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Study on the Feasibility of Community Doctors Guided by Specialists to Use Basic Insulin

11. september 2020 opdateret af: Shenzhen Second People's Hospital

Study on the Feasibility and Treatment Experience of Community Doctors in Shenzhen Guided by Specialists to Use Basic Insulin in the Treatment of Adult Type 2 Diabetes Mellitus

At present, one of the reasons for the low blood sugar control rate in China is related to the late use of basic insulin and insufficient dose adjustment. If the community hospital can actively treat the diabetic patients who need to use insulin and adjust the dose in time, it will certainly improve the blood sugar control rate. However, at present, community doctors basically do not take the initiative to start insulin treatment, but only passively use insulin that has been prescribed by specialists, and there is a lack of ability to adjust the dose of insulin and treatment inertia. Therefore, it is very necessary for community doctors to receive guidance from endocrine specialists to improve their ability to use insulin. This study intends to carry out a study of endocrine specialists guiding community doctors to use basic insulin in the treatment of adult type 2 diabetes in Shenzhen Community Hospital. Through this study to understand whether the effectiveness and safety of community doctors actively using basic insulin therapy under the guidance of specialists can reach the level of specialists.

Studieoversigt

Status

Ukendt

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

The study consists of two parts: the screening period and the treatment follow-up period.

  1. Screening period (day 0): patients were screened according to the inclusion and exclusion criteria, and informed consent was completed.
  2. Treatment follow-up period (day 1-day 90)： Day 1： （1）all patients in the group received diet and exercise education；（2）Collect patients' basic data (name, sex, age, height, weight, waist circumference, hip circumference, etc.), detect plasma FBG and HbA1c (sent to the central laboratory for testing)；（3）Initial treatment： On the basis of the original oral medicine, the patient will initial basic insulin. The initial dose of basic insulin is 0.2U/kg/d.

Day 2-Day 89:

  1. Community patient group：The community doctor adjusts the dosage of insulin daily according to the patient's FBG: the dose is titrated by increments of 0.07U/kg daily until the fasting blood glucose （FBG）≤7 mmol / L, and if the FBG≤ 3.9mmol/L, the 0.07U/kg is reduced. Inpatient group：Endocrinologists in the in-patient department use the same basic insulin dose adjustment regimen to treat patients.
  2. It can be discontinued when the basic insulin is reduced to 8U and the fasting blood glucose reaches the standard for 3 days.

Day 90：Patients were re-examined the plasma FBG and HbA1c (sent to the central laboratory for testing), and community doctors filled in the treatment experience questionnaire.

Follow-up requirements: Patients use the complimentary blood glucose meter to monitor FPG every day, 2 hours postprandial blood glucose and night blood glucose are optional, and blood sugar is measured at any time if there are symptoms of hypoglycemia. The community doctor adjusted the insulin dose according to the blood glucose level every day, and the patients were followed up by telephone every week to collect the use of hypoglycemia, diet, exercise and other hypoglycemic drugs, and record the time when the FPG reached the standard, the total amount of insulin glargine, hypoglycemia and so on.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

150

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 65 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Diagnosis of T2DM (WHO1999 diabetes diagnostic criteria)；
  2. The age is ≥ 18 and ≤ 65 years old;
  3. Continuous use of 2 or more oral hypoglycemic drugs for 1 month but HbA1c ≥ 8.0% and FPG ≥ 10mmol/L.

Exclusion Criteria:

  1. Severe abnormal liver and kidney function and cardiac insufficiency;
  2. Complicated with all kinds of acute and chronic infection or coronary heart disease, kidney disease, connective tissue disease, tumor, stroke and so on;
  3. There are acute metabolic disorders caused by stress and diseases affecting glucose metabolism, such as pheochromocytoma, acromegaly, Cushing syndrome, hyperthyroidism and so on.
  4. Acute complications of diabetes, such as diabetic ketoacidosis, hyperglycemic hyperosmotic coma or lactic acidosis, etc.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: community patient group
The community doctor adjusts the basic insulin dosage daily according to the fasting blood glucose of the patient under the guidance of the specialist.
Medicin: basic insulin
  1. Initial dose of basic insulin: 0.2U/kg/d.
  2. Dose titration regimens: the dose is titrated by increments of 0.07U/kg daily until the fasting blood glucose（FBG）≤7 mmol / L, and if the FBG≤ 3.9mmol/L, the 0.07U/kg is reduced.
  3. Injection time: subcutaneous injection before going to bed every night.
Andre navne:
  • Glargine 300U/3ml
Aktiv komparator: inpatient group
Endocrinologists in the in-patient department use the same basic insulin dose adjustment regimen to treat patients.
Medicin: basic insulin
  1. Initial dose of basic insulin: 0.2U/kg/d.
  2. Dose titration regimens: the dose is titrated by increments of 0.07U/kg daily until the fasting blood glucose（FBG）≤7 mmol / L, and if the FBG≤ 3.9mmol/L, the 0.07U/kg is reduced.
  3. Injection time: subcutaneous injection before going to bed every night.
Andre navne:
  • Glargine 300U/3ml

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Time to achieve target FBG
Tidsramme: From the beginning of intervention to fasting blood glucose ≤ 7.0mmol/L，assessed up to 3 months.
Treatment days when FBG reached the standard (≤ 7.0mmol/L) after treatment with basal insulin.
From the beginning of intervention to fasting blood glucose ≤ 7.0mmol/L，assessed up to 3 months.
Decrease of HbA1c
Tidsramme: At the end of 3 months of follow-up.
The change of HbA1c before and after treatment with basal insulin.
At the end of 3 months of follow-up.
Incidence of hypoglycemia
Tidsramme: At the end of 3 months of follow-up.
The proportion of the occurrence of hypoglycemia to the number of total blood glucose monitoring.
At the end of 3 months of follow-up.

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Daily doses of insulin at the study end point.
Tidsramme: At the end of 3 months of follow-up.
The daily doses of insulin at the study end point.
At the end of 3 months of follow-up.

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Shenzhen Second People's Hospital

Efterforskere

  • Studiestol: Dewen Yan, Shenzhen Second People's Hospital

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Forventet)

1. december 2020

Primær færdiggørelse (Forventet)

31. december 2021

Studieafslutning (Forventet)

31. marts 2022

Datoer for studieregistrering

Først indsendt

3. september 2020

Først indsendt, der opfyldte QC-kriterier

11. september 2020

Først opslået (Faktiske)

17. september 2020

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

17. september 2020

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

11. september 2020

Sidst verificeret

1. september 2020

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • YANDEWEN

Plan for individuelle deltagerdata (IPD)

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