Insulin titration for patients with type 2 diabetes commencing insulin can be problematic with many patients not achieving target blood glucose levels. A patient self-titration of insulin Model of Care (MoC) has been implemented with eligible patients using titration protocols to adjust their insulin doses following their first injection.
This study aimed to evaluate participant satisfaction with the MoC & titration protocols, & changes to selected clinical indicators after 3 months of insulin therapy.
Ethics approval was received to conduct a 2 year longitudinal observational study of patients using the MoC. The MoC & titration protocols were developed & piloted. Patients were recruited with their signed consent & consent & referral of their doctor. Initial data were collected at recruitment & at 3 months. Analysis of MoC & protocols includes qualitative self-report data & Likert scale responses. Quantative analysis includes descriptive data, mean±SD [range]) and paired t tests. Significance is set at p<0.05.
Of 30 patients recruited, 4 withdrew. Data are presented on 26 participants (18 male, 8 female). Age, body mass index and HbA1c at recruitment were 60±10 [37-81] years, 30.7±6.1 [22.8-51.3] kg/m2 and 9.69 ±1.14 [7.7-12.1] %, respectively. After 3 months of insulin therapy, body weight increased by an average of 2.0 kg (95% CI 0.6 to 3.3, p<0.01) and HbA1c decreased by an average of 1.6 % (95%CI -1.1 to -2.0, p<0.0001). All participants (100%) attributed to the MoC improved skills, knowledge & confidence in insulin dose adjustment & diabetes self-management. All (100%) strongly agreed/agreed the protocols were easy to use.
In summary, participants after 3 months were supportive of the MoC & protocols reporting improvements in skills, knowledge, confidence & self management. Initial results show a significant increase in participant’s weight and a highly significant reduction in HbA1c. Study participants will be followed for a further 18 months to determine longer term outcomes.