Comparison of Insulin Degludec With Insulin Glargine U100 for Adults With Type 1 Diabetes Crossing Multiple Time Zones. (SafrTravlT1D)

Comparison of Insulin Degludec With Insulin Glargine U100 for Adults With Type 1 Diabetes Travelling Across Multiple Time Zones. A Pilot Study.

The purpose of the proposed study is to compare insulin Degludec [TRESIBA® (insulin degludec injection)] with insulin Glargine U100 [Lantus® (insulin glargine injection)] to determine the basal insulin of choice for adults with type 1 diabetes (T1D) who fly non-stop across multiple time zones. With the introduction of Degludec as basal insulin for T1D and the opportunity to vary time of injection between 8 and 40 hours, the use of Degludec as a basal insulin may make it easier for both people living with T1D and diabetologists to plan long-haul travel compared to the use of existing basal insulins when crossing multiple time zones.The study hypothesis is that once daily Degludec as the basal insulin will provide better glycemic control for people with type 1 diabetes on multiple daily injections who are traveling non-stop across multiple time zones than once daily Glargine U100.

Study Overview

• Status: Completed
• Conditions: Diabetes Mellitus, Type 1
• Intervention / Treatment: Drug: Insulin Degludec; Device: TRESIBA® FLEXTOUCH®; Drug: Insulin Glargine; Device: LANTUS® SOLOSTAR® INSULIN PEN

Detailed Description

This study will be an open-label, single center, pilot study. Participants will be randomized to either Glargine U100 or Degludec as the basal insulin, then a 2 week break, and followed by a cross-over to the other insulin. Each study period will begin in Honolulu, Hawaii (HI) (airport code HNL) with a non-stop flight to Newark, New Jersey (NJ) (EWR) lasting approximately 10 hours with a 6 hour time difference between destinations. After up to 72 hours in EWR, participants will return to Honolulu and spend up to 72 hours at that destination. Investigators plan to recruit 25 adults with established T1D currently being treated with multiple daily injections of insulin (MDI).

• Study Type: Interventional
• Enrollment (Actual): 25
• Phase: Phase 4

Contacts and Locations

Study Locations

• United States
  • California
    • Santa Barbara, California, United States, 93105
      • Sansum Diabetes Research Institute
  • Hawaii
    • Honolulu, Hawaii, United States, 96814
      • inControl Diabetes Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Males or females ≥18 and ≤65 years of age.
2. Type 1 diabetes mellitus (diagnosed clinically and treated with multiple daily injections of insulin) for ≥12 months.
3. HbA1c <10% within 30 days of being enrolled in the study
4. Current treatment with any basal insulin analogue as the once daily basal insulin given in the evening (22) and no fewer than three injections with rapid acting bolus insulin (e.g. insulin aspart, insulin lispro, or insulin glulisine) as mealtime bolus insulin therapy.
5. No contraindication to long-haul travel.
6. No recurrent severe hypoglycemia (more than 1 severe hypoglycemic event requiring hospitalization during the last 12 months), or hypoglycemia unawareness as judged by a score of >4 on the Gold score (23), or hospitalization for diabetic ketoacidosis during the previous 6 months.
7. Willing and able to use a continuous glucose monitoring device (e.g. Dexcom G4).
8. Ability to self-manage insulin therapy (verbal confirmation at screening visit) of a changed bolus insulin dose the preceding 2 months prior to screening.

9. Ability and willingness to adhere to the protocol, including performance of self-monitored blood glucose (SMBG) readings and self-adjustment of insulin doses according to protocol.

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Exclusion Criteria:

1. Current use of an insulin pump.
2. Use within the last 3 months prior to enrollment visit 1 of any glucose-lowering drug other than insulin.
3. Initiation or significant change of any systemic treatment which, in the investigator's opinion, could interfere with glucose metabolism, such as systemic corticosteroids, beta-blockers or monoamine oxidase inhibitors (inhaled corticosteroids allowed).
4. Proliferative retinopathy or maculopathy requiring treatment, according to the investigator.
5. Pregnancy, breast-feeding, the intention of becoming pregnant or not using adequate contraceptive measures.
6. Any clinically significant disease or disorder, which in the investigator's opinion could interfere with the results of the trial.
7. Mental incapacity, psychiatric disorder, unwillingness or language barriers precluding adequate understanding or cooperation, including subjects not able to read or write, and known or suspected abuse of alcohol, narcotics, or illicit drugs.
8. Known or suspected allergy to any of the trial products or related products.

9. Receipt of any investigational drug or participation in other trials within 1 month prior to Visit 1.

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Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Insulin Degludec; Subjects with type 1 diabetes and on multiple daily injections will use basal insulin Degludec and the TRESIBA® FLEXTOUCH® pens during a long-haul flight and randomized to this arm first or second.	Drug: Insulin Degludec; Subjects will use Insulin Degludec (Tresiba) with TRESIBA® FLEXTOUCH® pens as their basal insulin during a 9-10 hour flight, at each destination, and then during a return flight.; Other Names: Tresiba; Device: TRESIBA® FLEXTOUCH®; Subjects will use Tresiba FlexTouch pens when using Tresiba as their basal insulin during a 9-10 hour flight, at each destination, and then during a return flight.; Other Names: Insulin Degludec
Active Comparator: Insulin Glargine U100; Subjects with type 1 diabetes and on multiple daily injections will use basal insulin Glargine U100 and the LANTUS® SOLOSTAR® INSULIN PEN during a long-haul flight and randomized to this arm first or second.	Drug: Insulin Glargine; Subjects will use Insulin Glargine (Lantus) with LANTUS® SOLOSTAR® INSULIN PEN as their basal insulin during a 9-10 hour flight, at each destination, and then during a return flight.; Other Names: Lantus; Device: LANTUS® SOLOSTAR® INSULIN PEN; Subjects will use Lantus SoloStar insulin pens when using Lantus as their basal insulin during a 9-10 hour flight, at each destination, and then during a return flight.; Other Names: Insulin Glargine

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Continuous Glucose Monitoring - Time in Range (70-140 mg/dl)	Time in range (70-140 mg/dl) [percentage of glucose readings or hours per day] by continuous glucose monitoring (CGM) during the initial 24 hours local time (starting within 2 hours after arriving) in Newark, NJ after flying 9-10 hours West to East (from Honolulu, HI) and after the return journey from Newark to Honolulu (flying East to West).	During the initial 24 hours local time and starting within 2 hours after arrival

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Continuous Glucose Monitoring - Time in Range (70-180 mg/dl)	Time in range (70-180 mg/dl) [percentage of glucose readings or hours per day] by continuous glucose monitoring (CGM) during the first 24 hours after arriving in HNL and EWR (starting within 2 hours after arrival).	During the initial 24 hours local time and starting within 2 hours after arrival
Mean ± SD CGM Glucose (mg/dl)	Mean ± standard deviation of CGM glucose (mg/dl) by CGM during the flight and during the 72 hours at the destination	In flight period of time and for 72 hours at each destination
CGM % Time <70 mg/dl	% time <70 mg/dl by CGM	In flight period of time and for 72 hours at each destination
CGM % Time 70-180 mg/dl	% time 70-180 mg/dl by CGM	In flight period of time and for 72 hours at each destination
CGM % Time >180 mg/dl	% time >180 mg/dl by CGM	In flight period of time and for 72 hours at each destination
CGM - Coefficient of Variation (CV)	Coefficient of variation of CGM values - glycemic variability (CV, %)	In flight period of time and for 72 hours at each destination
CGM Fasting Blood Glucose (FBG)	Fasting Blood Glucose (FBG) was determined using CGM at each destination on the morning after arrival.	At 0600 local time on the morning after arrival at each destination
Liverpool Jet-Lag Questionnaire	This is a Questionnaire about jet-lag and fatigue administered at the destinations after arrival. Jet Lag is rated on a 0-10 scale (0 - insignificant jet lag to 10 - very bad jet lag). Fatigue is rated on a scale of -5 to +5 (more fatigue to less fatigue).	After 24 and 48 hours at the destination after arrival
Sleep Quantity Measured by ActiGraph	Measurement of sleep duration (TST - Total sleep time in minutes)	During 24 hours at each destination
Sleep Efficiency Measured by ActiGraph	Measurement of sleep efficiency (SE% - total sleep time in minutes divided by time in bed in minutes)	During 24 hours at each destination

Collaborators and Investigators

• Sponsor: Sansum Diabetes Research Institute
• Collaborators: Novo Nordisk A/S
• Investigators: Principal Investigator: David Kerr, M.D., Sansum Diabetes Research Institute

Publications and helpful links

General Publications

• Bevier WC, Castorino KN, Axelrod C, Haroush G, Farfan CC, Shelton N, Nelson K, Spink LA, Liu H, Kerr D. Traveling Across Time Zones With Type 1 Diabetes: A Pilot Study Comparing Insulin Degludec With Insulin Glargine U100. Diabetes Care. 2022 Jan 1;45(1):67-73. doi: 10.2337/dc21-1524.

Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2018
• Primary Completion (Actual): September 19, 2020
• Study Completion (Actual): September 19, 2020

Study Registration Dates

• First Submitted: September 11, 2018
• First Submitted That Met QC Criteria: September 11, 2018
• First Posted (Actual): September 13, 2018

Study Record Updates

• Last Update Posted (Actual): November 1, 2022
• Last Update Submitted That Met QC Criteria: October 6, 2022
• Last Verified: October 1, 2022

More Information

Terms related to this study

• Keywords: Continuous Glucose Monitor; Insulin Degludec; Insulin Glargine; Air Travel
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Immune System Diseases; Autoimmune Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 1; Hypoglycemic Agents; Physiological Effects of Drugs; Insulin; Insulin, Globin Zinc; Insulin, Long-Acting; Insulin Glargine
• Other Study ID Numbers: ISS-001227; U1111-1210-7350 (Registry Identifier: Universal Trial Number - World Health Organization (WHO))

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided
• IPD Plan Description: Undecided to whether to make individual participant data available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes