Visual Abstract

To titrate basal and bolus insulin sequentially or simultaneously during SIT remains controversial. Here we report an easy titration order verified in a 7-10 day SIT period. Insulin naïve Chinese T2D adults receiving stable doses of metformin and 1-2 oral antihyperglycemic drugs with HbA1c 7.5%-11.0% were treated with once-daily insulin glargine 100 U/mL (Gla-100) and thrice-daily insulin glulisine (Glu) for 7-10 days titrated to achieve a fasting blood glucose (FBG) <7 mmol/L and 2-hour postprandial glucose (2hPG) <10 mmol/L. Gla-100 was titrated first until FBG achieved 4.4-6.1 mmol/L, then Glu was titrated to achieve pre-meal blood glucose 4.4-6.1 mmol/L. Of 466 patients screened, 397 entered the SIT period; 391 (98.5%) completed. Baseline mean (SD) age was 54.2 (8.8) years, duration of disease was 6.8 (3.0) years, BMI was 26.0 (3.2) kg/m2, HbA1c was 9.1% (1.1), and FBG was 10.7 (2.5) mmol/L; 59.2% were male. Overall, 94.4% of patients achieved the predefined target at the end of the SIT period (Table). The mean time to first achieving 2hPG target was less than the time to first achieving FBG target, implying that titrating basal insulin first could minimize Glu dose increases and potential hypoglycemia risk.

In conclusion, when starting basal-bolus regimen in SIT, basal-first titration order was effective, fast to target and well tolerated in Chinese T2D patients.


L. Guo: Consultant; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., BD, Eli Lilly and Company, Merck & Co., Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk, Sanofi China. J. Liu: Employee; Self; Sanofi China. X. Zhang: None. N. Cui: Employee; Self; Sanofi China. H. Yin: None. Y. Mu: Speaker’s Bureau; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi-Aventis. H. Wan: None. J. Wang: None. B. Xu: None. G. Wang: None. C. Jiang: None. L. Liang: None. W. Feng: Employee; Self; Sanofi China.


Sanofi China (NCT03359837)

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