Insights into optimal basal insulin titration in type 2 diabetes: R esults of a quantitative survey
Open accessAbstract
Aims: Basal insulin ( BI ) treatment initiation and dose titration in type 2 diabetes ( T2DM ) are often delayed. Such “clinical inertia” results in poor glycaemic control and high risk of long‐term complications. This survey aimed to determine healthcare professional ( HCP ) and patient attitudes to BI initiation and titration. Methods: An online survey ( J uly– A ugust 2015) including HCP s and patients with T2DM in the USA , F rance and G ermany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months. Results: Participants comprised 386 HCP s and 318 people with T2DM . While >75% of HCP s reported discussing titration at the initiation visit, only 16% to 28% of patients remembered such discussions, many (32%–42%) were unaware of the need to titrate BI , and only 28% to 39% recalled mention of the time needed to reach glycaemic goals. Most HCP s and patients agreed that more effective support tools to assist BI initiation/titration are needed; patients indicated that provision of such tools would increase confidence in self‐titration. HCP s identified fear of hypoglycaemia, failure to titrate in the absence of symptoms, and low patient motivation as important titration barriers. In contrast, patients identified weight gain, the perception that titration meant worsening disease, frustration over the time to reach HbA1c goals and fear of hypoglycaemia as major factors. Conclusion: A disconnect exists between HCP ‐ and patient‐perceived barriers to effective BI titration. To optimize titration, strategies should be targeted to improve HCP –patient communication, and provide support and educational tools. Video Abstract: A free Video Abstract to accompany this article is available at: https://player.vimeo.com/video/239644085 .
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Results of an online survey in the USA, France and Germany showed that 32-42% of individuals with diabetes receiving basal insulin therapy were unaware of the need to titrate their insulin and 74% of physicians reported fear of hypoglycaemia as a barrier to optimal titration.
“Indeed, results of an online survey in the USA, France and Germany showed that 32–42% of individuals with diabetes receiving basal insulin therapy were unaware of the need to titrate their insulin and 74% of physicians reported fear of hypoglycaemia as a barrier to optimal titration [16].”
For some therapies, such as insulin, the perceived lack of efficacy may be a consequence of suboptimal titration due to patient and physician concerns such as weight gain, fear of hypoglycaemia, multiple daily injections, complexity of therapy or therapeutic burden.
“However, it is important to consider that for some therapies, such as insulin, the perceived lack of efficacy may be a consequence of suboptimal titration due to patient and physician concerns such as weight gain, fear of hypoglycaemia, multiple daily injections, complexity of therapy or therapeutic burden [16, 17].”
Patients who are concerned about hypoglycaemia are more likely to discontinue their insulin therapy.
“Additionally, patients who are concerned about hypoglycaemia are more likely to discontinue their insulin therapy.14”
From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [14]
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- Authors
- Berard, L., Bonnemaire, M., Mical, M., & Edelman, S.
- Affiliations
- Winnipeg Regional Health Authority (CA)
- Sanofi (France) (FR)
- University of California San Diego California
- Corresponding author
- Berard, Lori
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2017-09-12
- Volume
- 20
- Issue
- 2
- Pages
- 301-308
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC5811840
- OpenAlex
- W2739009446
- Cited by
- 69
- References
- 26
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 8 · 2021: 9 · 2020: 10 · 2019: 19 · 2018: 4 · 2017: 2
- FWCI
- 7.57
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- basal insulin, insulin dose adjustment, type 2 diabetes, clinical inertia, clinician attitudes, patient attitudes, fear of hypoglycemia, glycemic control, patient education
- MeSH terms
- Self-Management, Adult, Aged, Attitude of Health Personnel, Diabetes Mellitus, Type 2, Dose-Response Relationship, Drug, Female, France, Germany, Glycated Hemoglobin, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Risk, United States, Drug Monitoring, Health Care Surveys, Internet, Diabetes Complications
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