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Evidence-Based Medicine 2006;11:46; doi:10.1136/ebm.11.2.46
Copyright © 2006 by the BMJ Publishing Group Ltd.
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Therapeutics

Glargine dose titration by patients and physicians was equally effective for preventing severe hypoglycaemia

Davies M, Storms F, Shutler S, et al. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care 2005;28:1282–8.[Abstract/Free Full Text]

Q In patients with suboptimally controlled type 2 diabetes mellitus, is insulin glargine dose titration by a physician equivalent to titration by the patient for preventing severe hypoglycaemia and improving glycaemic control?

Clinical impact ratings GP/FP/Primary care ******{star} Internal medicine *****{star}{star} Endocrine ******{star}

Key Words: blood glucose • diabetes mellitus (type 2) • insulin

The first 150 words of the full text of this article appear below.

METHODS
Formula Design: randomised controlled trial.*

Formula Allocation: unclear concealment.*

Formula Blinding: unblinded.*

Formula Follow up period: 24 weeks.

Formula Setting: 611 centres in 59 countries in Western and Eastern Europe, South America, Asia, and Africa/Middle East.

Formula Patients: 5033 patients >=18 years of age (mean age 58 y, 58% women) with suboptimally controlled type 2 diabetes mellitus (required basal long acting insulin for the control of hyperglycaemia) and glycated haemoglobin [HbA1C] concentrations >7.0% and <12.0% and BMI <40 kg/m2. Exclusion criteria included impaired renal function and acute or chronic metabolic acidosis.

Formula Intervention: physician led dose titration of insulin glargine (n = 2529) or self managed dose adjustments (n = 2504). Patients in the physician managed group had their basal insulin dose adjusted weekly. In the self managed group, patients adjusted their basal insulin every 3 days, but these adjustments were reviewed by the investigator. Both algorithms had a target fasting blood glucose of <=100 . . . [Full text of this article]

Sarah E Capes, MD, MSc, FRCPC

Vancouver Island Health Authority, Victoria, British Columbia, Canada


Related Article

Glossary
Evid. Based Med. 2006 11: 63a. (in Glossary) [Extract] [Full Text] [PDF]





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