{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T03:12:49Z","timestamp":1771557169835,"version":"3.50.1"},"reference-count":34,"publisher":"American Diabetes Association","issue":"3","license":[{"start":{"date-parts":[[2021,8,28]],"date-time":"2021-08-28T00:00:00Z","timestamp":1630108800000},"content-version":"vor","delay-in-days":2755,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0\/"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,3,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESEARCH DESIGN AND METHODS<\/jats:title><jats:p>Patients with type 2 diabetes, an HbA1c level &amp;gt;7% (53 mmol\/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level \u22646 mmol\/L (108 mg\/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA1c level \u22647% (53 mmol\/mol) without severe hypoglycemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>After a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA1c level of \u22647% (53 mmol\/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI \u22123.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of \u22125% (P noninferiority = 0.011).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>In stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm.<\/jats:p><\/jats:sec>","DOI":"10.2337\/dc13-1636","type":"journal-article","created":{"date-parts":[[2013,10,30]],"date-time":"2013-10-30T02:53:21Z","timestamp":1383101601000},"page":"604-610","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":19,"title":["Does a Patient-Managed Insulin Intensification Strategy With Insulin Glargine and Insulin Glulisine Provide Similar Glycemic Control as a Physician-Managed Strategy? Results of the START (Self-Titration With Apidra to Reach Target) Study"],"prefix":"10.2337","volume":"37","author":[{"given":"Stewart B.","family":"Harris","sequence":"first","affiliation":[{"name":"Department of Family Medicine, The University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Fran\u00e7ois","family":"Yale","sequence":"additional","affiliation":[{"name":"Department of Medicine, McGill University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lori","family":"Berard","sequence":"additional","affiliation":[{"name":"Winnipeg Regional Health Authority, Health Sciences Centre, Winnipeg Diabetes Research Group, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Stewart","sequence":"additional","affiliation":[{"name":"Sanofi Canada, Medical and Regulatory Affairs, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Abbaszadeh","sequence":"additional","affiliation":[{"name":"Sanofi Canada, Medical and Regulatory Affairs, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Webster-Bogaert","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, The University of Western Ontario, London, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hertzel C.","family":"Gerstein","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1167","published-online":{"date-parts":[[2014,2,11]]},"reference":[{"key":"2022031220315927400_B1","doi-asserted-by":"crossref","first-page":"330","DOI":"10.2337\/diacare.25.2.330","article-title":"Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57)","volume":"25","author":"Wright","year":"2002","journal-title":"Diabetes Care"},{"key":"2022031220315927400_B2","first-page":"181","article-title":"Sources of physician care for people with diabetes","volume-title":"In Diabetes in Ontario: An ICES Practice Atlas","author":"Jaakkimainen","year":"2003"},{"key":"2022031220315927400_B3","first-page":"e418","article-title":"Clinical inertia in patients with T2DM requiring insulin in family practice","volume":"56","author":"Harris","year":"2010","journal-title":"Can Fam Physician"},{"key":"2022031220315927400_B4","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1111\/j.1365-2362.2004.01356.x","article-title":"Insulin therapy in type 2 diabetes: role of the long-acting insulin glargine analogue","volume":"34","author":"Yki-J\u00e4rvinen","year":"2004","journal-title":"Eur J Clin Invest"},{"key":"2022031220315927400_B5","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.2165\/00003495-200262130-00014","article-title":"Insulin aspart: a review of its use in the management of type 1 and 2 diabetes mellitus","volume":"62","author":"Chapman","year":"2002","journal-title":"Drugs"},{"key":"2022031220315927400_B6","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1111\/j.1464-5491.2006.01881.x","article-title":"A randomized trial of adding insulin glargine vs. avoidance of insulin in people with type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and\/or sulphonylureas. 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