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  • Nishanth T, Hong Chang T, Suresh R, Phong Ching L, Yun Ann C, Wanling Z, Emily Tse Lin H, David C, Su-Yen G, Yong Mong B
  • Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study
  • JMIR Formative Research
  • DOI: 10.2196/11848
  • PMID: 30303485
  • PMCID: 6352016
Preprints Accepted Manuscript

Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study

Abstract

background

Self-monitoring of blood glucose (SMBG) using online diabetes management platforms has demonstrated promise in managing type 2 diabetes (T2D). However, the effectiveness of such systems incorporating algorithm-guided insulin titration has not been extensively studied in Asian populations.

objective

This study evaluates the efficacy and safety of the ALRT Telehealth Solution, an FDA-cleared online platform that integrates SMBG with algorithm-driven insulin dose adjustments, in improving glycemia in insulin-treated T2D.

methods

This 24-week, pre-post intervention study enrolled 25 adults with T2D (mean age 58.9 years, 56.0% male) on twice-daily premixed insulin. Inclusion criteria included baseline HbA1c 7.5%–9.9% (58–86 mmol/mol), body mass index (BMI) ≤40 kg/m², and experience with SMBG. Participants uploaded twice-daily SMBG data weekly via a mobile app, which generated insulin titration recommendations based on a predefined algorithm. Physicians reviewed and approved the recommendations, which were then communicated back to participants via the app. Primary outcome was the change in HbA1c from baseline to 24 weeks. Secondary outcomes included changes in fasting plasma glucose (FPG), insulin dose, hypoglycemia incidence, and SMBG adherence.

results

Participants achieved significant reductions in HbA1c from 8.6% (70 mmol/mol) at baseline to 7.4% (57 mmol/mol) at 24 weeks (p<0.01), with reductions of 0.8% and 0.4% in the first and second 12 weeks, respectively. FPG decreased from 8.7 (2.0) mmol/L to 7.1 (1.4) mmol/L (p<0.01). Mean total daily insulin dose increased modestly from 0.73 (0.31) to 0.79 (0.34) units/kg/day (p<0.01). Participants demonstrated high adherence, completing 97.4% of prescribed SMBG measurements. During the study, 48.0% of participants experienced at least one hypoglycemia episode, predominantly mild (88.5%, glucose 3.0–3.9 mmol/L). Hypoglycemia episodes increased from 24 during weeks 0–12 to 72 during weeks 13–24. There were no episodes of severe hypoglycemia requiring external assistance. BMI increased slightly from 29.0 (3.6) kg/m² to 29.5 (3.6) kg/m² (p=0.03), reflecting a modest weight gain associated with improved glycemia.

conclusions

In conclusion, patients with insulin-treated T2D initiated on an internet-based glucose monitoring system with algorithm-guided dosing recommendations showed significant improvement in glycemic control compared to baseline. High adherence rates underscore the feasibility of integrating algorithm-guided insulin titration into routine care. While hypoglycemia incidence rose slightly, episodes were predominantly mild, and no severe events occurred. This intervention shows promise for broader adoption in T2D management, particularly in resource-constrained settings.

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Copyright

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it’s website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.

Citation

Please cite as:

Nishanth T, Hong Chang T, Suresh R, Phong Ching L, Yun Ann C, Wanling Z, Emily Tse Lin H, David C, Su-Yen G, Yong Mong B

Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study

JMIR Formative Research

DOI: 10.2196/14886

URL: https://preprints.jmir.org/preprint/11848

PMID: 31789598

PMCID: 6352016

Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study

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