title: The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol.
abstract: BACKGROUND
  Patients on insulin glargine typically visit a clinician to obtain advice on how to adjust their insulin dose. These multiple clinic visits can be costly and time-consuming, particularly for low-income patients. It may be feasible to achieve insulin titration through text messages and phone calls with patients instead of face-to-face clinic visits.
  
  
  OBJECTIVE
  The objectives of this study are to (1) evaluate if the Mobile Insulin Titration Intervention (MITI) is clinically effective by helping patients reach their optimal dose of insulin glargine, (2) determine if the intervention is feasible within the setting and population, (3) assess patient satisfaction with the intervention, and (4) measure the costs associated with this intervention.
  
  
  METHODS
  This is a pilot study evaluating an approach to insulin titration using text messages and phone calls among patients with insulin-dependent type 2 diabetes in the outpatient medical clinic of Bellevue Hospital Center, a safety-net hospital in New York City. Patients will be randomized in a 1:1 ratio to either the MITI arm (texting/phone call intervention) or the usual-care arm (in-person clinic visits). Using a Web-based platform, weekday text messages will be sent to patients in the MITI arm, asking them to text back their fasting blood glucose values. In addition to daily reviews for alarm values, a clinician will rereview the texted values weekly, consult our physician-approved titration algorithm, and call the patients with advice on how to adjust their insulin dose. The primary outcome will be whether or not a patient reaches his/her optimal dose of insulin glargine within 12 weeks.
  
  
  RESULTS
  Recruitment for this study occurred between June 2013 and December 2014. We are continuing to collect intervention and follow-up data from our patients who are currently enrolled. The results of our data analysis are expected to be available in 2015.
  
  
  CONCLUSIONS
  This study explores the use of widely-available text messaging and voice technologies for insulin titration. We aim to show that remote insulin titration is clinically effective, feasible, satisfactory, and cost saving for low-income patients in a busy, urban clinic.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT01879579; http://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6WUEgjZUO).
authors: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States.
authors: Natalie
authors: http://orcid.org/0000-0003-2956-5876
authors: N
authors: Levy
authors: Victoria
authors: http://orcid.org/0000-0002-5480-0578
authors: V
authors: Moynihan
authors: Annielyn
authors: http://orcid.org/0000-0001-9165-3100
authors: A
authors: Nilo
authors: Karyn
authors: http://orcid.org/0000-0003-1543-0962
authors: K
authors: Singer
authors: Lidia S
authors: http://orcid.org/0000-0003-4943-6756
authors: LS
authors: Bernik
authors: Mary-Ann
authors: http://orcid.org/0000-0001-7697-8759
authors: MA
authors: Etiebet
authors: Yixin
authors: http://orcid.org/0000-0003-0104-9140
authors: Y
authors: Fang
authors: James
authors: http://orcid.org/0000-0001-8037-1028
authors: J
authors: Cho
authors: Sundar
authors: http://orcid.org/0000-0003-1360-4324
authors: S
authors: Natarajan
keywords: delivery of care; health care disparities; patient care management; remote consultation; telemedicine