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

Abstract

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

Acknowledgments

This work was supported by the Health and Family Planning Commission of Guangzhou Municipality (grant number: 20171A011301) and Science and Technology project of Guangzhou (grant numbers: 201707010365 and 201707010045).

Author contributions

Wangen Li contributed to the design of the study, data analysis, and manuscript preparation and overviewing. Other coauthors participated in the patient recruitment, implementation of the study, safety monitoring, and manuscript overviewing. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.