An SMS-Guided Basal Insulin Titration in People with Type 2 Diabetes New on Insulin.

IF 3.8 3区医学 Q2 Medicine Diabetes Therapy Pub Date : 2024-11-01 Epub Date: 2024-09-30 DOI:10.1007/s13300-024-01650-2

Tim Snel, Sven Reinhardt, Helena Koenig, Stefan Pleus, Guido Freckmann

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Abstract

Introduction: The shortage of general practitioners (GPs) and the increasing prevalence of type 2 diabetes create significant pressure on primary healthcare services. To enable that medical services are available to all that need it, innovative solutions are needed. One of those, a Short Message Service (SMS)-supported basal insulin titration service is investigated in this study. The primary objective was to determine the percentage of subjects who achieved stable fasting blood glucose (FBG) within their individual target range with this service after week 16.

Methods: This single-arm, 16-week study aimed to enroll 111 adults diagnosed with type 2 diabetes that needed insulin. The study subjects measured their FBG 4 consecutive days to establish a baseline, then received SMS prompts for daily FBG measurements and evening insulin injections until their FBG stabilized within the target range. Adjusting the insulin based on the FBG. Once stabilization was achieved, subjects continued with their optimal insulin dose for the remainder of the study. Sixteen weeks after the baseline, subjects measured FBG for 4 days before visit 4, where these values were read by the healthcare provider.

Results: Out of the planned 111 subjects, only 30 were enrolled, with one withdrawal prior to service activation. Challenges in subject recruitment were attributed to the COVID-19 outbreak, limited eligibility, competing studies, and new medications delaying insulin initiation. Subjects were on average 59.97 years old, had an HbA1c of 9.29% a FBG of 205.64 mg/dl, and had diabetes for 10 years. Among the 29 subjects who started the service, 72% achieved successful titration at visit 4, with a median time of 49 days. Notable improvements were observed in HbA1c levels (decreased by 1.58%) and FBG levels (decreased by 64 mg/dl) over the 16-week study period. No adverse events or device-related issues were reported.

Conclusions: Despite recruitment challenges, guided basal insulin titration holds promise for insulin therapy initiation in individuals. The findings emphasize the potential of tele-medical approaches, specifically through remote messaging, in managing diabetes and improving therapy adherence.

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短信指导新使用胰岛素的 2 型糖尿病患者进行基础胰岛素滴定。

导言：全科医生（GP）的短缺和 2 型糖尿病发病率的上升给初级医疗保健服务带来了巨大压力。为了让所有需要的人都能享受到医疗服务，我们需要创新的解决方案。本研究调查了其中一种由短信服务（SMS）支持的基础胰岛素滴定服务。主要目的是确定在使用该服务 16 周后，空腹血糖（FBG）稳定在个人目标范围内的受试者百分比：这项为期 16 周的单臂研究旨在招募 111 名确诊为需要使用胰岛素的 2 型糖尿病成人。研究对象连续 4 天测量血糖生成指数（FBG）以建立基线，然后接收短信提示，每天测量血糖生成指数并在晚上注射胰岛素，直到血糖生成指数稳定在目标范围内。根据 FBG 调整胰岛素。一旦达到稳定，受试者在研究的剩余时间内将继续使用最佳胰岛素剂量。基线测定 16 周后，受试者在第 4 次就诊前测量 4 天的 FBG，由医疗服务提供者读取这些数值：结果：在计划招募的 111 名受试者中，只有 30 人被招募，其中一人在服务启动前退出。COVID-19疫情的爆发、受试者资格的限制、竞争性研究以及新药推迟了胰岛素的使用，都给受试者的招募工作带来了挑战。受试者平均年龄为 59.97 岁，HbA1c 为 9.29%，FBG 为 205.64 mg/dl，患糖尿病已有 10 年。在开始接受该服务的 29 名受试者中，72% 的人在第 4 次就诊时成功滴定，中位时间为 49 天。在为期 16 周的研究期间，HbA1c 水平（降低了 1.58%）和 FBG 水平（降低了 64 mg/dl）均有显著改善。无不良事件或设备相关问题报告：结论：尽管在招募方面存在挑战，但引导式基础胰岛素滴定仍有望帮助个人开始胰岛素治疗。研究结果强调了远程医疗方法（特别是通过远程信息传递）在管理糖尿病和改善治疗依从性方面的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.