Submission Type

Patient Safety and Quality Improvement Exemplars



Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.


This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was the change in A1C value between pre-protocol enrollment and post-protocol measurement.


Nurse care managers managed 180 (87.8%) patients while 25 (12.2%) were managed by pharmacists. Patients enrolled in the LAIT protocol experienced a significant decrease in A1C (from 9.97 ± 1.85% pre-referral to 8.60 ± 1.67% post-referral, p


The LAIT protocol was successful in improving glycemic control among patients with T2D. Future enhancements to the protocol could focus on analyzing referral utilization and patient engagement.


The LAIT protocol allows pharmacists and nurse care managers to make a significant contribution toward achieving glycemic goals in those with uncontrolled diabetes.



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