Feasibility of a New Approach to Initiate Insulin in Type 2 Diabetes

Treatment inertia and prescription complexity are among reasons that people with type 2 diabetes (T2D) do not reach glycemic targets. This study investigated feasibility of a new approach to basal insulin initiation, where the dose needed to reach a glycemic target is estimated from two weeks of insulin and continuous glucose monitoring (CGM) data.

This was an exploratory single arm study with a maximum length of 84 days. Eight insulin naïve people with T2D, planning to initiate basal insulin, wore a CGM throughout the study period. A predetermined regime was followed for the first two weeks after which the end dose was estimated. The clinician decided whether to follow this advice and continued the titration until target was reached using a twice weekly stepwise titration algorithm. The primary outcome was the comparison between the estimated and the actual end doses.

Median age of participants was 57 years (range: 50-77 years), duration of diabetes was 16 years (range: 5-29 years), and Bodi Mass Index (BMI) was 30.2 kg/m² (range: 22.0-36.0 kg/m²). The median study end dose was 37 U (range: 20-123 U). The estimated end dose was smaller than or equal to the study end dose in all cases, with median error of 26.7% (range: 0.0%-75.8% underestimation). No self-monitoring of blood glucose values were below 70 mg/dL and no severe hypoglycemia occurred.

While accuracy may be improved, it was found safe to predict the study end dose of insulin degludec from two weeks of data.