Difference of Basal Insulin Titration Method in Reducing HbA1c Among Type 2 Diabetes Mellitus (T2DM) Patients.
to Identify Which Titration Regimen of Basal Insulin (Being Daily Titration vs 3 Daily Titration) is Better in Reducing hba1c and Have Lesser Hypoglycemia
About this trial
This is an interventional treatment trial for to Identify Which Titration Regimen of Basal Insulin (Being Daily Titration vs 3 Daily Titration) is Better in Reducing hba1c and Have Lesser Hypoglycemia
Eligibility Criteria
Inclusion Criteria:
Type 2 Diabetes Mellitus patients with
- Adults aged 18 years and above
- HbA1c >7.5% and Fasting blood sugar > 8mmol/L
- Newly diagnosed T2DM with osmotic symptoms or HbA1c >10% or FPG >13mmol/L
- Insulin naïve patients
- Patients planned for insulin initiation
- Ability to give informed consent
- Ability to perform self-monitoring blood glucose
Exclusion Criteria:
- Diabetes other than type 2 diabetes mellitus
- Diabetes in pregnancy
- Diabetes with chronic kidney disease stage 3,4 and 5 (eGFR <60ml/min/1.73m2)
- Patient with history of severe hypoglycemia
- Active proliferative diabetic retinopathy
- Any medical condition that may influence HbA1c measurements (e.g., thalassemia, sickle cell anemia)
- Treatment with systemic corticosteroid
Sites / Locations
- University Malaya Medical CentreRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Daily basal insulin titration
3 daily basal insulin titration
Participants in this intervention arm will be started with basal insulin of 10 units or 0.2 unit/kg (whichever lower) at pre-bed time. They will then check their morning fasting CBG the following day. If they have no hypoglycemia symptoms or documented hypoglycemic CBG (<3.9mmol/L), and their fasting CBG is more than 7mmol/L, they will then self-titrate their basal insulin by 1 unit (ie 10+1) the following night. This same process is going to be repeated until their fasting CBG achieve 7mmol/L or lower. Then, they will continue and maintain on the desired basal insulin dosage till their appointment. The maximum basal insulin that is allowed to be titrated by the participants is up to 0.5unit/kg. Participants are required to document down their CBG and any hypoglycemia symptoms in a simple table method provided to them
Participants in this intervention arm will be started with basal insulin of 10 units or 0.2 unit/kg (whichever lower) at pre-bed time. They will then check their morning fasting CBG the following 3 days. If they have no hypoglycemia symptoms or documented hypoglycemic CBG (<3.9mmol/L), and their fasting CBG is more than 7mmol/L (for 2 out of 3 days), they will then self-titrate their basal insulin by 2 units (ie 10+2) on the 3rd night. This same process is going to be repeated until their fasting CBG achieved 7mmol/L or lower. Then, they will continue and maintain on the desired basal insulin dosage till their appointment. The maximum basal insulin that is allowed to be titrated by the participants is up to 0.5unit/kg. Participants are required to document down their CBG and any hypoglycemia symptoms in a simple table method provided to them.