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Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study

INTRODUCTION: Subcutaneous administration of insulin is the preferred method for achieving glucose control in non-critically ill patients with diabetes. Glucose-based titration protocols were widely applied in clinical practice. However, most of these algorithms are experience-based and there is con...

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Autores principales: Zhang, Xiaodan, Zhang, Tong, Xiang, Guangda, Wang, Wenbo, Li, Yanli, Du, Tao, Zhao, Yunjuan, Mosha, Singla Sethiel, Li, Wangen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493103/
https://www.ncbi.nlm.nih.gov/pubmed/32933950
http://dx.doi.org/10.1136/bmjdrc-2020-001261
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author Zhang, Xiaodan
Zhang, Tong
Xiang, Guangda
Wang, Wenbo
Li, Yanli
Du, Tao
Zhao, Yunjuan
Mosha, Singla Sethiel
Li, Wangen
author_facet Zhang, Xiaodan
Zhang, Tong
Xiang, Guangda
Wang, Wenbo
Li, Yanli
Du, Tao
Zhao, Yunjuan
Mosha, Singla Sethiel
Li, Wangen
author_sort Zhang, Xiaodan
collection PubMed
description INTRODUCTION: Subcutaneous administration of insulin is the preferred method for achieving glucose control in non-critically ill patients with diabetes. Glucose-based titration protocols were widely applied in clinical practice. However, most of these algorithms are experience-based and there is considerable variability and complexity. This study aimed to compare the effectiveness and safety of a weight-based insulin titration algorithm versus glucose-based algorithm in hospitalized patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: This randomized clinical trial was carried out at four centers in the South, Central and North China. Inpatients with T2DM were randomly assigned (1:1) to receive weight-based and glucose-based insulin titration algorithms. The primary outcome was the length of time for reaching blood glucose (BG) targets (fasting BG (FBG) and 2-hour postprandial BG (2hBG) after three meals). The secondary outcome included insulin dose for achieving glycemic control and the incidence of hypoglycemia during hospitalization. RESULTS: Between January 2016 and June 2019, 780 patients were screened, and 575 completed the trial (283 in the weight-based group and 292 in the glucose-based group). The lengths of time for reaching BG targets at four time points were comparable between two groups. FBG reached targets within 3 days and 2hBG after three meals within 4 days. There is no significant difference in insulin doses between two groups at the end of the study. The total daily dosage was about 1 unit/kg/day, and the ratio of basal-to-bolus was about 2:3 in both groups. The incidence of hypoglycemia was similar in both groups, and severe hypoglycemia was not detected in either of the groups. CONCLUSIONS: Weight-based insulin titration algorithm is equally effective and safe in hospitalized patients with T2DM compared with glucose-based algorithm. TRIAL REGISTRATION NUMBER: NCT03220919.
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spelling pubmed-74931032020-09-24 Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study Zhang, Xiaodan Zhang, Tong Xiang, Guangda Wang, Wenbo Li, Yanli Du, Tao Zhao, Yunjuan Mosha, Singla Sethiel Li, Wangen BMJ Open Diabetes Res Care Emerging Technologies, Pharmacology and Therapeutics INTRODUCTION: Subcutaneous administration of insulin is the preferred method for achieving glucose control in non-critically ill patients with diabetes. Glucose-based titration protocols were widely applied in clinical practice. However, most of these algorithms are experience-based and there is considerable variability and complexity. This study aimed to compare the effectiveness and safety of a weight-based insulin titration algorithm versus glucose-based algorithm in hospitalized patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: This randomized clinical trial was carried out at four centers in the South, Central and North China. Inpatients with T2DM were randomly assigned (1:1) to receive weight-based and glucose-based insulin titration algorithms. The primary outcome was the length of time for reaching blood glucose (BG) targets (fasting BG (FBG) and 2-hour postprandial BG (2hBG) after three meals). The secondary outcome included insulin dose for achieving glycemic control and the incidence of hypoglycemia during hospitalization. RESULTS: Between January 2016 and June 2019, 780 patients were screened, and 575 completed the trial (283 in the weight-based group and 292 in the glucose-based group). The lengths of time for reaching BG targets at four time points were comparable between two groups. FBG reached targets within 3 days and 2hBG after three meals within 4 days. There is no significant difference in insulin doses between two groups at the end of the study. The total daily dosage was about 1 unit/kg/day, and the ratio of basal-to-bolus was about 2:3 in both groups. The incidence of hypoglycemia was similar in both groups, and severe hypoglycemia was not detected in either of the groups. CONCLUSIONS: Weight-based insulin titration algorithm is equally effective and safe in hospitalized patients with T2DM compared with glucose-based algorithm. TRIAL REGISTRATION NUMBER: NCT03220919. BMJ Publishing Group 2020-09-15 /pmc/articles/PMC7493103/ /pubmed/32933950 http://dx.doi.org/10.1136/bmjdrc-2020-001261 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Emerging Technologies, Pharmacology and Therapeutics
Zhang, Xiaodan
Zhang, Tong
Xiang, Guangda
Wang, Wenbo
Li, Yanli
Du, Tao
Zhao, Yunjuan
Mosha, Singla Sethiel
Li, Wangen
Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title_full Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title_fullStr Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title_full_unstemmed Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title_short Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
title_sort comparison of weight-based insulin titration (wit) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
topic Emerging Technologies, Pharmacology and Therapeutics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493103/
https://www.ncbi.nlm.nih.gov/pubmed/32933950
http://dx.doi.org/10.1136/bmjdrc-2020-001261
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