Effectiveness and safety of physician versus patient-led titration of insulin glargine in Indian patients with type 2 diabetes mellitus: A sub-analysis of the Asian Treat to Target Lantus Study (ATLAS).

Abstract

BACKGROUND\nTitration of basal insulin led by either the physician or patient is not well understood in India. This analysis of Indian subset of Asian Treat to Target Lantus Study (ATLAS) compared effectiveness of patient-led with physician-led titration of once-daily insulin glargine 100 U/mL (Glargine-U-100) in patients with type 2 diabetes mellitus (T2DM) uncontrolled on oral anti-diabetic agents (OADs).\n\n\nMETHODS\nIn this open-label parallel group study, randomized patients (either physician-led or patient-led [self-titration] group) followed the same dose-titration algorithm (FBG target 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA1c) at week-24 in the patient-led vs. physician-led group.\n\n\nRESULTS\nPatients (40-75 years) were randomized to either the physician-led (n=39) or patient-led (n=36) group. At week-24, self-titration led to a greater decline in HbA1c than physician-led titration (-1.3% vs. -1.1%). Mean decrease in FBG was more in the patient-led than physician-led group (-53.7 mg/dL vs. -35.5 mg/dL). The mean daily dose of Glargine-U-100 at week-24 was higher in the patient-led than physician-led group (30.0 U vs. 23.8 U). At any time during the study, 30.6% and 7.7% patients in the patient-led and physician-led groups, respectively, showed target HbA1c level of <7.0% without severe hypoglycemia. Treatment satisfaction and quality of life improved in both groups. Overall, treatment was safe and well-tolerated, and none of the events led to treatment discontinuation.\n\n\nCONCLUSION\nPatient-led adjustment of Glargine-U-100 in outpatient setting can be a safe and effective method for glycemic control in Indian patients with T2DM uncontrolled on OADs.