CHOICE: CHanges to Treatment and Outcomes in Patients With Type 2 Diabetes Initiating InjeCtablE Therapy

CHOICE: CHanges to Treatment and Outcomes in Patients With Type 2 Diabetes Initiating InjeCtablE Therapy - A European Observational Study of Patients With Type 2 Diabetes Initiating Injectable Therapy to Determine Time to Treatment Change, Factors Associated With Treatment Changes and Outcomes Over 24 Months

Patients initiating injectable therapy for type 2 diabetes (insulin or exenatide) in usual clinical practice will be enrolled and followed up for two years in order to describe actual practice with regards to the time on initial treatment regime, whether treatment regimens are being modified, what treatment modifications are made, and clinical and patient-reported outcomes.

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes Mellitus
• Intervention / Treatment: Drug: exenatide; Drug: any human insulin or analog insulin(s) given in any regimen by subcutaneous injection

• Study Type: Observational
• Enrollment (Actual): 2515

Contacts and Locations

Study Locations

• Denmark
  • Amager, Denmark
    • Research Site
  • Ronne, Denmark
    • Research Site
• France
  • Toul Cedex, France
    • Research Site
• Germany
  • Alsfeld, Germany
    • Research Site
  • Aschaffenburg, Germany
    • Research
  • Asslar, Germany
    • Research Site
  • Augsburg, Germany
    • Research Site
  • Bad Aibling, Germany
    • Research Site
  • Bad Homburg, Germany
    • Research Site
  • Bad Mergentheim, Germany
    • Research Site
  • Bergheim, Germany
    • Research Site
  • Berlin, Germany
    • Research Site
  • Birkenfeld, Germany
    • Research
  • Bosenheim, Germany
    • Research Site
  • Bruchsal, Germany
    • Research Site
  • Dortmund, Germany
    • Research Site
  • Dresden, Germany
    • Research Site
  • Duisburg, Germany
    • Research Site
  • Eberswalde, Germany
    • Research Site
  • Eilenburg, Germany
    • Research Site
  • Eisenach, Germany
    • Research Site
  • Erfurt, Germany
    • Research Site
  • Essen, Germany
    • Research Site
  • Frankfurt, Germany
    • Research Site
  • Gebhardshain, Germany
    • Research Site
  • Gersfeld, Germany
    • Research Site
  • Giessen, Germany
    • Research Site
  • Gifhorn, Germany
    • Research Site
  • Grassau, Germany
    • Research Site
  • Gross-Gerau, Germany
    • Research Site
  • Hadmersleben, Germany
    • Research Site
  • Halle, Germany
    • Research Site
  • Hamburg, Germany
    • Research Site
  • Hammelburg, Germany
    • Research Site
  • Hennigsdorf, Germany
    • Research Site
  • Hohenmolsen, Germany
    • Research Site
  • Ismaning, Germany
    • Research Site
  • Kothen, Germany
    • Research Site
  • Kutenholz, Germany
    • Research Site
  • Langen, Germany
    • Research Site
  • Langenfeld, Germany
    • Research Site
  • Leipzig, Germany
    • Research Site
  • Lichtenfels, Germany
    • Research Site
  • Ludwigsburg, Germany
    • Research Site
  • Luneburg, Germany
    • Research Site
  • Marburg, Germany
    • Research Site
  • Mayen, Germany
    • Research Site
  • Meissen, Germany
    • Research Site
  • Minden, Germany
    • Research Site
  • Monchengladbach, Germany
    • Research Site
  • Munchen, Germany
    • Research Site
  • Munster, Germany
    • Research Site
  • Nassau, Germany
    • Research Site
  • Netphen, Germany
    • Research Site
  • Oberhausen, Germany
    • Research Site
  • Pirmasens, Germany
    • Research Site
  • Recklinghausen, Germany
    • Research Site
  • Rehburg-Loccum, Germany
    • Research Site
  • Reichenbach, Germany
    • Research Site
  • Riesa, Germany
    • Research Site
  • Saarbrucken, Germany
    • Research Site
  • Saarlouis, Germany
    • Research Site
  • Schkeuditz, Germany
    • Research Site
  • Schonwalde, Germany
    • Research Site
  • Schweinfurt, Germany
    • Research Site
  • Seligenstadt, Germany
    • Research Site
  • Siegen, Germany
    • Research Site
  • Stockach, Germany
    • Research Site
  • Thale, Germany
    • Research Site
  • Ubach-Palenberg, Germany
    • Research Site
  • Ueckermunde, Germany
    • Research Site
  • Villingen-Schwenningen, Germany
    • Research Site
  • Volklingen, Germany
    • Research Site
  • Warburg, Germany
    • Research Site
  • Weissenberg, Germany
    • Research Site
  • Werl, Germany
    • Research Site
  • Westfalica, Germany
    • Research Site
  • Wilhelmshaven, Germany
    • Research Site
  • Wurzen, Germany
    • Research Site
• Greece
  • Kozani, Greece
    • Research Site
  • N. Efkarpia, Greece
    • Research Site
  • Thessaloniki, Greece
    • Research Site
  • Veroia, Greece
    • Research Site
• Sweden
  • Angelholm, Sweden
    • Research Site
  • Angered, Sweden
    • Research Site
  • Dalby, Sweden
    • Research Site
  • Falun, Sweden
    • Research Site
  • Goteborg, Sweden
    • Research Site
  • Limhamn, Sweden
    • Research Site
  • Lulea, Sweden
    • Research Site
  • Malmo, Sweden
    • Research Site
  • Skivarp, Sweden
    • Research Site
  • Skovde, Sweden
    • Research Site
  • Stockholm, Sweden
    • Research Site
  • Vadstena, Sweden
    • Research Site
  • Vastervik, Sweden
    • Research Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of patients aged 18 or above, with type 2 diabetes starting any of the available initial injectable treatment options (any insulin, or exenatide BID) for the treatment of type 2 diabetes as part of routine clinical care.

Description

Inclusion Criteria:

• are aged 18 or above
• diagnosed with type 2 diabetes
• have had a treatment decision made within the normal course of care to initiate either insulin or exenatide for the treatment of type 2 diabetes
• have not previously been treated with either insulin or exenatide
• are not simultaneously participating in another study which includes an investigational drug or procedure at study entry
• have been fully informed and given their written consent for use of their data
• have sufficient understanding of the primary language of their country such that they will be able to complete the questionnaires.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
1; exenatide	Drug: exenatide; subcutaneous injection, 5mcg or 10mcg, twice a day; Other Names: Byetta
2; insulin	Drug: any human insulin or analog insulin(s) given in any regimen by subcutaneous injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Estimates of Probability to Remain on Initial Injectable Treatment at 12 and 24 Months.	The primary objective of this study is to estimate the time spent on initial treatment regime before significant treatment change for patients with type 2 diabetes initiating therapy with either insulin or exenatide for the first time. Initial treatment regime is defined as the treatment regime prescribed when the patient is enrolled in the study. Significant treatment change for patients initiated on insulin or exenatide is defined as at least one of the following: Insulin: Addition of a new medication for the treatment of type 2 diabetes; A change in the number of times insulin is administered per day; Discontinuation of any insulin initiated at baseline; Substitution of a human insulin for an analogue insulin or vice-versa.; Switching between brands of the same class/type of insulin is not included in the definition of significant treatment change. Exenatide: Addition of a new medication for the treatment of type 2 diabetes; Discontinuation of exenatide.	Month 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Higher Body Mass Index (BMI) Associated With Treatment Choice at Baseline	Higher BMI was one of the Factors evaluated for association with treatment choice at baseline. BMI was calculated as body weight in kilograms (kg) divided by height in meters (m) squared (kg/m^2). The mean BMI at baseline is provided below and the statistical analysis provides the 2 arms odds ratio for BMI=1 kg/m^2 higher. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	Baseline
Higher Hemoglobin A1c (HbA1) Associated With Treatment Choice at Baseline	Higher HbA1c was one of the Factors evaluated for association with treatment choice at baseline.HbA1c was reported in percent of hemoglobin. The mean HbA1c at baseline is provided below and the statistical analysis provides the 2 arms odds ratio for HbA1c=1% higher.	Baseline
Older Age Associated With Treatment Choice at Baseline	Older age (1 year older) was one of the Factors evaluated for association with treatment choice at baseline. The mean age at baseline is provided below and the statistical analysis provides the 2 arms odds ratio for age 1 year older. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	Baseline
Disinhibited Eating Associated With Treatment Choice at Baseline	Diabetes Health Profile (DHP-18) - consists of 18 items across 3 domains (psychological distress, barriers to activity, and disinhibited eating), with each item standardized score rated from 0-100; 0=no dysfunction, higher numbers=greater dysfunction. The subscale of disinhibited eating was one of the Factors evaluated for association with treatment choice at baseline. The number of participants with disinhibited eating at baseline is provided below and the statistical analysis provides the 2 arms odds ratio for disinhibited eating. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	Baseline
Higher Random Glucose Associated With Treatment Choice at Baseline	Random Glucose 1 millimole per liter (mmol/L) higher was one of the Factors evaluated for association with treatment choice at baseline. Random glucose is a glucose within the last 6 months prior to baseline. The mean is provided below and the statistical analysis provides the 2 arms odds ratio for the glucose 1 mmol/L higher. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	6 months prior to Baseline
Frequent Blood Glucose Self Monitoring Associated With Treatment Choice at Baseline	Frequent glucose self-testing (1 test/week more) was one of the Factors evaluated for association with treatment choice at baseline. The mean number of self monitoring blood glucose tests per week over the last 4 weeks prior to baseline was determined at baseline and is provided below. The statistical analysis provides the 2 arms odds ratio. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	4 weeks prior to Baseline
Diet and Exercise Advice in Diabetes Management Associated With Treatment Choice at Baseline	Receipt of diet and exercise advice was one of the Factors evaluated for association with treatment choice at baseline. The number of participants who checked yes or no during the baseline visit for prior receipt of diet/exercise advice in his/her Diabetes management is provided below and the statistical analysis provides the 2 arms odds ratio. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	Baseline
Higher Value of Low Density Lipoprotein Cholesterol Associated With Treatment Choice at Baseline	Higher (1 mmol/L higher) LDL cholesterol was one of the Factors evaluated for association with treatment choice at baseline. The mean LDL cholesterol at baseline is provided below and the statistical analysis provides the 2 arms odds ratio for 1 mmol/L higher at baseline. Participants were assigned to the exenatide BID or insulin cohort based the injectable treatment started at baseline; analyses were conducted irrespective of later treatment changes. Baseline was Visit T1 (prior to start of treatment).	Baseline
Changes in HbA1c From Baseline to Month 24	Changes in HbA1c From Baseline to Month 24	Baseline, Month 24
Percentage of Patients Achieving HbA1c Concentration <7.0% at Month 24	Percentage of Patients Achieving HbA1c Concentration <7.0% at Month 24. Only patients with baseline HbA1c >= 7.0 % were included in this analysis	Month 24
Percentage of Patients Achieving HbA1c Concentration <6.5% at Month 24	Percentage of Patients Achieving HbA1c Concentration <6.5% at Month 24. Note: Only patients with baseline HbA1c >=6.5% were included in this analysis.	Month 24
Changes in Weight From Baseline to Month 24	Changes in Weight From Baseline to Month 24	Baseline, Month 24
Incidence of Gastro Intestinal Symptoms Between Baseline and 24 Months	Incidence of Gastro Intestinal Symptoms between Baseline and 24 Months	Baseline to Month 24
Incidence of Hypoglycemia Between Baseline and 24 Months	Incidence of Hypoglycemia between Baseline and 24 Months	Baseline to Month 24
Reasons for Discontinuation of Baseline Regimen	Reasons for Discontinuation of Baseline Regimen	Baseline to Month 24
Factors Associated With Treatment Change in Insulin Cohort	Hazards ratios from Backward Cox Regression Model for time to significant treatment change in Insulin cohort	Baseline to Month 24
Factors Associated With Treatment Change in Exenatide BID Cohort	Hazards ratios from Backward Cox Regression Model for time to significant treatment change in Exenatide BID cohort. EQ-5D (Health Questionnaire Copyright @ Euro QoL Group 1998).	Baseline to Month 24
Percentage of Patients Contacting Health Care Providers Between Baseline and 24 Months	Percentage of Patients Contacting Health Care Providers Between Baseline and 24 Months	Baseline to Month 24
Number of Contacts With Health Care Providers Between Baseline and 24 Months	Number of contacts with Health Care Providers Between Baseline and 24 Months	Baseline to Month 24
Percentage of Patients Hospitalized Between Baseline and 24 Months	Percentage of Patients Hospitalized Between Baseline and 24 Months	Baseline to Month 24

Collaborators and Investigators

• Sponsor: AstraZeneca
• Collaborators: Eli Lilly and Company
• Investigators: Study Director: James Malone, MD, Eli Lilly and Company

Publications and helpful links

General Publications

• Schultheis P, Montoya MN, Zhao Q, Archer J, Madden T, Peipert JF. Contraception and ectopic pregnancy risk: a prospective observational analysis. Am J Obstet Gynecol. 2021 Feb;224(2):228-229. doi: 10.1016/j.ajog.2020.10.013. Epub 2020 Oct 10. No abstract available.
• Reaney M, Mathieu C, Ostenson CG, Matthaei S, Krarup T, Kiljanski J, Salaun-Martin C, Sapin H, Theodorakis M, Guerci B. Patient-reported outcomes among patients using exenatide twice daily or insulin in clinical practice in six European countries: the CHOICE prospective observational study. Health Qual Life Outcomes. 2013 Dec 26;11:217. doi: 10.1186/1477-7525-11-217.

Study record dates

Study Major Dates

• Study Start: January 1, 2008
• Primary Completion (Actual): December 1, 2011
• Study Completion (Actual): December 1, 2011

Study Registration Dates

• First Submitted: February 20, 2008
• First Submitted That Met QC Criteria: March 12, 2008
• First Posted (Estimate): March 13, 2008

Study Record Updates

• Last Update Posted (Estimate): April 9, 2015
• Last Update Submitted That Met QC Criteria: March 20, 2015
• Last Verified: March 1, 2015

More Information

Terms related to this study

• Keywords: diabetes; insulin; exenatide; Lilly; Amylin; Byetta
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Physiological Effects of Drugs; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Anti-Obesity Agents; Incretins; Insulin; Insulin, Globin Zinc; Exenatide
• Other Study ID Numbers: H8O-EW-B005