Achievement of Individualized HbA1c Targets with Self- vs. Physician-Led Titration of Basal Insulin (BI) in People with Type 2 Diabetes (T2DM), Newly or Recently Initiated on BI—Results from the DUNE Real-World Study
Authors: BERARD LORI , MAURICIO DIDAC , KHUNTI KAMLESH , FRANCO DENISE R. , WESTERBACKA JUKKA , CANDELAS CHRISTOPHE , PILORGET VALERIE , PERFETTI RICCARDO , MENEGHINI LUIGI 
Published: June 2018

DUNE was a 12-week, prospective, observational study of 3139 adults with T2DM, newly (at enrollment) or recently (&lt;12 months) initiated on BI. We evaluated the achievement of individualized HbA1c targets at 12 weeks according to self- vs. physician-led insulin titration. Irrespective of titration method, the proportion of participants who achieved their individualized HbA1c target at week 12 was &lt;30% in both the newly- and recently- initiated BI groups (Table). For both titration groups, there were comparable improvements in fasting plasma glucose from baseline and similar incidence of hypoglycemia. Increase in total daily BI dose for self- vs. physician-led titration in the recently initiated BI group was 4.85 vs. 4.91 U, respectively, while in newly initiated individuals it was 9.68 vs. 7.77 U, respectively. Most participants who were self-titrating did so every 1-3 days, compared with no more frequently than every week for most participants who had physician-led titration. In all groups, the most frequently utilized dose increment was 2 U. The inability of most participants to achieve their target HbA1c in a real-world scenario, irrespective of the method of titration, warrants further investigation.

Disclosure
L. Berard: Other Relationship; Self; Abbott, Becton, Dickinson and Company, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi, Montmed Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., LifeScan Canada. Consultant; Self; Ascensia Diabetes Care. Other Relationship; Self; Novo Nordisk Inc., Merck & Co., Inc. D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi. K. Khunti: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company, Sanofi-Aventis, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Consultant; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Sanofi-Aventis, Pfizer Inc.. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Sanofi-Aventis, Takeda Development Centre Europe Ltd., Servier. Research Support; Self; Novo Nordisk A/S. Consultant; Self; Pfizer Inc.. Research Support; Self; Novo Nordisk A/S. D.R. Franco: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Eli Lilly and Company. Advisory Panel; Self; Abbott. Speaker's Bureau; Self; Medtronic MiniMed, Inc.. Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi, Eli Lilly and Company. Speaker's Bureau; Self; Abbott. J. Westerbacka: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. C. Candelas: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. V. Pilorget: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. R. Perfetti: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association.