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Insulin Titration Trial. Will Hsu MD. Aldo Rossini MD. Sue Ghiloni RN, CDE. Paige Ricci. Insulin Titration Trial - Design. Type II Diabetics >18 yo , HbA1C 9-14%, Starting insulin 3 month, randomized, controlled trial Control: standard of care at Joslin

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## Insulin Titration Trial

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**Insulin Titration Trial**Will Hsu MD Aldo Rossini MD Sue Ghiloni RN, CDE Paige Ricci**Insulin Titration Trial - Design**• Type II Diabetics • >18 yo, HbA1C 9-14%, Starting insulin • 3 month, randomized, controlled trial • Control: standard of care at Joslin • Self-titration + diabetes educator • Intervention: apprenticeship at Joslin • Tablet with CollaboRhythm + 303 Protocol + coach • Primary Outcome: Δ HbA1C**p = 0.195**• ▼2% HbA1Cvs standard ~ ▼40% complications • ~ $4 K savings / year / patient, $120 K lifetime • ~ $15 B savings / year for US • ▼0.6% HbA1C vs Joslin ~ ▼12% complications • Spent extra $315 in clinician time per patient • $14,000 in lifetime savings per patient • ▼1% HbAIC~▼20% complications • Heart attack, stroke, kidney failure, vision loss… Menighini (2007) Avg HbA1C = 8.5% Sample = 5604 Duration = 6 months Yki-Jarvinen (2007) Avg HbA1C = 8.9% Sample = 121 Duration = 6 months Moore (2013) Avg HbA1C = 10.8% Sample = 25 Duration = 3 months Davis (2013) Real-world comparative outcomes of US type 2 diabetes patients initiating analog basal insulin therapy. Curr Med Res Op Caro (2002) Lifetime Costs of Complications Resulting from Type 2 Diabetes in the US. Diabetes Care American Association of Clinical Endocrinologists (2006) State of Diabetes Complications in America. CDC (2011) National Diabetes Fact Sheet. Stratton (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35). BMJ**Insulin Titration Trial - Experience**p = 0.015 p = 0.005 Pre Post Pre Post Bradley (1994) The Diabetes Treatment Satisfaction Questionnaire: DTSQ

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