Document Detail

"Symptom-based insulin adjustment for glucose normalization" (SIGN) algorithm: a pilot study.
MedLine Citation:
PMID:  23035774     Owner:  NLM     Status:  MEDLINE    
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.
Joyce Yu-Chia Lee; Keith Tsou; Jiahui Lim; Feaizen Koh; Sooim Ong; Sabrina Wong
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Publication Detail:
Type:  Journal Article     Date:  2012-10-04
Journal Detail:
Title:  Diabetes technology & therapeutics     Volume:  14     ISSN:  1557-8593     ISO Abbreviation:  Diabetes Technol. Ther.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-06-19     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  100889084     Medline TA:  Diabetes Technol Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1145-8     Citation Subset:  IM    
Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore.
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MeSH Terms
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 2 / blood,  drug therapy*,  physiopathology
Drug Administration Schedule
Guidelines as Topic
Hemoglobin A, Glycosylated / drug effects*,  metabolism
Hypoglycemia / blood,  drug therapy*
Hypoglycemic Agents / administration & dosage*,  pharmacology
Insulin / administration & dosage*,  pharmacology
Medication Adherence
Middle Aged
Pilot Projects
Prospective Studies
Severity of Illness Index
Reg. No./Substance:
0/Hemoglobin A, Glycosylated; 0/Hypoglycemic Agents; 0/Insulin; 0/hemoglobin A1c protein, human

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