Display options
Cite
Levy N, Moynihan V, Nilo A, et al. The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol. JMIR Res Protoc. 2015;4(1):e31doi: 10.2196/resprot.4206.
Levy, N., Moynihan, V., Nilo, A., Singer, K., Bernik, L. S., Etiebet, M. A., Fang, Y., Cho, J., & Natarajan, S. (2015). The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol. JMIR research protocols, 4(1), e31. https://doi.org/10.2196/resprot.4206
Levy, Natalie, et al. "The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol." JMIR research protocols vol. 4,1 (2015): e31. doi: https://doi.org/10.2196/resprot.4206
Levy N, Moynihan V, Nilo A, Singer K, Bernik LS, Etiebet MA, Fang Y, Cho J, Natarajan S. The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol. JMIR Res Protoc. 2015 Mar 13;4(1):e31. doi: 10.2196/resprot.4206. PMID: 25794243; PMCID: PMC4381814.
Copy Download .nbib Format: NLM
Share it on

JMIR Res Protoc. 2015 Mar 13;4(1):e31. doi: 10.2196/resprot.4206.

The Mobile Insulin Titration Intervention (MITI) for Insulin Glargine Titration in an Urban, Low-Income Population: Randomized Controlled Trial Protocol.

JMIR research protocols

Natalie Levy, Victoria Moynihan, Annielyn Nilo, Karyn Singer, Lidia S Bernik, Mary-Ann Etiebet, Yixin Fang, James Cho, Sundar Natarajan

Affiliations

  1. Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University School of Medicine, New York, NY, United States.

PMID: 25794243 PMCID: PMC4381814 DOI: 10.2196/resprot.4206

Abstract

BACKGROUND: Patients on insulin glargine typically visit a clinician to obtain advice on how to adjust their insulin dose. These multiple clinic visits can be costly and time-consuming, particularly for low-income patients. It may be feasible to achieve insulin titration through text messages and phone calls with patients instead of face-to-face clinic visits.

OBJECTIVE: The objectives of this study are to (1) evaluate if the Mobile Insulin Titration Intervention (MITI) is clinically effective by helping patients reach their optimal dose of insulin glargine, (2) determine if the intervention is feasible within the setting and population, (3) assess patient satisfaction with the intervention, and (4) measure the costs associated with this intervention.

METHODS: This is a pilot study evaluating an approach to insulin titration using text messages and phone calls among patients with insulin-dependent type 2 diabetes in the outpatient medical clinic of Bellevue Hospital Center, a safety-net hospital in New York City. Patients will be randomized in a 1:1 ratio to either the MITI arm (texting/phone call intervention) or the usual-care arm (in-person clinic visits). Using a Web-based platform, weekday text messages will be sent to patients in the MITI arm, asking them to text back their fasting blood glucose values. In addition to daily reviews for alarm values, a clinician will rereview the texted values weekly, consult our physician-approved titration algorithm, and call the patients with advice on how to adjust their insulin dose. The primary outcome will be whether or not a patient reaches his/her optimal dose of insulin glargine within 12 weeks.

RESULTS: Recruitment for this study occurred between June 2013 and December 2014. We are continuing to collect intervention and follow-up data from our patients who are currently enrolled. The results of our data analysis are expected to be available in 2015.

CONCLUSIONS: This study explores the use of widely-available text messaging and voice technologies for insulin titration. We aim to show that remote insulin titration is clinically effective, feasible, satisfactory, and cost saving for low-income patients in a busy, urban clinic.

TRIAL REGISTRATION: Clinicaltrials.gov NCT01879579; http://clinicaltrials.gov/ct2/show/NCT01879579 (Archived by WebCite at http://www.webcitation.org/6WUEgjZUO).

Keywords: delivery of care; health care disparities; patient care management; remote consultation; telemedicine

References

  1. J Diabetes Sci Technol. 2011 Sep 01;5(5):1246-54 - PubMed
  2. Diabetes Obes Metab. 2013 Aug;15(8):690-700 - PubMed
  3. Diabetes Care. 2010 Aug;33(8):1738-40 - PubMed
  4. Diabetes Res Clin Pract. 2011 Oct;94(1):e24-6 - PubMed
  5. Diabetes Care. 2006 Jan;29(1):1-8 - PubMed
  6. Diabetes Technol Ther. 2012 Aug;14(8):675-82 - PubMed
  7. Diabetologia. 2009 Nov;52(11):2324-7 - PubMed
  8. BMC Health Serv Res. 2008 Feb 04;8:33 - PubMed
  9. J Med Internet Res. 2011 Dec 31;13(4):e126 - PubMed
  10. J Clin Nurs. 2007 Jun;16(6):1082-7 - PubMed
  11. Ann Fam Med. 2007 Nov-Dec;5(6):511-8 - PubMed
  12. JMIR Res Protoc. 2014 Oct 24;3(4):e54 - PubMed
  13. Am J Manag Care. 2012 Feb 01;18(2):e42-7 - PubMed
  14. J Diabetes Sci Technol. 2013 May 01;7(3):612-22 - PubMed
  15. J Am Pharm Assoc (2003). 2012;52(6):e266-72 - PubMed
  16. Health Qual Life Outcomes. 2007 Oct 10;5:57 - PubMed

Publication Types

Grant support