Toujeo Versus NPH Self-titration Study

NCT03389490 — Phase 4, Completed, 50 participants, Elaine Chow

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A Pilot Study to Describe the Glycaemic Variability of Insulin Glargine 300U/ml Versus NPH (Neutral Protamine Hagedorn) in the Insulin-naïve Type 2 Diabetes Patients Following a Patient-adjusted Insulin Algorithm in Hong Kong

RegistryNCT03389490
StatusCompleted
PhasePhase 4
Study typeInterventional; randomized, parallel, masking: single, treatment
Enrollment50 (Actual)
SponsorElaine Chow (Other); collaborators: Sanofi
ConditionsDiabetes Mellitus, Type 2
InterventionsInsulin Glargine 300 UNT/ML, Neutral protamine hagedorn insulin (Drug)
Datesstart 2018-01-01, primary completion 2019-12-17, completion 2020-05-01, first posted 2018-01-03, last updated 2021-08-03
Locations1 site in Hong Kong

Related Papers Related Patents Related Grants Related Experts
All trials for Diabetes Mellitus, Type 2 All trials of Insulin Glargine 300 UNT/ML All trials of Neutral protamine hagedorn insulin

-Summary

This is a 24 week, multicentre, prospective, randomized, controlled, parallel-designed (1:1) pilot study.The study will compare glycemic variability in patients treated with insulin glargine U300/ml insulin versus conventional (NPH) insulin using a self titration algorithm.50 type 2 diabetes patients who are newly started on insulin will be recruited. They will be randomly allocated to either insulin glargine U300 or NPH insulin for 26 weeks. All subjects will follow a insulin-self titration algorithm. The study will consist of 9 visits over 26 weeks. Blood glucose variability will be collected by CGM for 7 consecutive days at baseline (week -1) and at week 24.Secondary endpoints other than data on glycemic variability, including HbA1c, fasting plasma glucose, inflammatory markers will be measured during three periods (week 0, week 12 and week 24).

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+Arms and interventions

ArmTypeInterventionsDescription
ActiveExperimentalDrug: Insulin Glargine 300 UNT/MLInsulin glargine 300U/ml
ControlActive comparatorDrug: Neutral protamine hagedorn insulinNeutral Protamine Hagedorn insulin
  • Insulin Glargine 300 UNT/ML (Drug): Self titration of insulin glargine U300
  • Neutral protamine hagedorn insulin (Drug): Self titration of NPH insulin

+Outcome measures

Primary outcomes

  • Glycemic variability [24 weeks]: Standard deviation of glucose from continuous glucose monitoring

Secondary outcomes

  • Glycemic variability [24 weeks]: Mean Amplitude of Glycemic excursions and Means of Daily Differences
  • Percentage time in target [24 weeks]: Percentage of time <3.0mmol/L and >10.0mmol/L
  • Glycated haemoglobin [24 weeks]: HbA1c
  • Fasting blood glucose [24 weeks]: FPG
  • Incidence of hypoglycemia [24 weeks]: Overall incidence of hypoglycemia and nocturnal hypoglycemia
  • Proportion of patients achieving HbA1c <7.0% [24 weeks]: Proportion of patients achieving HbA1c <7.0% at week 24 without confirmed hypoglycemia
  • Treatment satisfaction [24 weeks]: ITSQ questionnaire
  • Inflammatory markers [24 weeks]: change in hs C reactive protein
  • Heart rate variability [24 weeks]: Change in heart rate variability

+Eligibility

Sex: All, ages: 18 Years to 75 Years

Inclusion Criteria:

* Type 2 diabetic suboptimally controlled on their previous antidiabetic treatment

  * 18 ≤ age ≤ 75
  * Stable dose of oral antidiabetic treatment for > 8 weeks
  * The number of OADs that the patients used should be "3" or less
  * HbA1c level > 7.0% and < 10%
  * Fasting plasma glucose > 8mmol/L and <15mmol
  * BMI < 40 kg/m2
  * Patient who is capable and willing to perform regular SMBG
  * Patient who is capable and willing for insulin injection
  * Confirmed written consent
  * Insulin naïve

Exclusion Criteria:

* Participation in a clinical trial with any investigational drug used with curative intent and within 30 days prior to study entry
* Patient known to have hypoglycaemia unawareness or recurrent major hypoglycaemia
* Any product containing prandial insulin
* Concomitant medication known to interface with glucose metabolism (such as systematic steroids)
* Change in dose of non-insulin anti-diabetic treatment or initiation of new anti-diabetic medications in the last 8 weeks prior to screening
* Patients treated with steroid or nonsteroidal anti-inflammatory drugs
* Patient who had experienced an acute concurrent illness during the 3-month period before the investigation
* Patient with hepatic disease and end-stage renal disease
* Patients unable to comply with follow-up visits
* Pregnant or breastfeeding women

+Locations (1)

FacilityCityCountryStatus
Prince of Wales HospitalHong Kong, ShatinHong Kong

+Publications

  • Results publication: Ling J, Poon EWM, Yang A, Yeung T, Loo K, Ozaki R, Ma RCW, Luk AOY, Kong APS, Chan JCN, Chow E. Glycemic Variability and Time in Range During Self-titration of Once Daily Insulin Glargine 300 U/ml Versus Neutral Protamine Hagedorn Insulin in Insulin-naive Chinese Type 2 Diabetes Patients. Diabetes Ther. 2021 May;12(5):1399-1413. doi: 10.1007/s13300-021-01046-6. Epub 2021 Mar 18. PMID 33738774
  • Results publication: Semlitsch T, Engler J, Siebenhofer A, Jeitler K, Berghold A, Horvath K. (Ultra-)long-acting insulin analogues versus NPH insulin (human isophane insulin) for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2020 Nov 9;11(11):CD005613. doi: 10.1002/14651858.CD005613.pub4. PMID 33166419

+Investigators

  • Elaine Chow, Principal investigator, Chinese University of Hong Kong