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Insulin Therapy in the Hospital Comparing Two Protocols

8 de septiembre de 2009 actualizado por: John H. Stroger Hospital

Basal/Bolus Insulin Therapy in the Hospital Ward Comparison of Two Protocols: Feasibility Study

The purpose of this study is to determine if by using insulin analog (Glargine and lispro insulin) with an insulin pen the investigators are able to obtain a higher rate of correct timing of insulin and food administration as when compared to the usual therapy (insulin NPH and regular) with syringes.

Descripción general del estudio

Tipo de estudio

Intervencionista

Inscripción (Anticipado)

60

Fase

  • Fase 4

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

    • Illinois
      • Chicago, Illinois, Estados Unidos, 60612
        • John H Stroger Jr. Hospital

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

18 años a 80 años (Adulto, Adulto Mayor)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria:

  • Uncontrolled blood sugar:

    • Random blood sugar ≥ 200mg/dl
    • Pre-prandial blood sugar greater than 180 mg/dl on two occasions within 24 hours.
  • Patient may be off insulin or on subcutaneous inpatient insulin regimen less than 36 hours.
  • Transition from an Insulin Drip in the intensive care units to subcutaneous insulin upon transfer to general ward.
  • Patient is able to eat and oral feeding is expected.

Exclusion Criteria:

  • Patients receiving inpatient oral hypoglycemic agents
  • Patients with chronic kidney disease stages 4 & 5 (estimated GFR of <30ml/min) and on dialysis
  • Patient with chronic liver disease
  • Patient with hypoglycemia unawareness
  • Pregnancy
  • Patients who are on "NPO" for medical reasons.
  • Patient is expected to stay in the hospital for less than 3 days.
  • Patient on a new inpatient insulin regimen for > 36 hours.

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: Aleatorizado
  • Modelo Intervencionista: Asignación paralela
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Comparador activo: 2
The active control group will receive twice daily NPH insulin as basal insulin and bolus (prandial) insulin as regular insulin to be administered 30 minutes before meals. The administration of basal (prandial) regular insulin and food will be done as the current usual care on the hospital ward. The protocol for initial insulin dose and subsequent dose adjustment has been developed by the "Inpatient Diabetes Advisory Group" and is detailed in appendix B. The patient will receive information regarding diabetes treatments, appropriate diet and diabetic self management which will be provided by the nursing and nutritional staff.
The active control group will receive twice daily NPH insulin as basal insulin and bolus (prandial) insulin as regular insulin to be administered 30 minutes before meals. The administration of basal (prandial) regular insulin and food will be done as the current usual care on the hospital ward. The protocol for initial insulin dose and subsequent dose adjustment has been developed by the "Inpatient Diabetes Advisory Group" and is detailed in appendix B. The patient will receive information regarding diabetes treatments, appropriate diet and diabetic self management which will be provided by the nursing and nutritional staff.
Experimental: 1
The study group will receive Insulin Glargine as basal insulin and bolus (prandial) insulin as lispro insulin (choice between pens or vials will be made). The administration of bolus (prandial) insulin pen or syringe will be delivered concurrently with the food tray (the concept of "insulin pen/syringe on the food tray") by the nursing staff that together with hospital food services identifies the food tray for the patients in the study group. The protocol for initial insulin dose and subsequent dose adjustment has been developed by the "Inpatient Diabetes Advisory Group" and is detailed in appendix A. The patient will receive information regarding diabetes treatments, appropriate diet and diabetic self management which will be provided by the nursing and nutritional staff
The study group will receive Insulin Glargine as basal insulin. The protocol for initial insulin dose and subsequent dose adjustment has been developed by the "Inpatient Diabetes Advisory Group" and is detailed in appendix A. The patient will receive information regarding diabetes treatments, appropriate diet and diabetic self management which will be provided by the nursing and nutritional staff.
Otros nombres:
  • Insulina lantus
Bolus (prandial) insulin as lispro insulin (choice between pens or vials will be made). The administration of bolus (prandial) insulin pen or syringe will be delivered concurrently with the food tray (the concept of "insulin pen/syringe on the food tray") by the nursing staff that together with hospital food services identifies the food tray for the patients in the study group. The protocol for initial insulin dose and subsequent dose adjustment has been developed by the "Inpatient Diabetes Advisory Group" and is detailed in appendix A. The patient will receive information regarding diabetes treatments, appropriate diet and diabetic self management which will be provided by the nursing and nutritional staff.

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Periodo de tiempo
The rate of correct timing of insulin and food administration
Periodo de tiempo: Correct time was 30 min before to 30 minutes after meal was given for control group, and 15 minutes before to 15 minutes after in case group
Correct time was 30 min before to 30 minutes after meal was given for control group, and 15 minutes before to 15 minutes after in case group
Pre and post- prandial glucose levels
Periodo de tiempo: Pre prandial glucose levels were obtained from 0 to 15 minutes before meal , post prandial glucose levels were obtained 2 hours after mealtime
Pre prandial glucose levels were obtained from 0 to 15 minutes before meal , post prandial glucose levels were obtained 2 hours after mealtime

Medidas de resultado secundarias

Medida de resultado
Periodo de tiempo
Length of hospital stay
Periodo de tiempo: Measured 24 hours after patient is dischargerd, from day 1 of admission until day of discharge
Measured 24 hours after patient is dischargerd, from day 1 of admission until day of discharge
Nursing staff satisfaction scores for evaluation of the two methods
Periodo de tiempo: 24 hours after last patient is discharged
24 hours after last patient is discharged
Hypoglycemia rates.
Periodo de tiempo: From day 1 of admission until day of discharge, obtained from capillary blood checks done QAC and 2 hours postprandial
From day 1 of admission until day of discharge, obtained from capillary blood checks done QAC and 2 hours postprandial
High excursions of blood sugars (>300 mg/dl).
Periodo de tiempo: From day 1 of admission until day of discharge, obtained from capillary blood checks done QAC and 2 hours postprandial
From day 1 of admission until day of discharge, obtained from capillary blood checks done QAC and 2 hours postprandial

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Colaboradores

Investigadores

  • Investigador principal: Leon Fogelfeld, MD, John H Stroger Jr. Hospital
  • Silla de estudio: Evelyn Lacuesta, MD, John H Stroger Jr. Hospital
  • Silla de estudio: Yannis Guerra, MD, Rush University Hospital

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio

1 de diciembre de 2006

Finalización primaria (Actual)

1 de marzo de 2009

Finalización del estudio (Actual)

1 de junio de 2009

Fechas de registro del estudio

Enviado por primera vez

9 de febrero de 2009

Primero enviado que cumplió con los criterios de control de calidad

11 de febrero de 2009

Publicado por primera vez (Estimar)

12 de febrero de 2009

Actualizaciones de registros de estudio

Última actualización publicada (Estimar)

9 de septiembre de 2009

Última actualización enviada que cumplió con los criterios de control de calidad

8 de septiembre de 2009

Última verificación

1 de septiembre de 2009

Más información

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

Ensayos clínicos sobre Diabetes Mellitus, Tipo 2

Ensayos clínicos sobre NPH insulin and regular insulin

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