Lack of coordination between partners: Investigation of physician-preferred and patient-preferred (4P) basal insulin titration algorithms in the real world

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Abstract

Background: Patient-centered care is respectful to a patient’s preference. All prior clinical trials on patient self-titration algorithms for basal insulin were decided by physicians. We hypothesized that patients and physicians have different preferences. Patients and methods: Physicians and diabetes patients were asked to choose their preferred insulin glargine self-titration algorithm among 5 algorithms. Algorithm 1, 1 U increase once daily; algorithm 2, 2 U increase every 3 days; algorithm 3, 3 U increase every 3 days; algorithm 4, titration every 3 days according to fasting blood glucose, and algorithm 5, weekly titration 2–8 U based on 3-day mean fasting blood glucose levels. Results: Eleven (5.2%) out of 210 physicians and 180 (90.9%) out of 198 patients preferred algorithm 1 (χ 2 =300.4, p=0.000). In contrast, 195 (92.9%) physicians and 18 (9.1%) patients preferred algorithm 2 (χ 2 =286.6, p=0.000). In addition, 4 (1.9%) physicians but no patients preferred algorithm 3 (χ 2 =2.099, p=0.124). Neither physicians nor patients chose algorithms 4 or 5. Most physicians preferred algorithm 2 since it is recommended by guidelines, but most patients preferred algorithm 1 for its simplicity. Conclusion: Patients had different preferences compared with physicians. Attention should be given to patients’ preferences to increase adherence and improve glycemic control.

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Zhang, T., Zhao, Y., Du, T., Zhang, X., Li, X., Liu, R., … Li, W. (2018). Lack of coordination between partners: Investigation of physician-preferred and patient-preferred (4P) basal insulin titration algorithms in the real world. Patient Preference and Adherence, 12, 1253–1259. https://doi.org/10.2147/PPA.S169000

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