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Inpatient Diabetes on Corticosteroids

9 september 2019 uppdaterad av: Hennepin Healthcare Research Institute
Despite a significant problem with out-of-control glucose levels in patients with diabetes receiving corticosteroids for a variety of illnesses, there are no published protocols addressing how to adequately treat corticosteroid-induced hyperglycemia. Investigators propose to test a protocol using scheduled dosing of NPH (Neutral protamine Hagedorn) insulin for inpatients with diabetes receiving corticosteroids. NPH insulin action is ideally timed to counteract corticosteroid-induced hyperglycemia, and the dose is added to the patient's usual insulin regimen and timed to correspond to the corticosteroid dosing regimen. Investigators will prospectively enroll eligible consented patients with diabetes who are receiving corticosteroids as part of their treatment in a large county hospital, will randomize them to intervention or control groups, and will monitor their glucose levels during their inpatient stay. The protocol will demonstrate improved control of glucose levels with minimal risk of hypoglycemia, and will provide a practical and readily implementable protocol using NPH insulin as therapy for corticosteroid-induced diabetes.

Studieöversikt

Status

Avslutad

Betingelser

Intervention / Behandling

Detaljerad beskrivning

As above.

Studietyp

Interventionell

Inskrivning (Faktisk)

85

Fas

  • Fas 4

Kontakter och platser

Det här avsnittet innehåller kontaktuppgifter för dem som genomför studien och information om var denna studie genomförs.

Studieorter

  • Förenta staterna
    • Minnesota
      • Minneapolis, Minnesota, Förenta staterna, 55415
        • Hennepin County Medical Center

Deltagandekriterier

Forskare letar efter personer som passar en viss beskrivning, så kallade behörighetskriterier. Några exempel på dessa kriterier är en persons allmänna hälsotillstånd eller tidigare behandlingar.

Urvalskriterier

Åldrar som är berättigade till studier

18 år till 79 år (Vuxen, Äldre vuxen)

Tar emot friska volontärer

Nej

Kön som är behöriga för studier

Allt

Beskrivning

Inclusion Criteria:

  • Prior history of diabetes
  • Able to provide informed consent
  • Receiving corticosteroids while hospitalized of greater than 10 mg/d prednisone or the equivalent of dexamethasone or methylprednisolone
  • Expect to be hospitalized for 48 hours

Exclusion Criteria:

  • Renal failure with GFR (glomerular filtration rate) < 30 ml/min/1.73m2
  • ALT (alanine aminotransferase) > 2 times upper normal for laboratory

Studieplan

Det här avsnittet ger detaljer om studieplanen, inklusive hur studien är utformad och vad studien mäter.

Hur är studien utformad?

Designdetaljer

  • Primärt syfte: Behandling
  • Tilldelning: Randomiserad
  • Interventionsmodell: Parallellt uppdrag
  • Maskning: Ingen (Open Label)

Vapen och interventioner

Deltagargrupp / Arm
Intervention / Behandling
Experimentell: NPH with steroid dose

Receive NPH with each corticosteroid dose during the study duration (2-5 days).

Low dose corticosteroids High dose corticosteroids Eating and 6a-8p 0.15 units NPH/kg 0.3 units NPH/kg NPO(nothing by mouth) or 8p-6a 0.1 units NPH/kg 0.2 units NPH/kg
Läkemedel: NPH
NPH given per study table based on steroid dose and patient weight in kg.
Andra namn:
  • NPH Lilly Insulin
Läkemedel: Correction Factor
Given at 2 units per 50 mg/dl over 200 mg/dl and increased to 3 units/50 mg/dl over 200 if glucose rises to over 300 mg/dl. Administered qid during study duration.
Andra namn:
  • Rapid acting regular insulin
Aktiv komparator: Control - Background and correction insulin
Receive usual care with background insulin and correction factor for duration of study (2-5 days)
Läkemedel: Correction Factor
Given at 2 units per 50 mg/dl over 200 mg/dl and increased to 3 units/50 mg/dl over 200 if glucose rises to over 300 mg/dl. Administered qid during study duration.
Andra namn:
  • Rapid acting regular insulin

Vad mäter studien?

Primära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Mean POC Glucose Level Between Groups
Tidsram: Assessed from enrollment to discharge or enrollment to day five.
Primary outcome measure was mean blood glucose levels measured pre-meal and at bedtime in study patients and controls for the duration of the intervention. Values shown are the overall mean point of care blood glucose.
Assessed from enrollment to discharge or enrollment to day five.

Sekundära resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Episodes of Hypoglycemia Between NPH and Control Groups
Tidsram: Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown represent cumulative episodes of hypoglycemia per group.
Hypoglycemia was defined as point of care glucose less than 70 mg/dL.
Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown represent cumulative episodes of hypoglycemia per group.

Andra resultatmått

Resultatmått
Åtgärdsbeskrivning
Tidsram
Percentage of Point of Care Glucose Measurements Between 70 - 180 mg/dL
Tidsram: From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown are the overall percentage of glucose measurements between 70 - 180 mg/dl.
From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Incidence of Hyperglycemia Defined as Point of Care Glucose 180 - 300 mg/dL
Tidsram: From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown are the overall percentage of glucose measurements 180 - 300 mg/dL.
From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Incidence of Hyperglycemia Defined as Point of Care Glucose 300 - 400 mg/dl
Tidsram: From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown are the overall percentage of glucose measurements 300 - 400 mg/dl.
From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Incidence of Hyperglycemia Defined as Point of Care Glucose > 400 mg/dL
Tidsram: From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Glucose levels measured pre-meal, at bedtime, and during symptoms of hypoglycemia in study patients and controls for the duration of the intervention. Values shown are the overall percentage of glucose measurements > 400 mg/dL.
From day 1 (day of enrollment) to day 5 (last day of study participation) or final day of hospitalization if less than 5 days. Point of care glucose was checked before breakfast, lunch, dinner, bed time and during symptoms of hypoglycemia.
Difference in Length of Stay Between NPH and Control Group
Tidsram: Measured from the day of admission till the day of discharge
Time difference of hospitalization between the NPH and control groups.
Measured from the day of admission till the day of discharge
Mean Point of Care (POC) Glucose Level in Both Groups.
Tidsram: On day 1 of study enrollment. Point of care glucose was checked before breakfast, lunch, dinner, and bed time.
The overall mean point of care glucose levels in the NPH group and control group on the first day of the study.
On day 1 of study enrollment. Point of care glucose was checked before breakfast, lunch, dinner, and bed time.
Mean Point of Care (POC) Glucose Level in Both Groups.
Tidsram: On day 5 or last day of hospitalization (if less than 5 days) glucose level as measured by point of care glucose before breakfast, lunch, dinner and bed time.
The overall mean point of care glucose levels in the NPH group and control group on the last day of the study.
On day 5 or last day of hospitalization (if less than 5 days) glucose level as measured by point of care glucose before breakfast, lunch, dinner and bed time.
Correlation of C-peptide With Age
Tidsram: plasma C-peptide was measured once at the time of enrollment
plasma C-peptide was measured once at the time of enrollment
Correlation of C-peptide With BMI
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With eGFR
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With Serum Creatinine
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With ALT
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With Hemoglobin A1c
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With Duration of Diabetes
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment
Correlation of C-peptide With Plasma Glucose
Tidsram: Measured the time of enrollment
Measured the time of enrollment
Correlation of C-peptide With Length of Stay
Tidsram: Measured once at the time of enrollment
Measured once at the time of enrollment

Samarbetspartners och utredare

Det är här du hittar personer och organisationer som är involverade i denna studie.

Sponsor

Hennepin Healthcare Research Institute

Samarbetspartners

Eli Lilly and Company

Utredare

  • Huvudutredare: Lisa Fish, MD, Hennepin County Medical Center, Minneapolis

Publikationer och användbara länkar

Den som ansvarar för att lägga in information om studien tillhandahåller frivilligt dessa publikationer. Dessa kan handla om allt som har med studien att göra.

Allmänna publikationer

Studieavstämningsdatum

Dessa datum spårar framstegen för inlämningar av studieposter och sammanfattande resultat till ClinicalTrials.gov. Studieposter och rapporterade resultat granskas av National Library of Medicine (NLM) för att säkerställa att de uppfyller specifika kvalitetskontrollstandarder innan de publiceras på den offentliga webbplatsen.

Studera stora datum

Studiestart

1 juli 2014

Primärt slutförande (Faktisk)

1 juni 2016

Avslutad studie (Faktisk)

1 juni 2016

Studieregistreringsdatum

Först inskickad

4 september 2013

Först inskickad som uppfyllde QC-kriterierna

24 oktober 2013

Första postat (Uppskatta)

28 oktober 2013

Uppdateringar av studier

Senaste uppdatering publicerad (Faktisk)

1 oktober 2019

Senaste inskickade uppdateringen som uppfyllde QC-kriterierna

9 september 2019

Senast verifierad

1 september 2019

Mer information

Termer relaterade till denna studie

Nyckelord

Ytterligare relevanta MeSH-villkor

Andra studie-ID-nummer

  • MMRF-13-3658

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