Abstract:
BACKGROUND. Self-monitoring of blood glucose (SMBG) can inform on the timing of hyperglycaemia, but there is currently no standardised
approach to utilising these data to improve glycaemic control in patients with type 2 diabetes.
OBJECTIVES. To assess the improvement in glycaemic control when an insulin titration algorithm was used in combination with SMBG in
patients with poorly controlled, insulin-treated type 2 diabetes.
METHODS. This 6-month prospective study recruited 39 poorly controlled (glycated haemoglobin (HbA1c) ≥8.5%; 69.4 mmol/mol) type
2 diabetes subjects using twice-daily biphasic insulin from two state hospitals in Tshwane, South Africa. Patients were asked to perform
structured SMBG over 4 weeks and return monthly for consultations where physicians titrated insulin doses using an algorithm guided by
the data collected. The primary endpoint was the trend in HbA1c measured at baseline and 3 and 6 months.
RESULTS. Mean HbA1c decreased over the study period by 1.89% (95% confidence interval (CI) –2.46 - –1.33; p<0.001). The hypoglycaemic
event rate (<4.0 mmol/L) was 33.08 events per patient year. Total daily insulin use increased by a mean of 40.12 units over the study period
(standard error 7.7; p<0.001) and weight increased by an average of 3.98 kg (95% CI 2.56 - 5.41; p<0.001).
CONCLUSIONS. Monthly algorithmic insulin titration guided by structured SMBG can markedly improve glycaemic control in patients with
type 2 diabetes by aggressively increasing insulin doses not previously expected in this population, with moderate hypoglycaemic events
and weight gain observed.
