title: Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational ATLAS study.
abstract: OBJECTIVE
  Self-adjustment of insulin dose is commonly practiced in Western patients with type 2 diabetes but is usually not performed in Asian patients. This multinational, 24-week, randomized study compared patient-led with physician-led titration of once-daily insulin glargine in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering agents.
  
  
  METHODS
  Patient-led (n = 275) or physician-led (n = 277) subjects followed the same dose-titration algorithm guided by self-monitored fasting blood glucose (FBG; target, 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA1c) at week 24 in the patient-led versus physician-led titration groups.
  
  
  RESULTS
  Patient-led titration resulted in a significantly higher drop in HbA1c value at 24 weeks when compared with physician-led titration (-1.40% vs. -1.25%; mean difference, -0.15; 95% confidence interval, -0.29 to 0.00; P = .043). Mean decrease in FBG was greatest in the patient-led group (-2.85 mmol/L vs. -2.48 mmol/L; P = .001). The improvements in HbA1c and FBG were consistent across countries, with similar improvements in treatment satisfaction in both groups. Mean daily insulin dose was higher in the patient-led group (28.9 units vs. 22.2 units; P<.001). Target HbA1c of <7.0% without severe hypoglycemia was achieved in 40.0% and 32.9% in the patient-led and physician-led groups, respectively (P = .086). Severe hypoglycemia was not different in the 2 groups (0.7%), with an increase in nocturnal and symptomatic hypoglycemia in the patient-led arm.
  
  
  CONCLUSIONS
  Patient-led insulin glargine titration achieved near-target blood glucose levels in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering drugs, demonstrating that Asian patients can self-uptitrate insulin dose effectively when guided.
authors.affiliation: Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Garg
authors.affiliation: Global Diabetes Division, Sanofi, Paris, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Admane
authors.affiliation: Department of Primary Care and Population Health, University College London, London, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.affiliation: Department of Diabetology, Metabolism, and Endocrinology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Odawara
authors.affiliation: Department of Endocrinology, Chinese PLA General Hospital, Hai dian District, Beijing, China.
authors.forename: Chang-Yu
authors.initials: CY
authors.lastname: Pan
authors.affiliation: Fortis CDOC Center of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, Chirag Enclave, New Delhi, India.
authors.forename: Anoop
authors.initials: A
authors.lastname: Misra
authors.affiliation: Endocrinology Research Center, Russian Academy of Medical Sciences, Moscow, Russian Federation.
authors.forename: Iwona R
authors.initials: IR
authors.lastname: Jarek-Martynowa
authors.affiliation: Department of Endocrinology, Shaukhat Khanum Cancer Hospital and Research Center, Lahore, Pakistan.
authors.forename: Syed
authors.initials: S
authors.lastname: Abbas-Raza
authors.affiliation: St. Luke's Medical Center, Quezon City, Philippines.
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Mirasol
authors.affiliation: Global Diabetes Division, Sanofi, Paris, France.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Perfetti
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069036:Insulin Glargine; C517652:hemoglobin A1c protein, human