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Device-supported automated basal insulin titration in adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Luo Y 1 , Chang Y 2 , Zhao Z 3 , Xia J 4 , Xu C 3 , Bee YM 5 Show all authors , Li X 6 , Sheu WH 7 , McGill M 8 , Chan SP 9 , Deodat M 10 , Suastika K 11 , Thy KN 12 , Chen L 13 , Shan Kong AP 14 , Chen W 15 , Deerochanawong C 16 , Yabe D 17 , Zhao W 18 , Lim S 19 , Yao X 20 , Ji L 1

Affiliations 

  • 1 Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China
  • 2 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
  • 3 Tianjin Tiantian Biotechnology Co., Ltd., Tianjin 300000, China
  • 4 Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo China, Ningbo, Zhejiang 315100, China
  • 5 Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore
  • 6 Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • 7 Division of Endocrinology and Metabolism, Taipei Veterans General Hospital, Taipei 222, Taiwan
  • 8 Diabetes Centre, Royal Prince Alfred Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2050, Australia
  • 9 Department of Medicine, Faculty of Medicine, University of Malaya, Lembah Pantai, Kuala Lumpur 59100, Malaysia
  • 10 Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario L8V 5C2, Canada
  • 11 Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Prof. IGNG Ngoerah Hospital, Udayana University, Denpasar, Bali 80114, Indonesia
  • 12 Ho Chi Minh University of Medicine and Pharmacy Medic Medical Center, Ho Chi Minh City 700000, Vietnam
  • 13 Chu Hsien-I Memorial (Metabolic Diseases) Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin 300134, China
  • 14 Division of Endocrinology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region 999077, China
  • 15 Department of Clinical Nutrition, Department of Health Medicine, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital, Beijing 100730, China
  • 16 College of Medicine, Rangsit University, Bangkok 10400, Thailand
  • 17 Departments of Diabetes, Endocrinology and Metabolism/Rheumatology and Clinical Immunology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
  • 18 Department of Endocrinology, Peking Union Medical College Hospital, Beijing 100730, China
  • 19 Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam 13620, South Korea
  • 20 Center for Clinical Practice Guideline Conduction and Evaluation, Children's Hospital of Fudan University, Shanghai 201100, China
Lancet Reg Health West Pac, 2023 Jun;35:100746.
PMID: 37424694 DOI: 10.1016/j.lanwpc.2023.100746

Abstract

BACKGROUND: Technological advances make it possible to use device-supported, automated algorithms to aid basal insulin (BI) dosing titration in patients with type 2 diabetes.

METHODS: A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the efficacy, safety, and quality of life of automated BI titration versus conventional care. The literature in Medline, Embase, Web of Science, and the Cochrane databases from January 2000 to February 2022 were searched to identify relevant studies. Risk ratios (RRs), mean differences (MDs), and their 95% confidence intervals (CIs) were calculated using random-effect meta-analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.

FINDINGS: Six of the 7 eligible studies (889 patients) were included in meta-analyses. Low- to moderate-quality evidence suggests that patients who use automated BI titration versus conventional care may have a higher probability of reaching a target of HbA1c <7.0% (RR, 1.82 [95% CI, 1.16-2.86]); and a lower level of HbA1c (MD, -0.25% [95% CI, -0.43 to -0.06%]). No statistically significant differences were detected between the two groups in fasting glucose results, incidences of hypoglycemia, severe or nocturnal hypoglycemia, and quality of life, with low to very low certainty for all the evidence.

INTERPRETATION: Automated BI titration is associated with small benefits in reducing HbA1c without increasing the risk of hypoglycemia. Future studies should explore patient attitudes and the cost-effectiveness of this approach.

FUNDING: Sponsored by the Chinese Geriatric Endocrine Society.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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