An aggressive insulin titration pattern is associated with better glycemic control during short‐term intensive insulin therapy

AIM: To investigate the associations between insulin titration patterns and glycemic outcomes in continuous subcutaneous insulin infusion (CSII)-based short-term intensive insulin therapy (IIT). MATERIALS AND RESULTS: A total of 1,916 patients were stratified into ascending (n = 514) or descending (n = 1,402) groups, and aggressive (n = 681) or non-aggressive (n = 721) cohorts. dTIR was highest in the aggressive group, followed by the non-aggressive and ascending groups (89.7% [84.5, 93.6], 85.7% [79.6, 90.8], 76.2% [64.3, 84.9], respectively). Compared with the non-aggressive group, the aggressive group had a 1.73-percentage-point higher dTIR after adjustment (95% CI 0.91-2.56; P < 0.001), lower glucose variability, lower maximum and pump-suspension insulin doses, greater dose reduction, and shorter CSII treatment and hospitalization, with similar dTBR1 and post-therapy FG (6.1 ± 1.2 vs. 6.3 ± 1.2 mmol/L, P = 0.056). Predictors of post-therapy FG <6.1 mmol/L included higher BMI, greater dTIR and dTBR1 in both trajectory groups; younger age, lower HbA1c, longer CSII duration, and lower final insulin dose in the descending group. CONCLUSIONS: An aggressive titration pattern was associated with better glycemic control without increasing detected hypoglycemia relative to the non-aggressive pattern, suggesting a potential benefit of timely insulin titration that requires prospective evaluation.