Introduction: While basal insulin lowers blood sugar, it increases the risk of hypoglycemia and weight gain and doesn’t offer the potential cardiovascular benefits of GLP1-RAs. Transitioning a person with well-controlled T2DM from basal insulin to a GLP1-RA can be labor intensive and short-term may lead to hypoglycemia. The objective of this pilot program is to determine if MITI-GLP1 can lower basal insulin and increase GLP1-RA without hypoglycemia.
Methods: MITI-GLP1 uses basic cell phone technology available to our safety-net patients and sends a daily text message asking ‘What was your fasting blood sugar this morning?’ Patients text values daily and are advised over-the-phone weekly on if/how to lower their basal insulin and if/how to adjust their GLP1-RA. The process continues until the patient is on the max-tolerated GLP1-RA dose. Eligible patients in this cohort study have well-controlled T2DM, use once-daily basal insulin and are not on max-dose GLP1-RA. Use of meal-time insulin excludes patients. The primary outcome is % of patients with basal insulin lowered >50%. Secondary outcomes include the % of patients with basal stopped completely, the % with GLP1-RA raised >1 dose level, and the % of hypoglycemia during the transition. MITI-GLP1 is co-run by internists and nurses.
Results: Forty-six people were enrolled. The average age is 53 (SD +/- 11), 59% are men, 74% are Hispanic, 63% are uninsured. Five people were lost to f/up. Of the 41 people who graduated, 35 (85%) had basal dose lowered by > 50%, 30 (73%) had basal stopped completely, 37 (90%) had GLP1 raised >1 dose level and 1 of the 2023 text messages (0.05%) had a blood glucose < 70mg/dL.
Conclusion: A MITI-GLP1 program using basic cell phone technology can safely and effectively transition primary care patients with well-controlled T2DM from basal insulin to a GLP1-RA.
N. Levy: None. K. Nerlino: None. O. Sonubi: None. S. Bongalos: None. A. Dasilva: None. C. Uzor: None. Y. Liang: None.
