target control of plasma glucose.

Objective: To evaluate the efficacy of initiation of basal insulin therapy with self-titration in addition to oral therapy in type 2 diabetic patients whose plasma glucose remains uncontrolled.

Material and method: This was a retrospective study of chart review of selected case files of outpatients who visited diabetes clinic at Phrachomklao Hospital from 1 September 2013 to 31 August 2015 and SMBG logbooks from District Health Promoting Hospitals (DHPH).
Results: A total of 90 patients with evaluable data were identified. The majority of patients were female (70%) with mean age and time after diagnosis of 55.2 ± 10.2 years and 8.8 ± 4.8 years, respectively. The majority of the oral hypoglycemic agents used were Sulfonylureas in combination with Metformin (46.7%). Initial HbA1c was on average 9.2 ± 1.2% which was reduced to 8.0 ± 1.2% and 7.8 ± 1.3% at 3 and 6 months, respectively. The HbA1c target of 7% or less was reached in 18 subjects (20%) at the end of the study. Insulin dosage was titrated from initial dose of 7.9 ± 1.6 unit/day to 15.2 unit/day after 6 months. Weight increased similarly from 71.5 ± 15.0 kg to 72.5 ± 10.5 kg. Patient adherence to the treatment protocol for fingertip blood glucose test was high (96.0%). Of the total number of capillary blood glucose tests after basal insulin initiation, 1,222 (61.5%) were within defined criteria of proper plasma glucose. A mere 61 episodes of mild hypoglycemia were reported. No severe hypoglycemia was found.
Conclusion: Initiation of basal insulin at bedtime in type 2 diabetic patients whose glucose levels remain uncontrolled despite high doses of oral hypoglycemic agents should be encouraged in combination with weekly SMBG by fingertip sampling and self-titration of insulin doses. This practice markedly helps improve target control of plasma glucose without severe hypoglycemic episodes.