Insulin titration trial
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Insulin Titration Trial. Will Hsu MD. Aldo Rossini MD. Sue Ghiloni RN, CDE. Paige Ricci. Insulin Titration Trial - Design. Type II Diabetics >18 yo , HbA1C 9-14%, Starting insulin 3 month, randomized, controlled trial Control: standard of care at Joslin

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Insulin Titration Trial

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Insulin titration trial

Insulin Titration Trial

Will Hsu MD

Aldo Rossini MD

Sue Ghiloni RN, CDE

Paige Ricci


Insulin titration trial design

Insulin Titration Trial - Design

  • Type II Diabetics

    • >18 yo, HbA1C 9-14%, Starting insulin

  • 3 month, randomized, controlled trial

    • Control: standard of care at Joslin

      • Self-titration + diabetes educator

    • Intervention: apprenticeship at Joslin

      • Tablet with CollaboRhythm + 303 Protocol + coach

  • Primary Outcome: Δ HbA1C


Insulin titration trial technology

Insulin Titration Trial - Technology


Insulin titration trial technology1

Insulin Titration Trial - Technology


Insulin titration trial technology2

Insulin Titration Trial - Technology


Insulin titration trial technology3

Insulin Titration Trial - Technology


Insulin titration trial technology4

Insulin Titration Trial - Technology


Insulin titration trial technology5

Insulin Titration Trial - Technology


Insulin titration trial technology6

Insulin Titration Trial - Technology


Insulin titration trial technology7

Insulin Titration Trial - Technology


Insulin titration trial technology8

Insulin Titration Trial - Technology


Insulin titration trial technology9

Insulin Titration Trial - Technology


Insulin titration trial technology10

Insulin Titration Trial - Technology


Insulin titration trial technology11

Insulin Titration Trial - Technology


Insulin titration trial technology12

Insulin Titration Trial - Technology


Insulin titration trial technology13

Insulin Titration Trial - Technology


Insulin titration trial technology14

Insulin Titration Trial - Technology


Insulin titration trial technology15

Insulin Titration Trial - Technology


Insulin titration trial technology16

Insulin Titration Trial - Technology


Insulin titration trial

p = 0.195

  • ▼2% HbA1Cvs standard ~ ▼40% complications

    • ~ $4 K savings / year / patient, $120 K lifetime

    • ~ $15 B savings / year for US

  • ▼0.6% HbA1C vs Joslin ~ ▼12% complications

    • Spent extra $315 in clinician time per patient

    • $14,000 in lifetime savings per patient

  • ▼1% HbAIC~▼20% complications

    • Heart attack, stroke, kidney failure, vision loss…

Menighini (2007)

Avg HbA1C = 8.5%

Sample = 5604

Duration = 6 months

Yki-Jarvinen (2007)

Avg HbA1C = 8.9%

Sample = 121

Duration = 6 months

Moore (2013)

Avg HbA1C = 10.8%

Sample = 25

Duration = 3 months

Davis (2013) Real-world comparative outcomes of US type 2 diabetes patients initiating analog basal insulin therapy. Curr Med Res Op

Caro (2002) Lifetime Costs of Complications Resulting from Type 2 Diabetes in the US. Diabetes Care

American Association of Clinical Endocrinologists (2006) State of Diabetes Complications in America.

CDC (2011) National Diabetes Fact Sheet.

Stratton (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ


Insulin titration trial experience

Insulin Titration Trial - Experience

p = 0.015

p = 0.005

Pre

Post

Pre

Post

Bradley (1994) The Diabetes Treatment Satisfaction Questionnaire: DTSQ


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