Study of Insulin Lispro in Participants With Inadequately Controlled Type 2 Diabetes (AUTONOMY)
2014年4月3日 更新者:Eli Lilly and Company
Two Approaches to Escalate Lispro Therapy in Patients With Type 2 Diabetes Mellitus Not Achieving Adequate Glycemic Control on Basal Insulin Therapy and Oral Agents Alone (AUTONOMY)
Evidence regarding optimal methods of insulin dose adjustment is lacking in the literature.
The purpose of this study is to evaluate the efficacy and safety of two approaches to escalate prandial insulin therapy in participants with type 2 diabetes mellitus not achieving adequate glycemic control on basal insulin.
調査の概要
詳細な説明
Participants who enter the study and are already taking insulin glargine with a screening HbA1c >7.0% will be randomized to one of two treatment arms.
Both arms will add prandial insulin to existing basal insulin therapy.
研究の種類
介入
入学 (実際)
1117
段階
- フェーズ 4
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
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Arizona
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Phoenix、Arizona、アメリカ、85050
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California
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Concord、California、アメリカ、94520
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Fresno、California、アメリカ、93720
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Lakewood、California、アメリカ、90712
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Lancaster、California、アメリカ、93534
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Mission Hills、California、アメリカ、91345
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Tustin、California、アメリカ、92780
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Florida
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Bradenton、Florida、アメリカ、34208
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Jacksonville、Florida、アメリカ、32209
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Orlando、Florida、アメリカ、32806
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Pembroke Pines、Florida、アメリカ、33027
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Idaho
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Idaho Falls、Idaho、アメリカ、83404
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Lewiston、Idaho、アメリカ、83501
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Indiana
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Evansville、Indiana、アメリカ、47714
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Iowa
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Des Moines、Iowa、アメリカ、50314
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Kansas
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Topeka、Kansas、アメリカ、66606
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Kentucky
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Lexington、Kentucky、アメリカ、40503
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Louisiana
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Metairie、Louisiana、アメリカ、70006
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Shreveport、Louisiana、アメリカ、71106
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Massachusetts
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Haverhill、Massachusetts、アメリカ、01830
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Michigan
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Troy、Michigan、アメリカ、48085
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Minnesota
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Minneapolis、Minnesota、アメリカ、55416
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Missouri
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Clarkson Valley、Missouri、アメリカ、63011
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Nevada
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Las Vegas、Nevada、アメリカ、89119
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New Jersey
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Flemington、New Jersey、アメリカ、08822
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New York
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Syracuse、New York、アメリカ、13210
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Ohio
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Dayton、Ohio、アメリカ、45439
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Oregon
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Portland、Oregon、アメリカ、97210
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Pennsylvania
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Beaver、Pennsylvania、アメリカ、15009
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Philadelphia、Pennsylvania、アメリカ、19107
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Texas
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Dallas、Texas、アメリカ、75231
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Houston、Texas、アメリカ、77095
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San Antonio、Texas、アメリカ、78229
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Buenos Aires、アルゼンチン、C1425AGC
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Mar Del Plata、アルゼンチン、B7600FZN
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Rosario、アルゼンチン、2000
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Vienna、オーストリア、1130
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Manitoba
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Winnipeg、Manitoba、カナダ、R3E 3P4
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Prince Edward Island
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Charlottetown、Prince Edward Island、カナダ、C1A 1L2
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Quebec
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Sherbrooke、Quebec、カナダ、J1G 2E9
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Osijek、クロアチア、31000
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Slavonski Brod、クロアチア、35 000
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Zagreb、クロアチア、10000
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Frederiksberg、デンマーク、2000
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Kobenhavn、デンマーク、2400
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Kolding、デンマーク、6000
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Bourges、フランス、18000
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La Bouexiere、フランス、35340
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Nantes、フランス、44300
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Belem、ブラジル、66073-000
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Curitiba、ブラジル、80060-900
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Maringa、ブラジル、87015-320
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Caguas、プエルトリコ、00726
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Manati、プエルトリコ、00674
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Ponce、プエルトリコ、007171563
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Rio Piedras、プエルトリコ、00921
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San Juan、プエルトリコ、00917
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Lodz、ポーランド、90-242
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Lublin、ポーランド、20-538
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Poznan、ポーランド、61-655
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Szczecin、ポーランド、70-506
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Cuauhtemoc、メキシコ、06090
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Guadalajara、メキシコ、44150
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Guadalajara Jalisco、メキシコ、04460
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Mexico City、メキシコ、03300
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Monterrey、メキシコ、64710
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Kaunas、リトアニア、LT-51270
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Raseiniai、リトアニア、60127
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Ukmerge、リトアニア、20184
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Bucharest、ルーマニア、022441
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Oradea、ルーマニア、410169
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Saint Petersburg、ロシア連邦、197022
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Saratov、ロシア連邦、410053
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Stavropol、ロシア連邦、355035
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Halfway House、南アフリカ、1685
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Somerset West、南アフリカ、7130
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参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年~85年 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- Have type 2 diabetes
- Have been treated for at least 90 days with insulin glargine, neutral protamine Hagedorn (NPH), or detemir in combination with oral antihyperglycemic agents as monotherapy, dual, or triple therapy [sulfonylurea, meglitinide, metformin, pioglitazone, or dipeptidyl peptidase-4 (DPP-4) inhibitor] and in the opinion of the investigator requires further intensification of therapy
- Are treated with insulin glargine, NPH, or detemir at least 20 units per day (U/day) at enrollment
- Have an glycated hemoglobin (HbA1c) value greater than 7.0% and less than or equal to 12.0% according to the central laboratory at screening
- Capable of and willing to do the following: inject insulin with a prefilled pen, perform self blood glucose monitoring and record keeping as required by this protocol, as determined by the investigator
- Have given written informed consent to participate in this study in accordance with local regulations
Exclusion Criteria:
- Prior rapid- or short-acting insulin therapy: participants receiving scheduled long-term short-acting or rapid-acting or premixed insulin therapy within the past 6 months will not be eligible to participate in the study. Participants who have previously received short- or rapid-acting insulin as part of short-term insulin therapy (during gestational diabetes, during an acute hospitalization or illness) or occasional use will be allowed to participate in this study. Occasional use (e.g., used to treat acute hyperglycemia) shall be defined as less than daily administration of not more than 1 dose per day of short- or rapid-acting insulin
- Concomitant medications: glucagon-like peptide-1 (GLP-1) receptor agonist, alpha-glucosidase inhibitor, or rosiglitazone use concurrently or within 3 months prior to entry into the study
- Severe hypoglycemia: have had more than one episode of severe hypoglycemia (defined as requiring assistance of a third party due to disabling hypoglycemia) within 6 months prior to entry into the study
- Excessive insulin resistance: received a total daily dose of insulin greater than 2.0 units per kilogram (U/kg) at the time of randomization
- Morbid obesity: defined as a body mass index greater than or equal to 45 kilograms per square meter (kg/m²)
- Malignancy: have active or untreated malignancy, or have been in remission from clinically significant malignancy (other than basal cell or squamous cell skin cancer) for less than 5 years
- Cardiovascular: have cardiac disease with functional status that is New York Heart Association Class III or IV (see New York Heart Association Cardiac Disease Classifications) or have Congestive Heart Failure (CHF) requiring pharmacologic treatment or, in the investigator's opinion, have severe dependent edema (i.e., edema of the feet or ankles) or have any condition associated with hypoperfusion, hypoxemia, dehydration, or sepsis
- Renal: have a history of renal transplantation or are currently receiving renal dialysis or have serum creatinine greater than or equal to 2 milligrams per deciliter (mg/dL) if not on metformin
- Hepatic: have obvious clinical signs or symptoms of liver disease, acute or chronic hepatitis, or alanine aminotransferase/serum glutamic pyruvic transaminase (ALT/SGPT) greater than 3 times the upper limit of the reference range as defined by the central laboratory
- Hematologic: have known hemoglobinopathy or chronic anemia or other known blood disorder
- Reproductive:(for women) are pregnant or intend to become pregnant during the course of the study; are sexually active women of childbearing potential not actively practicing birth control by a method determined by the investigator to be medically acceptable; or are breastfeeding
- Allergy: have known allergy to insulin lispro, insulin glargine, or excipients contained in these products
- Glucocorticoid therapy: receiving chronic (lasting longer than 2 weeks) systemic glucocorticoid therapy (excluding topical and inhaled preparations) or have received such therapy within 2 weeks immediately before screening
- Adherence to protocol: have any other condition (including known drug or alcohol abuse or psychiatric disorder) that precludes the participant from following and completing the protocol
- Prior participation: are currently enrolled in, or have participated in, an interventional medical, surgical, or pharmaceutical drug or device or off-label use study (an investigational study in which a medical or surgical treatment was given) within 30 days prior to entry into the study, or persons who have previously completed or withdrawn from this study (after having signed the informed consent document). Participants may be ineligible if they are concurrently enrolled in any other type of medical research judged not to be scientifically or medically compatible with this study
- Non-approved drug: have been treated with a drug within the last 30 days that has not received regulatory approval at the time of study entry
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
実験的:3 Day Algorithm
Basal insulin glargine plus mealtime bolus insulin lispro titrated based on blood glucose readings from the past three days. (Sites were assigned to Study A and Study B according to an allocation plan that was pre-specified before initiation of Study A and Study B) |
Administered subcutaneously, up to three times daily for 24 weeks
他の名前:
Administered subcutaneously, dosage determined by investigator once daily for 24 weeks
|
|
実験的:Daily Algorithm
Basal insulin glargine plus mealtime bolus insulin lispro titrated based on blood glucose readings from the previous day. (Sites were assigned to Study A and Study B according to an allocation plan that was pre-specified before initiation of Study A and Study B) |
Administered subcutaneously, up to three times daily for 24 weeks
他の名前:
Administered subcutaneously, dosage determined by investigator once daily for 24 weeks
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change From Baseline to 24 Week Endpoint in Glycated Hemoglobin (HbA1c)
時間枠:Baseline, 24 weeks
|
The change from baseline to 24 weeks in the percentage of HbA1c in plasma.
The Least Squares (LS) mean was estimated from a mixed-effects model with repeated measures (MMRM) that included the independent variables: fixed effects for treatment, country, sulfonylurea/meglitinide use, visit, treatment by visit interaction with baseline HbA1c as a covariate.
|
Baseline, 24 weeks
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Percentage of Participants Achieving Glycated Hemoglobin (HbA1c) Target Values
時間枠:24-week endpoint
|
Percentage of participants who achieved HbA1c levels of ≤7.0% or ≤6.5%.
|
24-week endpoint
|
|
Percentage of Participants ≥65 Years of Age Achieving Glycated Hemoglobin (HbA1c) Target Concentration
時間枠:24-week endpoint
|
Percentage of participants ≥65 years of age achieving HbA1c target concentration of ≤7.0% or ≤6.5%.
|
24-week endpoint
|
|
Change From Baseline to 24 Week Endpoint in Body Weight
時間枠:Baseline, 24-weeks
|
Body weight was measured twice at each indicated visit and the average of the 2 measurements was used for analyses.
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction .
|
Baseline, 24-weeks
|
|
Time to Reach Glycated Hemoglobin (HbA1c) Target Values
時間枠:Baseline through 24 weeks
|
Percentage of participants is the number of participants who achieved HbA1c target values of ≤6.5% or ≤7.0% during the specified time period divided by the total number of participants who did not discontinue from the study but had not reached HbA1c target at the beginning of the specified post baseline time period (≤100 days and ≥101 days).
Participants who did not experience an outcome before discontinuation or completion of the study were censored using the date of discontinuation.
Participants who were lost to follow up the date of discontinuation were considered to be the date of last contact.
|
Baseline through 24 weeks
|
|
Change From Baseline to 24 Week Endpoint in Fasting Glucose
時間枠:Baseline, 24 weeks
|
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
Baseline, 24 weeks
|
|
Change From Baseline to 24 Week Endpoint in Fasting Glucose in Participants ≥65 Years of Age
時間枠:Baseline, 24 weeks
|
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
Baseline, 24 weeks
|
|
Change From Baseline to 24 Week Endpoint in 1,5-anhydroglucitol (1,5-AG)
時間枠:Baseline, 24 weeks
|
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
Baseline, 24 weeks
|
|
Change From Baseline to 24 Weeks in 7-Point Self-Monitored Blood Glucose (SMBG) Profile
時間枠:Baseline, 24 weeks
|
7-Point Self-Monitored Blood Glucose profiles are measures of blood glucose concentration taken 7 time a day at the morning pre-meal, morning 2-hours (HR) postprandial (PP), midday pre-meal, midday 2-hours post-meal, evening pre-meal, bedtime and 0300 hour (3 am).
Each participant took measures over any 3 days and the average was calculated for each of the 7 time points.
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
Baseline, 24 weeks
|
|
Daily Dose of Insulin: Total, Basal and Prandial (Bolus)
時間枠:24 weeks
|
Total insulin was the sum of basal insulin (glargine) that was required to manage normal daily blood fluctuations and prandial insulin that was taken at meal time.
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
24 weeks
|
|
Daily Dose of Insulin Per Kilogram of Body Weight: Total, Basal and Prandial (Bolus)
時間枠:24 weeks
|
Total insulin was the sum of basal insulin (glargine) that was required to manage normal daily blood fluctuations and prandial insulin that was taken at meal time.
Total, basal and prandial amounts were then divided by the participant's body weight in kilograms (kg).
Least Squares (LS) mean calculated using mixed model repeating measure (MMRM) analysis that included baseline, treatment, country, sulfonylurea/meglitinide use, baseline glycated hemoglobin (HbA1c) strata (≤8% and >8%), visit and treatment-by-visit interaction.
|
24 weeks
|
|
The Number of Participants With a Hypoglycemic Episode (Incidence)
時間枠:Randomization through 24 weeks overall
|
A hypoglycemic episode was defined as any time a participant felt they were experiencing a sign or symptom that was associated with hypoglycemia, or had a blood glucose level of ≤70 milligram per deciliter [mg/dL, ≤3.9 millimoles per liter (mmol/L)] even if it was not associated with signs, symptoms or treatment (consistent with current American Diabetes Association 2005 guidelines).
|
Randomization through 24 weeks overall
|
|
The Number of Participants ≥65 Years of Age With Hypoglycemic Episodes (Incidence)
時間枠:Randomization through 24 weeks overall
|
A hypoglycemic episode in participants ≥ 65 years of age was defined as any time a participant felt they were experiencing a sign or symptom that was associated with hypoglycemia, or had a blood glucose level of ≤70 milligram per deciliter [mg/dL, ≤3.9 millimoles per liter (mmol/L)] even if it was not associated with signs, symptoms or treatment (consistent with current American Diabetes Association 2005 guidelines).
|
Randomization through 24 weeks overall
|
|
The Rate of Hypoglycemic Episodes
時間枠:Randomization through 24 weeks overall
|
The hypoglycemia rate per 30 days was calculated as the number of hypoglycemic episodes reported divided by the number of days at risk times 30.
|
Randomization through 24 weeks overall
|
|
Percentage of Participants With Severe Hypoglycemic Episodes
時間枠:Randomization up to 24 weeks
|
Severe hypoglycemia is defined as an event requiring assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions.
These episodes may be associated with sufficient neuroglycopenia to induce seizure or coma.
Plasma glucose measurements may not be available during such an event, but neurological recovery attributable to the restoration of plasma glucose to normal is considered sufficient evidence that the event was induced by low plasma glucose.
|
Randomization up to 24 weeks
|
協力者と研究者
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スポンサー
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2010年12月1日
一次修了 (実際)
2013年1月1日
研究の完了 (実際)
2013年1月1日
試験登録日
最初に提出
2010年9月30日
QC基準を満たした最初の提出物
2010年10月5日
最初の投稿 (見積もり)
2010年10月7日
学習記録の更新
投稿された最後の更新 (見積もり)
2014年4月23日
QC基準を満たした最後の更新が送信されました
2014年4月3日
最終確認日
2014年4月1日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。