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Lack of coordination between partners: investigation of Physician-Preferred and Patient-Preferred (4P) basal insulin titration algorithms in the real world

Authors Zhang T, Zhao Y, Du T, Zhang X, Li X, Liu R, Wang Y, Chen B, He L, Li W

Received 22 March 2018

Accepted for publication 13 May 2018

Published 18 July 2018 Volume 2018:12 Pages 1253—1259

DOI https://doi.org/10.2147/PPA.S169000

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 2

Editor who approved publication: Dr Naifeng Liu


Tong Zhang,1 Yunjuan Zhao,2 Tao Du,2 Xiaodan Zhang,2 Xiaowei Li,2 Ruike Liu,3 Yunlin Wang,4 Bo Chen,5 Ling He,6 Wangen Li2

1Department of Endocrinology, The Third Affiliated Hospital, Southern Medical University, Guangzhou 510630, People’s Republic of China; 2Department of Endocrinology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, People’s Republic of China; 3Department of Endocrinology, The Third People’s Hospital of Dongguan, Dongguan 523326, People’s Republic of China; 4Department of Endocrinology, Foshan Hospital, Southern Medical University, Foshan 528000, People’s Republic of China; 5Department of Endocrinology, Guangdong Second Provincial General Hospital, Guangzhou 510317, People’s Republic of China; 6Department of Endocrinology, Guangzhou First People’s Hospital, Guangzhou 510180, People’s Republic of China

Background: Patient-centered care is respectful to a patient’s preference. All prior clinical trials on patient self-titration algorithms for basal insulin were decided by physicians. We hypothesized that patients and physicians have different preferences.
Patients and methods: Physicians and diabetes patients were asked to choose their preferred insulin glargine self-titration algorithm among 5 algorithms. Algorithm 1, 1 U increase once daily; algorithm 2, 2 U increase every 3 days; algorithm 3, 3 U increase every 3 days; algorithm 4, titration every 3 days according to fasting blood glucose, and algorithm 5, weekly titration 2–8 U based on 3-day mean fasting blood glucose levels.
Results: Eleven (5.2%) out of 210 physicians and 180 (90.9%) out of 198 patients preferred algorithm 1 (χ2=300.4, p=0.000). In contrast, 195 (92.9%) physicians and 18 (9.1%) patients preferred algorithm 2 (χ2=286.6, p=0.000). In addition, 4 (1.9%) physicians but no patients preferred algorithm 3 (χ2=2.099, p=0.124). Neither physicians nor patients chose algorithms 4 or 5. Most physicians preferred algorithm 2 since it is recommended by guidelines, but most patients preferred algorithm 1 for its simplicity.
Conclusion: Patients had different preferences compared with physicians. Attention should be given to patients’ preferences to increase adherence and improve glycemic control.

Keywords: type 2 diabetes, titration algorithm, insulin glargine, basal insulin, self-adjustment, shared decision-making, adherence

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