Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-analysis.

Despite various basal insulin titration strategies being available, their comparative effectiveness remains unclear.

尽管存在多种基础胰岛素调整策略，但它们的相对有效性仍然不明确。

To compare the effectiveness of different basal insulin titration strategies on glycemic control in patients with type 2 diabetes.

比较不同基础胰岛素调整策略在2型糖尿病患者血糖控制中的有效性。

data_sources

PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and EBSCO Open Dissertations were searched from inception to January 2024.

从建库至2024年1月，对PubMed、Embase、Cochrane中央控制试验注册处（CENTRAL）、CINAHL和EBSCO开放学位论文进行了检索。

study_selection

We included published trials with evaluation of basal insulin titration strategies for glycemic control in type 2 diabetes.

我们纳入了评估基础胰岛素调整策略以控制2型糖尿病血糖的已发表试验。

data_extraction

Data on HbA1c and severe hypoglycemia were extracted.

提取了有关糖化血红蛋白（HbA1c）和严重低血糖的数据。

data_synthesis

Studies were categorized with the theme, intensity, and provider/platform (TIP) framework.

研究根据主题、强度和提供者/平台（TIP）框架进行分类。

"Theme" referred to conventional titration (Conv) or self-titration (ST), "intensity" was categorized as high (Conv, >1/month; ST, ≥2/week) or low (Conv, ≤1/month; ST, <2/week), and for "provider/platform" categories included supported by health care provider (HCP for Conv or S-HCP for ST), patient led (Pt), and supported by application (S-App).

"主题"指的是传统滴定（Conv）或自我滴定（ST），"强度"被分类为高（Conv，>1/月；ST，≥2/周）或低（Conv，≤1/月；ST，<2/周），而"提供者/平台"的类别包括由医疗保健提供者支持（Conv的HCP或ST的S-HCP）、患者主导（Pt）和支持应用程序（S-App）。

The ST/High/S-HCP strategy resulted in the greatest HbA1c reduction in comparison with all others (e.g., ST/High/S-App, mean difference -0.75 [95% CI -1.26, -0.25], and Conv/Low/HCP, -1.19 [95% CI -1.67, -0.72]).

ST/High/S-HCP策略相较于其他策略（例如，ST/High/S-App，平均差异-0.75 [95% 置信区间 -1.26, -0.25]，以及Conv/Low/HCP，-1.19 [95% 置信区间 -1.67, -0.72]）带来了最大的糖化血红蛋白降低。

Severe hypoglycemia risk did not differ significantly across strategies.

各策略之间严重低血糖风险没有显著差异。

limitations

The number of studies per network meta-analysiswas limited, and not all TIP combinations were evaluated.

网络荟萃分析中每项研究的数量有限，不是所有的TIP组合都被评估。

Conclusions

Self-titration at least twice a week with health care provider support leads to superior HbA1c reduction in comparison with other strategies, without increasing the risk of severe hypoglycemia.

每周至少自行调整两次，并在医疗保健提供者支持下，与其他策略相比，可实现更优越的糖化血红蛋白（HbA1c）降低，且不会增加严重低血糖的风险。

This approach should be considered for clinical practice, where appropriate, to achieve optimal glycemic control in patients with type 2 diabetes.

在适当的临床实践中，应考虑采用这种方法以实现2型糖尿病患者的最佳血糖控制。