Background: Studies show titrating insulin in the hospital for 2-4 weeks at diagnosis of type 2 diabetes mellitus (T2DM) can restore production of endogenous insulin to achieve remission. The purpose of the Remission through Early Monitored Insulin Therapy- Duration Month (REMIT-DM) pilot study was to evaluate if individuals with T2DM in an outpatient setting could self-titrate insulin with an innovative titration algorithm using glucose values and trends from a real-time continuous glucose monitor (CGM).
Methods: A diabetes educator trained 10 insulin naïve T2DM participants on use of a basal-bolus multiple daily insulin injection algorithm designed to achieve euglycemia (fasting glucose (FG) < 100 mg/dL, 2-hour (2h) post-prandial glucose (PPG) < 120 mg/dL) during 4 weeks of insulin therapy based on Dexcom G6 real-time CGM values and trends. Primary outcome was participant ability to do algorithm titrations using CGM readings. Secondary outcomes included achievement of goal FG and 2h-PPG, time in days to achievement of goals, CGM time in range (TIR), patient distress via the PAID-5 scale prior to and at completion of the 4-week intervention, and assessment of satisfaction with REMIT-DM experience.
Results: Nine of 10 participants were able to use the self-titration algorithm while 7 achieved goal FG and 8 goal 2h-PPG over 4 weeks of insulin therapy. Mean time to FG and 2h-PPG goals were 9.75 ± 6.01 and 7.11 ± 4.64 days, respectively. Mean CGM TIR during insulin therapy was 80.67 ± 10.7%. Mean PAID-5 scores pre-post use of titration protocol was 8.9 and 7.6, respectively. Scores >8 indicate possible diabetes-related distress. All reported high satisfaction with experience.
Conclusions: Insulin naïve patients were able to follow and self-titrate insulin using real-time CGM values and trends according to an innovative remission insulin algorithm in an outpatient setting. DM-related distress was reduced while all reported satisfaction. Insulin titration at diagnosis warrants further exploration.
S.I. Sobel: None. K. Ruppert: None. P.M. McCarthy: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. D.A. Rometo: None.
University of Pittsburgh Clinical and Translational Science Institute