ADA: Patients Beat Physicians at Insulin Dose Adjustment

CHICAGO, June 25 -- Type 2 diabetes patients taught to titrate their own insulin detemir (Levemir) dose may equal or exceed the results that physicians achieve, researchers reported here.

In a real-world study, patients using a dose self-adjustment algorithm had significantly greater fasting plasma glucose reductions (P

The control group had physicians adjust insulin detemir dose based on standard of care.

Dose adjustments were not enforced in either group.

Baseline characteristics were similar between groups. All patients were to have an HbA1c of no more than 12% and had to be judged "likely to benefit from initiation, addition, switching to, or continuation of insulin detemir therapy" to enter the trial. The majority (85%) of patients gave "improve glycemic control" as the reason for starting a new therapy.

After 26 weeks, overall HbA1c levels were improved slightly but significantly more by patient-driven dose adjustment than standard of care (P=0.0106), though both strategies improved levels compared with baseline (8.5% versus 7.9% and 8.5% versus 8.0%, respectively, both P

Dr. Meneghini concluded that patient-driven dose adjustments "appear to be a safe and effective alternative to physician-directed dose adjustment in the primary care setting."

However, he noted that even the best algorithm cannot improve outcomes if it is not carried through.