Little is known about the discussion regarding titration at the time basal insulin is initiated for people with type 2 diabetes (T2DM) and about how titration occurs in the real world. This qualitative study investigated attitudes and practices of health care professionals (HCPs) and patients associated with basal insulin titration. Twelve virtual focus groups, comprising 23 HCPs (8 endocrinologists, 15 primary care physicians) and 22 adult patients with T2DM whose length of time since starting basal insulin was ≤ 4 years, were recruited from panels from across the U.S. from June to August 2017. Fifteen of 23 HCPs (65%) reported that they typically discussed titration at the time basal insulin was first prescribed. Twelve of 23 (52%) discussed target blood glucose (BG) ranges in initial conversations. Thirteen of 23 (57%) said most of their patients did not completely understand elements of the titration discussion. Of 16 HCPs who discussed what they do when their patients appear overwhelmed by or do not comprehend treatment instructions, 9 would start most of their patients on HCP-guided titration, 5 would delay titration and 2 would encourage self-titration without delay. HCPs on average reported 43% of their adult T2DM patients reached their A1c target within 6 months; they also reported 40% of their self-titrating patients ever reached their A1c target. Seventeen of 22 patients (77%) began titration when basal insulin was prescribed, and recalled injection and dose adjustment instruction from initial conversations. Twelve of 22 (55%) felt they were provided insufficient context on expectations around increasing insulin and/or how long titration could take. Four patients said they linked dose increases to personal failure. Eleven of 22 patients identified as self-titraters. Of 16 patients aware of their A1c or BG targets, 5 (31%) achieved them and 3 of 5 patients took ≥ 12 months to do so. HCPs and patients revealed patients often do not understand the basal insulin titration process and often do not achieve treatment goals.


C. Uzoigwe-Smith: Employee; Self; Novo Nordisk Inc.. M. Levin: None. D.B. Pfaff: None. M. Mocarski: Employee; Self; Novo Nordisk Inc.. Stock/Shareholder; Self; Novo Nordisk A/S. C.M. Hamersky: Employee; Self; Novo Nordisk Inc. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at