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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
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



















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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