Related Experiment Video
Updated: May 23, 2025

Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
How can we best support insulin self-titration in type 2 diabetes patients: A systematic review and network
Panitan Pitak1, Kansak Boonpattharatthiti2, Anjana Fuangchan3
1Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; Department of Clinical Pharmacy, Nan Hospital, Nan, Thailand.
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.
Related Concept Videos
Insulin: Dosing Regimen and Adverse Effects
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Diabetes Mellitus: Type 2 and Gestational
Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...
Oral Hypoglycemic Agents: Biguanides and Glitazones

