Impact of Active Versus Usual Algorithmic Titration of Basal Insulin and Point-of-Care Versus Laboratory Measurement of HbA1c on Glycemic Control in Patients With Type 2 Diabetes

• DOI: 10.2337/diacare.29.01.06.dc05-1058
• Publication Date: 2006-04-22T01:21:16Z
• Authors: Laurence Kennedy; William H. Herman; Poul Strange; Anthony Harris
• Keywords: Blood Glucose Self-Monitoring

OBJECTIVE—The objective of this study was to assess the impact active versus usual monitoring algorithmic insulin titration and point-of-care (POC) laboratory HbA1c (A1C) measurement on glycemic control in primary care. RESEARCH DESIGN AND METHODS—The Glycemic Optimization with Algorithms Labs at Point Care (GOAL A1C) a 24-week, randomized, parallel-group, four-arm, open-label 7,893 adults type 2 diabetes uncontrolled by oral antidiabetic agents requiring insulin. Patients were randomly assigned investigators from 2,164 sites U.S. glargine either 1) (no unsolicited contact between visits) using simple algorithm A1C testing, 2) POC 3) (weekly monitored) or 4) testing. Outcome measures included change fasting self-monitoring blood glucose (SMBG) levels, percentage patients achieving <7.0%, hypoglycemia frequency. RESULTS—Significant SMBG reductions observed all arms (P < 0.0001). Compared titration, achieved greater reduction (1.5 vs. 1.3%; P 0.0001), (88 79 mg/dl; proportion <7.0% (38 30%; Among receiving testing associated an increase (41% for 36% laboratory; Hypoglycemia rates low (usual groups: 3.7 6.0 confirmed episodes/patient-year [P 0.001]; 0.09 0.14 severe [NS]). CONCLUSIONS—In predominantly care setting, addition significant improvements four arms. Active resulted incremental control, and, among portion <7.0%.