Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis
Background: Adjusting basal insulin doses is essential for lowering blood glucose while minimizing the risk of hypoglycemia. Despite various basal insulin titration strategies, their comparative effectiveness remains unclear.
Purpose: To compare the effectiveness of different basal insulin titration strategies on glycemic control in patients with type 2 diabetes.
Data Sources: PubMed, EMBASE, CENTRAL, CINAHL, and EBSCO Open Dissertation were searched from inception to January 2024. Study Selection: Published trials evaluating basal insulin titration strategies for glycemic control in type 2 diabetes were included.
Data Extraction: HbA1C and severe hypoglycemia were extracted.
Data Synthesis: Studies were categorized using the Theme, Intensity, and Provider/Platform (TIP) framework. Theme referred to conventional titration (Conv) or self-titration (ST); Intensity was defined as high (Conv: >1/month; ST: ≥2/week) or low (Conv: ≤1/month; ST: <2/week); and Provider/Platform included healthcare provider-supported (HCP for Conv or S-HCP for ST), patient-led (Pt), or application-supported (S-App). The ST/High/S-HCP strategy resulted in the greatest HbA1c reduction compared to all others (e.g., ST/High/S-App: MD -0.75; 95% CI -1.26 to -0.25; Conv/Low/HCP: MD -1.19; 95% CI -1.67 to -0.72). Severe hypoglycemia risk did not differ significantly across strategies.
Limitations: The number of studies per network meta-analysis was limited, and not all TIP combinations were evaluated.
Conclusions: Self-titration at least twice a week with healthcare provider support leads to superior HbA1c reduction compared to other strategies, without increasing the risk of severe hypoglycemia. This approach should be considered for clinical practice, where appropriate, to achieve optimal glycemic control in patients with type 2 diabetes.
