How can we best support insulin self-titration in type 2 diabetes patients: A systematic review and network meta-analysis

Abstract

Introduction

The efficacy of insulin self-titration in type 2 diabetes (T2D) varies by support strategy. This study aimed to identify the effects of different insulin self-titration support strategies in patients with T2D.

Methods

PubMed, EMBASE, CENTRAL, and EBSCO Open Dissertations were searched from inception to January 2023. Randomized controlled trials (RCTs) on T2D patients that reported HbA1c reduction of insulin self-titration supports were included. The interventions were classified based on the following components: dosage guidance (DG), non-dosage guidance (NDG) and empowerment. The pooled estimates were presented as mean differences (MDs) and risk ratios (RRs) with 95 % confidence interval (CI) using a random-effects model. The certainty of evidence was evaluated utilizing the CINeMA online platform.

Results

Seventeen RCTs (13,528 participants) were included. Compared with usual care (UC), the greatest reduction in HbA1c was observed in patients receiving dosage guidance/Empowerment (MD −1.20; 95 %CI: −2.33,−0.07), with moderate certainty of evidence. Lesser HbA1c reduction, MD [95 % CI], were observed in other support strategies when compared with usual care as follows: −0.97 [−1.24,−0.69] in non-dosage guidance/Empowerment, −0.42 [−0.60,−0.24] in dosage guidance, and −0.31 [−0.58,−0.03] in non-dosage guidance. The risk of severe hypoglycemia was not significantly difference among all support strategies, with very low certainty.

Conclusions

Incorporating patient empowerment into insulin self-titration support strategy, either dosage or non-dosage guidance, is more effective in lowering HbA1c.