"Symptom-based insulin adjustment for glucose normalization" (SIGN) algorithm: a pilot study

Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a "Symptom-based Insulin adjustment for Glucose Normalization"...

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Bibliographic Details
Published in:Diabetes technology & therapeutics Vol. 14; no. 12; p. 1145
Main Authors: Lee, Joyce Yu-Chia, Tsou, Keith, Lim, Jiahui, Koh, Feaizen, Ong, Sooim, Wong, Sabrina
Format: Journal Article
Language:English
Published: United States 01.12.2012
Subjects:
Algorithms
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - physiopathology
Drug Administration Schedule
Female
Glycated Hemoglobin A - drug effects
Glycated Hemoglobin A - metabolism
Guidelines as Topic
Humans
Hypoglycemia - blood
Hypoglycemia - drug therapy
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - pharmacology
Insulin - administration & dosage
Insulin - pharmacology
Male
Medication Adherence
Middle Aged
Pilot Projects
Prospective Studies
Severity of Illness Index
ISSN:1557-8593, 1557-8593
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Summary:Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a "Symptom-based Insulin adjustment for Glucose Normalization" (SIGN) algorithm was developed to guide clinicians in caring for patients with uncontrolled type 2 diabetes who have few to no SMBG records. This study examined the clinical outcome and safety of the SIGN algorithm. Glycated hemoglobin (HbA1c), insulin usage, and insulin-related adverse effects of a total of 114 patients with uncontrolled type 2 diabetes who refused to use SMBG or performed SMBG once a day for less than three times per week were studied 3 months prior to the implementation of the algorithm and prospectively at every 3-month interval for a total of 6 months after the algorithm implementation. Patients with type 1 diabetes, nonadherence to diabetes medications, or who were not on insulin therapy at any time during the study period were excluded from this study. Mean HbA1c improved by 0.29% at 3 months (P = 0.015) and 0.41% at 6 months (P = 0.006) after algorithm implementation. A slight increase in HbA1c was observed when the algorithm was not implemented. There were no major hypoglycemic episodes. The number of minor hypoglycemic episodes was minimal with the majority of the cases due to irregular meal habits. The SIGN algorithm appeared to offer a viable and safe approach when managing uncontrolled patients with type 2 diabetes who have few to no SMBG records.
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ISSN:1557-8593
1557-8593
DOI:10.1089/dia.2012.0140