Evaluation of the Effectiveness and Safety of Physician Versus Patient-led of Insulin Glargine Initiation and Titration in Type 2 Diabetes Mellitus (ATLAS)

Asian Treat to Target Lantus Study: A Randomized, Multicentre, Multinational, Open-Label, Parallel-Group, 24-Week Phase IV Study Evaluating the Effectiveness and Safety of Physician Versus Patient-led Initiation and Titration of Insulin Glargine in Type 2 Diabetes Mellitus

Primary Objective:

To compare patient-led titration (intervention group) versus physician-led titration (usual standard of care) in optimizing the clinical use of insulin glargine in an Asian population of patients with Type 2 diabetes mellitus (T2DM) uncontrolled on oral antidiabetic drugs (OADs).

Secondary Objectives:

To determine the difference in glycemic control, safety, quality of life and treatment satisfaction between patient-led titration and usual care.

Study Overview

• Status: Completed
• Conditions: Diabetes Mellitus, Type 2
• Intervention / Treatment: Drug: Insulin Glargine

• Study Type: Interventional
• Enrollment (Actual): 555
• Phase: Phase 4

Contacts and Locations

Study Locations

• China
  • Shanghai, China
    • Administrative Office
• India
  • Mumbai, India
    • Administrative Office
• Japan
  • Tokyo, Japan
    • Administrative Office
• Pakistan
  • Karachi, Pakistan
    • Administrative Office
• Philippines
  • Makati City, Philippines
    • Administrative Office
• Russian Federation
  • Moscow, Russian Federation
    • Administrative Office

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion criteria:

1. Diagnosed with T2DM duration of T2DM > 2 years
2. Insulin naïve
3. Continuous treatment with stable doses of 2 OADs (sulphonylureas, biguanides, alpha-glucosidase inhibitors, DPP-IV inhibitors, and glinides) for > three months prior to randomization
4. HbA1c levels 7% and 11 %
5. Body mass index (BMI) 20 and 40 kg/m2
6. Willing and able to perform blood glucose monitoring using a blood glucose meter

Exclusion criteria:

1. Diabetes other than type 2 diabetes (e.g. secondary to pancreatic disorders, drug or chemical agent intake),
2. Current or previous use of insulin (except for previous treatment of gestational diabetes or brief treatment with insulin for < 1 week),
3. Current treatment with thiazolidinediones,
4. Current or previous use (within the last 3 months) of GLP-1 receptor agonists or GLP-1 analogues,
5. Current or previous (within the last 3 months) use of any treatment for weight lost,
6. Active proliferative diabetic retinopathy,
7. Patient without any history of eye examination in the past 6 months,
8. Treatment with systemic corticosteroids in the 3 months prior to study entry,
9. Currently receiving treatment with monoamine oxidase inhibitors,
10. Currently receiving treatment with non-selective -blockers,
11. Treatment with any investigational product and/or device in the 2 months prior to study entry,
12. Likelihood of requiring treatment during the study period with drugs not permitted by the clinical trial protocol,
13. History of ketoacidosis or hyperosmolar hyperglycemic state,
14. History of stroke, myocardial infarction, angina pectoris, coronary artery bypass graft or percutaneous transluminal coronary angioplasty within the previous 12 months,
15. History of congestive heart failure,
16. History of hypoglycemia unawareness,
17. Unexplained hypoglycemia in the past 6 months,
18. Impaired renal function defined as, but not limited to, serum creatinine 1.5 mg/dL (133 mol/L) males or 1.4 mg/dL (124 mol/L) females or presence of macroproteinuria (>2gr/day),
19. Active liver disease (alanine transaminase ALAT greater than two times the upper limit of the reference range, as defined by the local laboratory),
20. Have any condition (including known substance or alcohol abuse or psychiatric disorder) that precludes the patient from following and completing the study protocol,
21. Had a blood transfusion or severe blood loss within the 3 months before screening, or have known hemoglobinopathy, hemolytic anemia or sickle cell anemia,
22. Known hypersensitivity / intolerance to insulin glargine or any of its excipients,
23. History of pancreatitis,
24. Currently undergoing therapy or planned radiological examinations requiring the administration of contrasting agents for malignancy (other than non-metastatic / early stage basal cell or squamous cell carcinoma),
25. Pregnant or lactating women (women of childbearing potential must have a negative pregnancy test at study entry and a medically approved contraception method),
26. Any medical condition that may have an influence on HbA1c rate.

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Initiation on a fixed dose of insulin glargine, then subjects will self-adjusted their basal insulin dose every 3 days	Drug: Insulin Glargine; Pharmaceutical form: solution for injection Route of administration: subcutaneous Dose regimen: initial: once a day in the evening at bedtime. Titration will occur each time the middle FPG (Fasting Plasma Glucose) value is above target; Other Names: Solostar
Active Comparator: Usual standard of care group; Initiation on a fixed dose of insulin glargine, then basal insulin dose is adjusted at each visit by a physician	Drug: Insulin Glargine; Pharmaceutical form: solution for injection Route of administration: subcutaneous Dose regimen: initial: once a day in the evening at bedtime. Titration will occur each time the middle FPG (Fasting Plasma Glucose) value is above target; Other Names: Solostar

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change (decrease) in mean hemoglobin glycosylated (HbA1c) level	from week 0 (baseline) to week 24 (end of study)

Secondary Outcome Measures

Outcome Measure	Time Frame
Percentage of patients achieving HbA1c levels < 7.0% without experiencing severe hypoglycemia	from week 0 (baseline) to week 24 (end of study)
Percentage of patients achieving target HbA1c levels (< 7.0% and <6.5%)	from week 0 (baseline) to week 24 (end of study)
Number of patients having a drop of 1% in HbA1c levels and/or a drop of at least 0.5%.	from week 0 (baseline) to week 24 (end of study)
Mean change in Fasting Plasma glucose (FPG) and Post Prandial blood Glucose (PPG)	from week 0 (baseline) to week 24 (end of study)
Evolution of Blood Glucose profiles	from week 0 (baseline) to week 24 (end of study)
Incidence of symptomatic hypoglycemia	from week 0 (baseline) to week 24 (end of study)
Incidence of nocturnal hypoglycemia	from week 0 (baseline) to week 24 (end of study)
Incidence of asymptomatic hypoglycemia	from week 0 (baseline) to week 24 (end of study)
Mean change in body weight in patients	from week 0 (baseline) to week 24 (end of study)
Mean insulin dose	from week 0 (baseline) to week 24 (end of study)
PROMs (patient reported outcome measures) scores from the DTSQs/c (diabetes treatment satisfaction questionnaire status) and EQ-5D (European quality of life - 5 dimensions)	from week 0 (baseline) to week 24 (end of study)

Collaborators and Investigators

• Sponsor: Sanofi

Publications and helpful links

General Publications

• ATLAS Study Group. Titration of Insulin Glargine in Patients with Type 2 Diabetes Mellitus in Asia: Physician- Versus Patient-Led? Rationale of the Asian Treat to Target Lantus Study (ATLAS). Diabetes Technol Ther. 2011 Jan;13(1):67-72. doi: 10.1089/dia.2010.0170.
• Garg SK, Admane K, Freemantle N, Odawara M, Pan CY, Misra A, Jarek-Martynowa IR, Abbas-Raza S, Mirasol RC, Perfetti R. Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational ATLAS study. Endocr Pract. 2015 Feb;21(2):143-57. doi: 10.4158/EP14079.OR.

Study record dates

Study Major Dates

• Study Start: August 1, 2010
• Primary Completion (Actual): June 1, 2012
• Study Completion (Actual): June 1, 2012

Study Registration Dates

• First Submitted: July 22, 2010
• First Submitted That Met QC Criteria: July 23, 2010
• First Posted (Estimate): July 26, 2010

Study Record Updates

• Last Update Posted (Estimate): July 8, 2013
• Last Update Submitted That Met QC Criteria: July 5, 2013
• Last Verified: July 1, 2013

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2; Hypoglycemic Agents; Physiological Effects of Drugs; Insulin Glargine
• Other Study ID Numbers: LANTU_R_04889; U1111-1116-2247 (Other Identifier: UTN)