Endocrine Abstracts

Introduction: Correct titration of basal insulin is one of the most important conditions allowing Type 2 Diabetes Mellitus patients to reach correct and personalised fasting plasma glucose. The persistence of the pandemic, together with the persistence of the SARS-CoV2 virus made titration process more complex, and pushed the Lombardy diabetologists to develop solutions which could be handled by the patient independently, or with the remote online assistance of diabetes team.

Patients, materials and methods: The Lombardy diabetologists participating in a training program shared their titration experiences of degludec basal insulin and its association with liraglutide (iDegLira). These physicians collected aggregated data of 387 subjects with T2DM (W:60%; M: 40%); homogeneous distribution in age groups 50 and 65 (31%); 65 and 75 (32%), and over 75 (28%), with 9% of the patients below 50; duration of illness <5 years (15%), 5 and 10 years (17%), 10 and 20 years (39%), over 20 years (29%). The patients had not adequate glycaemic control (90% with HbA1c>7.0%) with overweight or obesity (84.5% with BMI>25 kg/m2). Degludec was introduced for 129 patients, iDegLira for 258, titration was set up through modifications recommended by the diabetes team (244 patients); through the program “Titolando“ (www.titolando.it) (132 patients); with no education to titration (11 patients).

Results and discussion: Thanks to the diabetes centres support, the patients reached an adequate FPG (average 174.7 mg% at baseline; 122 mg% after 6.1 weeks of controlled titration, increase of basal insulin dose by 4.7 Ul/die); the self-titration with the program “Titolando“ obtained overlapping results (average FPG 178.5 mg% at baseline; 127 mg% after 7 weeks of self-managed titration, increase of basal insulin dose equal to 7UI/die). Less satisfactory the evolution of FPG in those who have independently modified the dosages of basal insulins (average FPG 199 mg% vs 140 mg% at six months follow-up, with increase of 5.9 UI of daily doses). The main limit and drawback of this retrospective observation consists in the fact of not having collected hypoglycaemia episodes.

Conclsions: During the pandemic, the remote support by Lombardy diabetes centres allowed to obtain satisfactory FPG after introduction of Degludec or iDegLira. Similarly, the process of self-titration led by the “Titolando“ program proved adequate, easy to understand and manage, and such as to offer a valid alternative in all the situations where it is not possible to provide clinical regular feedback to patients who are in therapy with basal insulins.