Article Summary Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Davies M, Storms F, Shutler S, Bianchi-Biscay M, Gomis R, for the AT.LANTUS Study Group. Diabetes Care. 2005;28:1282-1288. Objective: The primary objective was to compare 2 treatment algorithms (physician managed vs patient managed) in terms of incidence of severe hypoglycemia. Efficacy parameters were also assessed. Methods: Prospective, randomized, controlled, parallel design (1:1), multinational study in patients with type 2 diabetes suboptimally controlled on their previous treatment regimen. Inclusion criteria included the following: >18 years of age; antidiabetic treatment for >6 months (insulin and/or oral therapy); now requiring long-acting insulin; HbA1C levels >7.0 and <12%; and body mass index values of <40 kg/m2. Insulin-naïve patients randomized to algorithm 1 (physician managed) were initiated with 10 IU/day and a dose numerically equivalent to the highest fasting blood glucose (FBG) in mmol/L during the preceding 7 days for algorithm 2 (patient managed). Patients pretreated with insulin had their previous dose discontinued and an equivalent dose of glargine initiated. Results: The per-protocol population consisted of 2315 patients treated with algorithm 1 and 2273 receiving algorithm 2. No significant difference between groups for the incidence of severe hypoglycemia was reported. A significant difference in change in HbA1C from baseline to end point was observed in patients treated with algorithm 2 versus algorithm 1 (P<.001). Twenty-six percent of patients treated with algorithm 1 achieved an HbA1C of <7% at end point compared with 30% of patients treated with algorithm 2. A greater reduction in FBG was reported in patients treated with algorithm 2; however, overall, FBG decreased significantly in both groups from 170 mg/dL to 110 mg/dL. Conclusion: This study suggests that patients’ participation in the management of their treatment can safely lead to significant metabolic benefits.