- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02189395
Comparison of Neutral Protamine Hagedorn (NPH) and Lantus Based Insulin Regimen in the Management of Hypoglycemia in the Hospitalized Patients in Noncritical Care Setting
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The effect of insulin depends not only on the pharmacokinetics and pharmacodynamics of a particular preparation, but also on patient specific factors which includes state of inflammation, obesity etc. Although effect on glucose disposal is the central to insulin action, there could be differences of insulin action on other metabolic parameters. It is not known if there is a difference in suppression of inflammation with improved glycemic control which could vary with analog insulin. It is unknown if natural insulin (NPH, recombinant human insulin with protamine) differs from insulin analogs (glargine and detemir, made by substituting amino acid in the native sequence) in terms of metabolic outcome other than glucose disposal.
At this point it is uncertain if there is any clear benefit of use of lantus over NPH in inpatient glycemic management. Currently, both lantus and NPH based regimen is practiced in inpatient hospital setting. Current practice of inpatient insulin regimen is based more on familiarity of physicians with a particular insulin type and personal preference rather than evidenced based knowledge. Lantus is an expensive insulin preparation compared to NPH with uncertain benefit in inpatient setting. Current research proposal will compare this two insulin based regimen in the management of diabetes of hospitalized patients. Information obtained through this research will guide the investigators practice in this institution as well as in other institutions.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
California
-
Moreno Valley, California, United States, 92555
- Riverside County Regional Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients with type II diabetes regardless of duration of diagnosis with an admission blood glucose level between 140 mg/dL to 400 mg/dL will be included in the study.
Other inclusion criteria are as follows:
- age 18-80 years old
- treated with diet alone
- any combination of oral anti-diabetic agents or insulin treatment with any dosage before admission.
Exclusion Criteria:
- Hyperglycemia without a known history of diabetes
- H/o recent cardiac surgery (within 6 months)
- Impaired renal function (glomerular filtration rate less than 45)
- History of diabetic ketoacidosis
- Diabetes mellitus type 1
- Pregnancy
- Patients on steroid treatment
- Known hypopituitarism or adrenal insufficiency
- Known hypoglycemia of unawareness
- Length of stay <48 h
- And severe liver disease and patent admitted in intensive care unit.
- Patients already received an insulin dose greater than 0.5 units/kg body weight after admission prior to initiation of study protocol will be excluded from the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: NPH and regular insuline group
For the group receiving NPH and regular 2/3 and 1/3 formula will be followed.
If Nil per os (NPO), patient will receive NPH twice daily but AM dose will equal to PM dose.
Regular insulin given along with NPH will be held while patient is NPO.
A correctional dose of regular insulin will be given for any blood glucose >180 mg/dL.
If subjects were not eating, they could also receive correctional doses of regular insulin.
Correctional insulin could be given four times daily with meals or at bedtime.
|
|
Active Comparator: glargine and humalog group
Half of the total insulin dose will be given as glargine once daily, either in the AM or in the PM, depending on when the patient was enrolled.
The other half of the total daily insulin dose was given as humalog; doses were divided equally between breakfast, lunch, and dinner.
An additional correctional dose of humalog will be given for any blood glucose >180 mg/dL.
If subjects were not eating, they received glargine once daily and could also receive correctional doses of humalog.
Correctional humalog could be given four times daily with meals or at bedtime.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
difference in glycemic control between treatment groups as measured by the mean daily blood glucose
Time Frame: Duration of hospital stay, up to 24 weeks
|
Primary outcome of the study is to determine differences in glycemic control between treatment group as measured by the mean daily blood glucose
|
Duration of hospital stay, up to 24 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
number of hypoglycemic events
Time Frame: duration of hospital stay, up to 24 weeks
|
number of hypoglycemic events
|
duration of hospital stay, up to 24 weeks
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 437860
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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