“Symptom-based Insulin adjustment for Glucose Normalization” (SIGN) Algorithm: A Pilot Study

Abstract

Background: Lack of self-monitoring of blood glucose (SMBG) records in actual practice settings continues to create therapeutic challenges for clinicians, especially in adjusting insulin therapy. In order to overcome this clinical obstacle, a ''Symptom-based Insulin adjustment for Glucose Normalization'' (SIGN) algorithm was developed to guide clinicians in caring for patients with uncontrolled type 2 diabetes who have few to no SMBG records. This study examined the clinical outcome and safety of the SIGN algorithm. Subjects and Methods: Glycated hemoglobin (HbA1c), insulin usage, and insulin-related adverse effects of a total of 114 patients with uncontrolled type 2 diabetes who refused to use SMBG or performed SMBG once a day for less than three times per week were studied 3 months prior to the implementation of the algorithm and prospectively at every 3-month interval for a total of 6 months after the algorithm implementation. Patients with type 1 diabetes, nonadherence to diabetes medications, or who were not on insulin therapy at any time during the study period were excluded from this study. Results: Mean HbA1c improved by 0.29% at 3 months (P = 0.015) and 0.41% at 6 months (P = 0.006) after algorithm implementation. A slight increase in HbA1c was observed when the algorithm was not implemented. There were no major hypoglycemic episodes. The number of minor hypoglycemic episodes was minimal with the majority of the cases due to irregular meal habits. Conclusions: The SIGN algorithm appeared to offer a viable and safe approach when managing uncontrolled patients with type 2 diabetes who have few to no SMBG records.

Impact of pharmacist-involved collaborative care on the clinical, humanistic and cost outcomes of high-risk patients with type 2 diabetes (IMPACT): a randomized controlled trial

“…Poor glucose control is often due to inappropriate drug usage and lack of close follow‐up; hence, closer monitoring by clinical pharmacist provided timely drug optimization . In addition, the clinical pharmacists in our study were trained to use the SIGN algorithm specifically designed for Asian patients who refuse to use a glucose meter, and active insulin titration was still carried out despite low adherence rates of SMBG. Due to these interventions of the clinical pharmacists, patients in the multidisciplinary collaborative care arm benefitted from glycaemic improvement as any degree of improvement in HbA1c would lower the risk of diabetes‐related complications …”

“…Upon signing the informed consent forms, patients were randomized into the intervention (multidisciplinary collaborative care) or control (usual care) arms. In the intervention arm, physicians referred their patients to the diabetes nurse educators or dietitians as needed, while clinical pharmacists followed up regularly with all patients every four to 6 weeks via face‐to‐face visits or phone calls, following an established protocol . Each face‐to‐face session with the clinical pharmacists, diabetes nurse educators and dietitians lasted between 20 and 30 minutes (Figure ).…”

“…In the intervention arm, physicians referred their patients to the diabetes nurse educators or dietitians as needed, while clinical pharmacists followed up regularly with all patients every four to 6 weeks via face-to-face visits or phone calls, following an established protocol. 5,11,12 Each face-to-face session with the clinical pharmacists, diabetes nurse educators and dietitians lasted between 20 and 30 minutes ( Figure 1). All clinical pharmacists were boardcertified pharmacotherapy specialists.…”

Life Style Practice and Awareness during Ramadan Fasting in Bangladeshi Diabetic Population

“…13 The study patients were also asked if they had documentation of hypoglycemia (blood glucose <3.9 mmol/l) during Ramadan fasting. 14 The data were presented as mean±standard deviation (SD) for continuous variables and percentages for categorical variables.…”

“…In our country still no data is available about what percentage of diabetic patients who are in fasting, incidence of hypoglycemia or even food habit during Ramadan. Guidelines emphasize pre-Ramadan screening 11,13 but in true sense the diabetic patients do not undergo this type of screening satisfactorily. Aim of this study was to find out life style practices and knowledge about Ramadan fasting in Bangladeshi population.…”