Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Insulin Management in Patients with T2D

Lancet; ePub 2019 Feb 22; Bergenstal, et al

Superior glycemic control was achieved with the combination of automated insulin titration guidance and support from healthcare professionals compared with support from healthcare professionals alone, a new study found. Researchers recruited patients from 3 diabetes centers in the US who were eligible if they were aged 21‒70 years, diagnosed with type 2 diabetes (T2D) with a glycated hemoglobin (HbA1c) concentration of ≥7.5%, and ≤11%, and had been using the same insulin regimen for the previous 3 months. Eligible participants were randomly assigned 1:1 to either the d-Nav Insulin Guidance System and healthcare professional support (intervention group) or healthcare professional support alone (control group). The primary outcome was to compare average change in HbA1c from baseline to 6 months. They found:

  • 181 of 236 patients screened for eligibility were enrolled and randomly assigned to the intervention (n=93) and control (n=88) groups.
  • At baseline, mean HbA1c was 8.7% in the intervention group and 8.5% in the control group.
  • The mean decreased in HbA1c from baseline to 6 months was 1.0% in the intervention group and 0.3% in the control group.


Bergenstal RM, Johnson M, Passi R, et al. Automated insulin dosing guidance to optimize insulin management in patients with type 2 diabetes: A multicenter, randomized controlled trial. [Published online ahead of print February 22, 2019]. Lancet. doi:10.1016/S0140-6736(19)30368-X.

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