Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial
Xiling Hu,1,* Hongrong Deng,2,* Yao Zhang,2 Xiaodi Guo,2 Mengyin Cai,2 Cong Ling,3,* Kun Li4,* 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital...
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Dove Medical Press
2021
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type 2 diabetes mellitus basal insulin dosage titration Specialties of internal medicine RC581-951 |
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type 2 diabetes mellitus basal insulin dosage titration Specialties of internal medicine RC581-951 Hu X Deng H Zhang Y Guo X Cai M Ling C Li K Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
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Xiling Hu,1,* Hongrong Deng,2,* Yao Zhang,2 Xiaodi Guo,2 Mengyin Cai,2 Cong Ling,3,* Kun Li4,* 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 4School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cong LingDepartment of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of ChinaTel +86-13580465121Email doctor200@163.comKun LiSchool of Nursing, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, Guangdong, 510085, People’s Republic of ChinaTel +86-13822206519Email likun22@mail.sysu.edu.cnObjective: The main aim of this study was to evaluate a combined fasting blood glucose based dosage self-titration setting and decision supported telephone coaching intervention on glycemic control and diabetes self-management skills, compared to the conventional care.Methods: A 12-week, single-blinded, randomized controlled trial was conducted on adults with type 2 diabetes (T2DM) primarily treated with basal insulin. After randomization, the intervention group (IG, n = 426) received a basal insulin self-titration decision support intervention administered by the Diabetes Specialty Nurses while the control group (CG, n = 423) received conventional care for 12 weeks, both included five telephone interviews. The primary efficacy endpoint was the effect of intervention on glycemic control, measured as the change in glycated hemoglobin (HbA1c) from baseline to Week 12 (after intervention) compared to the control group. Other endpoints included comparisons of the effects of intervention on fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body weight, Michigan diabetes knowledge test (MDKT), diabetes empowerment scale-short Form (DES-DSF), and summary of diabetes self-care activities (SDSCA). Changes in the primary and secondary outcomes were compared using the t-test for continuous variables with a normal distribution and χ2-test for categorical variables.Results: The IG showed more improvements on mean HbA1c, compared to the CG (− 2.8% vs − 1.8%), so did the FPG, PPG, MDKT, DES-DSF and SDSCA (all P< 0.01) after the 12-week follow up. Though the final mean insulin dose in the IG was higher than the CG at the end of the study (0.32 U/kg vs 0.28 U/kg), the changes of body weight were similar between the two groups (0.46kg vs 0.40kg, P=0.246), and the proportion of patients with hypoglycemia events during the whole trial were similar (20.65% vs 17.73%, P=0.279).Conclusion: Decision supporting of basal insulin glargine self-titration assisted by Diabetes Specialty Nurses is effective and safe in patients with T2DM. Decision supported telephone coaching intervention offers ongoing encouragement, guidance, and determination of relevant sources of decisional conflict, facilitating adjusting the insulin dose.Keywords: type 2 diabetes mellitus, basal insulin, dosage titration |
| format |
article |
| author |
Hu X Deng H Zhang Y Guo X Cai M Ling C Li K |
| author_facet |
Hu X Deng H Zhang Y Guo X Cai M Ling C Li K |
| author_sort |
Hu X |
| title |
Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
| title_short |
Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
| title_full |
Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
| title_fullStr |
Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
| title_full_unstemmed |
Efficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial |
| title_sort |
efficacy and safety of a decision support intervention for basal insulin self-titration assisted by the nurse in outpatients with t2dm: a randomized controlled trial |
| publisher |
Dove Medical Press |
| publishDate |
2021 |
| url |
https://doaj.org/article/9c30abdb0de54d91a777fe641406c649 |
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oai:doaj.org-article:9c30abdb0de54d91a777fe641406c6492021-12-02T16:32:11ZEfficacy and Safety of a Decision Support Intervention for Basal Insulin Self-Titration Assisted by the Nurse in Outpatients with T2DM: A Randomized Controlled Trial1178-7007https://doaj.org/article/9c30abdb0de54d91a777fe641406c6492021-03-01T00:00:00Zhttps://www.dovepress.com/efficacy-and-safety-of-a-decision-support-intervention-for-basal-insul-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Xiling Hu,1,* Hongrong Deng,2,* Yao Zhang,2 Xiaodi Guo,2 Mengyin Cai,2 Cong Ling,3,* Kun Li4,* 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 4School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cong LingDepartment of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of ChinaTel +86-13580465121Email doctor200@163.comKun LiSchool of Nursing, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, Guangdong, 510085, People’s Republic of ChinaTel +86-13822206519Email likun22@mail.sysu.edu.cnObjective: The main aim of this study was to evaluate a combined fasting blood glucose based dosage self-titration setting and decision supported telephone coaching intervention on glycemic control and diabetes self-management skills, compared to the conventional care.Methods: A 12-week, single-blinded, randomized controlled trial was conducted on adults with type 2 diabetes (T2DM) primarily treated with basal insulin. After randomization, the intervention group (IG, n = 426) received a basal insulin self-titration decision support intervention administered by the Diabetes Specialty Nurses while the control group (CG, n = 423) received conventional care for 12 weeks, both included five telephone interviews. The primary efficacy endpoint was the effect of intervention on glycemic control, measured as the change in glycated hemoglobin (HbA1c) from baseline to Week 12 (after intervention) compared to the control group. Other endpoints included comparisons of the effects of intervention on fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body weight, Michigan diabetes knowledge test (MDKT), diabetes empowerment scale-short Form (DES-DSF), and summary of diabetes self-care activities (SDSCA). Changes in the primary and secondary outcomes were compared using the t-test for continuous variables with a normal distribution and χ2-test for categorical variables.Results: The IG showed more improvements on mean HbA1c, compared to the CG (− 2.8% vs − 1.8%), so did the FPG, PPG, MDKT, DES-DSF and SDSCA (all P< 0.01) after the 12-week follow up. Though the final mean insulin dose in the IG was higher than the CG at the end of the study (0.32 U/kg vs 0.28 U/kg), the changes of body weight were similar between the two groups (0.46kg vs 0.40kg, P=0.246), and the proportion of patients with hypoglycemia events during the whole trial were similar (20.65% vs 17.73%, P=0.279).Conclusion: Decision supporting of basal insulin glargine self-titration assisted by Diabetes Specialty Nurses is effective and safe in patients with T2DM. Decision supported telephone coaching intervention offers ongoing encouragement, guidance, and determination of relevant sources of decisional conflict, facilitating adjusting the insulin dose.Keywords: type 2 diabetes mellitus, basal insulin, dosage titrationHu XDeng HZhang YGuo XCai MLing CLi KDove Medical Pressarticletype 2 diabetes mellitusbasal insulindosage titrationSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 14, Pp 1315-1327 (2021) |