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Basal-bolus therapy with insulin detemir using the 303 algorithm in the US PREDICTIVE 303 trial
Jean-Louis Selam1, Luigi F Meneghini
1Diabetes Research Center, 2492 Walnut Ave, Tustin, California 92780, USA. jlselam@cox.net
Advances in Therapy
|March 5, 2009
Summary
Patients with type 2 diabetes using the 303 Algorithm for insulin detemir adjustments achieved similar glycemic control compared to physician-driven adjustments. This simplified, patient-led approach effectively manages blood sugar in basal-bolus therapy.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 2 diabetes management often involves complex insulin titration.
- Basal-bolus insulin therapy requires careful adjustment of both basal and bolus doses.
- Physician-driven adjustments can be time-consuming and may not always reflect real-time patient needs.
Purpose of the Study:
- To compare a simplified patient-driven algorithm (303 Algorithm) with physician-driven adjustments for insulin detemir.
- To evaluate the efficacy of patient-led insulin titration in type 2 diabetes patients on basal-bolus therapy.
- To assess glycemic control, fasting plasma glucose (FPG), and hypoglycemia rates between the two management approaches.
Main Methods:
- A subset of 193 patients with type 2 diabetes from the PREDICTIVE 303 study were randomized.
- One group used the 303 Algorithm to adjust insulin detemir doses every 3 days based on FPG levels.
- The control group received physician-directed adjustments of insulin detemir according to standard practice.
Main Results:
- Both groups achieved comparable reductions in glycated hemoglobin (HbA1c).
- The 303 Algorithm group demonstrated a significantly greater reduction in FPG compared to the standard-of-care group.
- Similar rates of overall hypoglycemia and weight reduction were observed in both groups.
Conclusions:
- Patient-driven adjustments of once-daily insulin detemir using the 303 Algorithm are as effective as physician-directed adjustments for improving glycemic control.
- The 303 Algorithm offers a viable, patient-empowering alternative for managing type 2 diabetes with basal-bolus insulin therapy.
- Simplified algorithms can support effective self-management of insulin therapy in type 2 diabetes.
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