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- Registre américain des essais cliniques
- Essai clinique NCT00440284
Flexible, Intensive vs. Conventional Insulin Therapy in Insulin-Naive Adults With Type 2 Diabetes
Flexible, Intensive vs. Conventional Insulin Therapy in Insulin-Naive Adults With Type 2 Diabetes - a Non-Blinded, Randomized Controlled Cross-Over Clinical Trial of Metabolic Control and Patient Preference
Objective. Flexible, intensive insulin therapy (FIT) with pre-prandial regular insulin and conventional insulin therapy (CIT) with twice daily premixed insulin are treatment options in patients with type 2 diabetes who become insulin dependent. While intensive insulin therapy can increase meal and life style flexibility, conventional therapy is easier to perform. The aim of the study was to compare metabolic outcomes and patient preferences of both treatment regimens.
Research Design and Methods. Non-blinded, randomized controlled cross-over clinical pilot trial. Insulin naive participants who failed therapeutic goals under oral antidiabetic therapy underwent FIT and CIT for two months. Patients completed standard Diabetes Treatment and Teaching Programs (DTTP) and trained FIT and CIT. Main outcome measures were glycosylated hemoglobin (GHb), mild and severe hypoglycemia, insulin dosage, blood pressure and body-mass-index (BMI). Before/after and inter-group analyses were performed. Finally, therapy preference was analyzed.
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Hypothesis In the undertaken study we tested the hypothesis that flexible, intensive and conventional insulin therapy in insulin-naive adults with type 2 diabetes are equally effective in regards to metabolic outcomes. We hypothesized that younger participants in employment would prefer flexible, intensive insulin therapy.
Flexible, intensive and conventional insulin therapy CIT consisted of twice daily injections of premixed insulin (30% regular insulin, 70% NPH-insulin) before breakfast and dinner. Participants followed individually adjusted diet plans with fixed amounts of carbohydrates. Daily blood-glucose self-control was performed before insulin injections. Participants documented blood glucose readings and insulin dosage. Limited self-adjustment of insulin dosage was taught and encouraged in the DTTP, i.e. variance of up to 4 IU insulin per injection.
In FIT, participants measured blood glucose before main meals and at bedtime and adjusted regular insulin dosages to actual blood glucose levels and their desired carbohydrate intake on a meal by meal basis. When necessary, NPH insulin was added at bedtime. Additional administration of oral antidiabetic drugs was not permitted.
Study design, randomization and intervention The trial was designed as a clinical, prospective, randomized, non-blinded, single center, cross-over pilot study.
After randomization, participants started insulin therapy either with FIT or CIT and completed a Diabetes Treatment and Teaching Program on an out-patient basis. In this four week run-in period with weekly visits, individual insulin dosage and carbohydrate intake was determined (figure 1). The run-in was followed by an 8 week study sequence until cross-over. At cross-over, participants were given one structured teaching session for refreshing and switched from CIT to FIT (Group A) or FIT to CIT (Group B), respectively. After a one week run-in period for insulin dose-adjustment, participants completed the second 8 week study sequence. Regular visits were held at the beginning and at the end of both study sequences. Additional visits were held after 2 weeks, to adjust therapy if necessary. During visits, a study team consisting of a diabetologist and a specially trained nurse educator analyzed personal diabetes records and gave advice regarding insulin dose adjustment and other problems related to current diabetes therapy. At the end of the trial, participants decided which therapy to continue.
Setting, eligibility criteria and outcome measures Participants were recruited in the outpatient clinic of the Unit of Endocrinology and Metabolic Diseases of the Department of Internal Medicine of the Friedrich-Schiller-University, Jena.
All patients with type 2 diabetes who failed to achieve their therapeutic goals under oral antidiabetic therapy and who were referred by local General Practitioners to the outpatient clinic for initiation of insulin therapy were candidates for inclusion in the study. Participants who agreed to participate in the study were recruited in consecutive order as they were referred to the out-patient clinic. They were not admitted to the study if any of the following criteria were present: (1) not type 2 diabetes, (2) diabetes duration <2 years, (3) not insulin naive, (4) ineffective oral antidiabetic therapy < 3 months, (5) GHb below 7 or above 11%, (6) age below 40 or above 65 years, (7) co-medication with corticosteroids, (8) pregnancy, severe mental or somatic diseases or (9) unwillingness to return for follow-up.
The primary end-point with respect to the effectiveness of FIT and CIT was glycosylated (GHb). Secondary end-points were mild and severe symptoms of hypoglycemia, insulin dosage, blood pressure, BMI and individual therapy preference.
Sample size To have a 90% chance of detecting as significant (at the two sided 5% level) a 0.5 % difference between the two groups in GHb, with an assumed standard deviation of 0.8%, 38 participants were required.
Type d'étude
Inscription
Phase
- Phase 3
Contacts et emplacements
Lieux d'étude
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Thuringia
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Jena, Thuringia, Allemagne, 07740
- Medical School, Friedrich Schiller University Jena
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
- All patients with type 2 diabetes who failed to achieve their therapeutic goals under oral antidiabetic therapy and who were referred by local General Practitioners to the outpatient clinic for initiation of insulin therapy were candidates for inclusion in the study.
- Participants who agreed to participate in the study were recruited in consecutive order as they were referred to the out-patient clinic.
Exclusion Criteria:
- Not type 2 diabetes,
- Diabetes duration <2 years,
- Not insulin naive,
- Ineffective oral antidiabetic therapy < 3 months,
- GHb below 7 or above 11%,
- Age below 40 or above 65 years,
- Co-medication with corticosteroids,
- Pregnancy, severe mental or somatic diseases or
- Unwillingness to return for follow-up.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation croisée
- Masquage: Aucun (étiquette ouverte)
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
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glycosylated hemoglobin (GHb)
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Mesures de résultats secondaires
Mesure des résultats |
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mild and severe hypoglycemia, insulin dosage, blood pressure and body-mass-index (BMI).
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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Christof Kloos, MD, Klinik Innere Medizin III, Medical School, Friedrich Schiller University
Publications et liens utiles
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude
Achèvement de l'étude
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Estimation)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 1b
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