Improving glycemic control with insulin detemir using the 303 Algorithm in insulin naïve patients with type 2 diabetes: A subgroup analysis of the US PREDICTIVE 303 study

Jean Louis Selam, Christoph Koenen, Wayne Weng, Luigi Meneghini

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective: PREDICTIVE 303 was a 26-week, prospective, randomized, open-label, multi-center study in patients with type 2 diabetes that investigated whether patient-driven adjustments of insulin detemir doses using the 303 Algorithm achieved similar glycemic control compared to standard-of-care, physician-driven adjustments in doses. This post hoc sub-analysis evaluates insulin naïve patients on oral anti-diabetic drugs (OADs) who were directed to start on once-daily insulin detemir as add-on therapy to any other glucose-lowering regimens. Methods: Patients in the 303 Algorithm group were instructed to adjust their detemir dose every 3 days based on mean fasting plasma glucose (FPG) values using a simple algorithm: mean FPG < 80 mg/dL, reduce dose by 3 units; between 80-110 mg/dL, no change; > 110 mg/dL, increase by 3 units. Physicians adjusted the detemir dose for patients in the Standard-of-care group according to their usual practice. No control insulin was used for comparison to insulin detemir. Results: Reductions in glycosylated hemoglobin (HbA1c) from baseline were similar between those patients in the 303 Algorithm and Standard-of-care groups (-1.1 and -1.0%, respectively; between group p = 0.0933); patients in the 303 Algorithm group achieved a greater reduction in FPG. Patients in both groups experienced a similar, tow rate of hypoglycemia. Over 95% and 92% of patients, respectively, used detemir once daily. Conclusion: These data indicate that patients with type 2 diabetes naïve to insulin can effectively implement the 303 Algorithm to initiate and adjust a once-daily dose of insulin detemir to achieve improvements in glycemic control.

Original languageEnglish
Pages (from-to)11-20
Number of pages10
JournalCurrent Medical Research and Opinion
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2008

Fingerprint

Type 2 Diabetes Mellitus
Insulin
Standard of Care
Social Adjustment
Glucose
Fasting
Insulin Detemir
Physicians
Glycosylated Hemoglobin A
Hypoglycemia
Pharmaceutical Preparations

Keywords

  • Insulin detemir
  • Insulin titration
  • Insulin-naïve
  • Long-acting insulin analog
  • PREDICTIVE 303
  • Type 2 diabetes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Improving glycemic control with insulin detemir using the 303 Algorithm in insulin naïve patients with type 2 diabetes : A subgroup analysis of the US PREDICTIVE 303 study. / Selam, Jean Louis; Koenen, Christoph; Weng, Wayne; Meneghini, Luigi.

In: Current Medical Research and Opinion, Vol. 24, No. 1, 01.01.2008, p. 11-20.

Research output: Contribution to journalArticle

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abstract = "Objective: PREDICTIVE 303 was a 26-week, prospective, randomized, open-label, multi-center study in patients with type 2 diabetes that investigated whether patient-driven adjustments of insulin detemir doses using the 303 Algorithm achieved similar glycemic control compared to standard-of-care, physician-driven adjustments in doses. This post hoc sub-analysis evaluates insulin na{\"i}ve patients on oral anti-diabetic drugs (OADs) who were directed to start on once-daily insulin detemir as add-on therapy to any other glucose-lowering regimens. Methods: Patients in the 303 Algorithm group were instructed to adjust their detemir dose every 3 days based on mean fasting plasma glucose (FPG) values using a simple algorithm: mean FPG < 80 mg/dL, reduce dose by 3 units; between 80-110 mg/dL, no change; > 110 mg/dL, increase by 3 units. Physicians adjusted the detemir dose for patients in the Standard-of-care group according to their usual practice. No control insulin was used for comparison to insulin detemir. Results: Reductions in glycosylated hemoglobin (HbA1c) from baseline were similar between those patients in the 303 Algorithm and Standard-of-care groups (-1.1 and -1.0{\%}, respectively; between group p = 0.0933); patients in the 303 Algorithm group achieved a greater reduction in FPG. Patients in both groups experienced a similar, tow rate of hypoglycemia. Over 95{\%} and 92{\%} of patients, respectively, used detemir once daily. Conclusion: These data indicate that patients with type 2 diabetes na{\"i}ve to insulin can effectively implement the 303 Algorithm to initiate and adjust a once-daily dose of insulin detemir to achieve improvements in glycemic control.",
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N2 - Objective: PREDICTIVE 303 was a 26-week, prospective, randomized, open-label, multi-center study in patients with type 2 diabetes that investigated whether patient-driven adjustments of insulin detemir doses using the 303 Algorithm achieved similar glycemic control compared to standard-of-care, physician-driven adjustments in doses. This post hoc sub-analysis evaluates insulin naïve patients on oral anti-diabetic drugs (OADs) who were directed to start on once-daily insulin detemir as add-on therapy to any other glucose-lowering regimens. Methods: Patients in the 303 Algorithm group were instructed to adjust their detemir dose every 3 days based on mean fasting plasma glucose (FPG) values using a simple algorithm: mean FPG < 80 mg/dL, reduce dose by 3 units; between 80-110 mg/dL, no change; > 110 mg/dL, increase by 3 units. Physicians adjusted the detemir dose for patients in the Standard-of-care group according to their usual practice. No control insulin was used for comparison to insulin detemir. Results: Reductions in glycosylated hemoglobin (HbA1c) from baseline were similar between those patients in the 303 Algorithm and Standard-of-care groups (-1.1 and -1.0%, respectively; between group p = 0.0933); patients in the 303 Algorithm group achieved a greater reduction in FPG. Patients in both groups experienced a similar, tow rate of hypoglycemia. Over 95% and 92% of patients, respectively, used detemir once daily. Conclusion: These data indicate that patients with type 2 diabetes naïve to insulin can effectively implement the 303 Algorithm to initiate and adjust a once-daily dose of insulin detemir to achieve improvements in glycemic control.

AB - Objective: PREDICTIVE 303 was a 26-week, prospective, randomized, open-label, multi-center study in patients with type 2 diabetes that investigated whether patient-driven adjustments of insulin detemir doses using the 303 Algorithm achieved similar glycemic control compared to standard-of-care, physician-driven adjustments in doses. This post hoc sub-analysis evaluates insulin naïve patients on oral anti-diabetic drugs (OADs) who were directed to start on once-daily insulin detemir as add-on therapy to any other glucose-lowering regimens. Methods: Patients in the 303 Algorithm group were instructed to adjust their detemir dose every 3 days based on mean fasting plasma glucose (FPG) values using a simple algorithm: mean FPG < 80 mg/dL, reduce dose by 3 units; between 80-110 mg/dL, no change; > 110 mg/dL, increase by 3 units. Physicians adjusted the detemir dose for patients in the Standard-of-care group according to their usual practice. No control insulin was used for comparison to insulin detemir. Results: Reductions in glycosylated hemoglobin (HbA1c) from baseline were similar between those patients in the 303 Algorithm and Standard-of-care groups (-1.1 and -1.0%, respectively; between group p = 0.0933); patients in the 303 Algorithm group achieved a greater reduction in FPG. Patients in both groups experienced a similar, tow rate of hypoglycemia. Over 95% and 92% of patients, respectively, used detemir once daily. Conclusion: These data indicate that patients with type 2 diabetes naïve to insulin can effectively implement the 303 Algorithm to initiate and adjust a once-daily dose of insulin detemir to achieve improvements in glycemic control.

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KW - Insulin titration

KW - Insulin-naïve

KW - Long-acting insulin analog

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