Glargine Dosing in Hospitalized Patients With Type 2 Diabetes and Renal Insufficiency

NCT00911625 | Completed Phase 4 Results FDA Drug

• 1 other identifier: 201463
• Study Type: interventional
• Target: 114
• Locations: 1 country
• Sites: 3

Brief Summary

It is imperative to devise easy to follow, yet appropriate, guidelines for insulin use in renal-impaired patients. This will be done by comparing two regimens: 1) glargine once daily plus mealtime glulisine based on weight alone and 2) a predetermined dosing reduction algorithm with glargine/glulisine based on weight with reduction for decreased estimated GFR by MDRD as follows: \< 30 ml/min/1.73m2 or on dialysis reduce dose by 50% from weight based calculation.

Conditions

Type 2 Diabetes; Renal Insufficiency

Keywords

glargine; glulisine; type 2 diabetes; renal insufficiency

Outcome Measures

Primary Outcomes (1)

• Average Blood Glucose Over 6 Days

  Participants have their blood glucose measured daily for six days. The average blood glucose measure over all six days is compared between the two treatment cohorts.

  6 Days

Secondary Outcomes (1)

• The Number of Participants Who Experience at Least One Blood Glucose Level Below 70 Milligrams Per Deciliter

  6 Days

Study Arms (2)

0.5 units/kg

ACTIVE COMPARATOR

Participants randomized to this arm will receive a standard-dose of 0.5 units/kg daily insulin. Half of this dose will be given as glargine and the other half will be given as glulisine.

Drug: 0.5 units/kg daily insulin

0.25 units/kg

EXPERIMENTAL

Participants randomized to this arm will receive an experimental dose of 0.25 units/kg daily insulin. Half of this dose will be given as glargine and the other half will be given as glulisine.

Drug: 0.25 units/kg daily insulin

Interventions

0.5 units/kg daily insulin DRUG

Participants randomized to receive this intervention will receive a standard-dose of 0.5 units/kg daily insulin. Half of this dose will be given as glargine and the other half will be given as glulisine.

Also known as: Lantus, Apidra

0.5 units/kg

0.25 units/kg daily insulin DRUG

Participants randomized to receive this intervention will receive an experimental dose of 0.25 units/kg daily insulin. Half of this dose will be given as glargine and the other half will be given as glulisine.

Also known as: Lantus, Apidra

0.25 units/kg

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Type 2 Diabetes Mellitus of mor than 1year
• GFR less than 30 ml/min/1.73m2 or dialysis
• Age greater than 18years
• Entry blood glucose (fasting or random) greater than 180mg%

You may not qualify if:

• Type 1 Diabetes Mellitus
• New onset hyperglycemia
• Pregnant
• Solid organ transplant within 1 year
• Steroids prednisone greater than 7.5mg/day or equivalent
• Hospital LOS predicted less than 2 days
• Severe liver disease
• Known hypopituitarism or adrenal insufficiency
• Patients in the ICU
• Patients with hypoglycemic unawareness
• Outpatient insulin dose less than 0.6 units/kg

Sponsors & Collaborators

• Loyola University: lead
• Sanofi: collaborator

Study Sites (3)

Northwestern University Medical Center

Chicago, Illinois, 60611, United States

Location

Rush University Medical Center

Chicago, Illinois, 60612, United States

Location

Loyola University Hospital

Maywood, Illinois, 60153, United States

Location

Related Publications (24)

• American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008 Mar;31(3):596-615. doi: 10.2337/dc08-9017.

  PMID: 18308683 BACKGROUND

• Baldwin D, Villanueva G, McNutt R, Bhatnagar S. Eliminating inpatient sliding-scale insulin: a reeducation project with medical house staff. Diabetes Care. 2005 May;28(5):1008-11. doi: 10.2337/diacare.28.5.1008.

  PMID: 15855558 BACKGROUND

• DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Rhee C, Wells A, Brandt S, Peterson S, Molitch ME. Inpatient management of hyperglycemia: the Northwestern experience. Endocr Pract. 2006 Sep-Oct;12(5):491-505. doi: 10.4158/EP.12.5.491.

  PMID: 17002924 BACKGROUND

• Schmeltz LR, DeSantis AJ, Thiyagarajan V, Schmidt K, O'Shea-Mahler E, Johnson D, Henske J, McCarthy PM, Gleason TG, McGee EC, Molitch ME. Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy. Diabetes Care. 2007 Apr;30(4):823-8. doi: 10.2337/dc06-2184. Epub 2007 Jan 17.

  PMID: 17229943 BACKGROUND

• Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, Puig A, Mejia R. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007 Sep;30(9):2181-6. doi: 10.2337/dc07-0295. Epub 2007 May 18.

  PMID: 17513708 BACKGROUND

• Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, Munoz C, Newton C, Peng L, Baldwin D. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009 Feb;94(2):564-9. doi: 10.1210/jc.2008-1441. Epub 2008 Nov 18.

  PMID: 19017758 BACKGROUND

• Umpierrez GE, Smiley D, Jacobs S, Peng L, Temponi A, Mulligan P, Umpierrez D, Newton C, Olson D, Rizzo M. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery). Diabetes Care. 2011 Feb;34(2):256-61. doi: 10.2337/dc10-1407. Epub 2011 Jan 12.

  PMID: 21228246 BACKGROUND

• Bernard JB, Munoz C, Harper J, Muriello M, Rico E, Baldwin D. Treatment of inpatient hyperglycemia beginning in the emergency department: a randomized trial using insulins aspart and detemir compared with usual care. J Hosp Med. 2011 May;6(5):279-84. doi: 10.1002/jhm.866.

  PMID: 21661100 BACKGROUND

• Murad MH, Coburn JA, Coto-Yglesias F, Dzyubak S, Hazem A, Lane MA, Prokop LJ, Montori VM. Glycemic control in non-critically ill hospitalized patients: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012 Jan;97(1):49-58. doi: 10.1210/jc.2011-2100. Epub 2011 Nov 16.

  PMID: 22090269 BACKGROUND

• Clement S, Braithwaite SS, Magee MF, Ahmann A, Smith EP, Schafer RG, Hirsch IB; American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care. 2004 Feb;27(2):553-91. doi: 10.2337/diacare.27.2.553. No abstract available.

  PMID: 14747243 BACKGROUND

• Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE; American Association of Clinical Endocrinologists; American Diabetes Association. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009 Jun;32(6):1119-31. doi: 10.2337/dc09-9029. Epub 2009 May 8. No abstract available.

  PMID: 19429873 BACKGROUND

• Umpierrez GE, Hellman R, Korytkowski MT, Kosiborod M, Maynard GA, Montori VM, Seley JJ, Van den Berghe G; Endocrine Society. Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2012 Jan;97(1):16-38. doi: 10.1210/jc.2011-2098.

  PMID: 22223765 BACKGROUND

• Fischer KF, Lees JA, Newman JH. Hypoglycemia in hospitalized patients. Causes and outcomes. N Engl J Med. 1986 Nov 13;315(20):1245-50. doi: 10.1056/NEJM198611133152002.

  PMID: 3534567 BACKGROUND

• Kagansky N, Levy S, Rimon E, Cojocaru L, Fridman A, Ozer Z, Knobler H. Hypoglycemia as a predictor of mortality in hospitalized elderly patients. Arch Intern Med. 2003 Aug 11-25;163(15):1825-9. doi: 10.1001/archinte.163.15.1825.

  PMID: 12912719 BACKGROUND

• Varghese P, Gleason V, Sorokin R, Senholzi C, Jabbour S, Gottlieb JE. Hypoglycemia in hospitalized patients treated with antihyperglycemic agents. J Hosp Med. 2007 Jul;2(4):234-40. doi: 10.1002/jhm.212.

  PMID: 17702035 BACKGROUND

• Turchin A, Matheny ME, Shubina M, Scanlon JV, Greenwood B, Pendergrass ML. Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care. 2009 Jul;32(7):1153-7. doi: 10.2337/dc08-2127.

  PMID: 19564471 BACKGROUND

• Bailon RM, Cook CB, Hovan MJ, Hull BP, Seifert KM, Miller-Cage V, Beer KA, Boyle ME, Littman SD, Magallanez JM, Fischenich JM, Harris JK, Scoggins SS, Uy J. Temporal and geographic patterns of hypoglycemia among hospitalized patients with diabetes mellitus. J Diabetes Sci Technol. 2009 Mar 1;3(2):261-8. doi: 10.1177/193229680900300206.

  PMID: 20144357 BACKGROUND

• Rubin DJ, Rybin D, Doros G, McDonnell ME. Weight-based, insulin dose-related hypoglycemia in hospitalized patients with diabetes. Diabetes Care. 2011 Aug;34(8):1723-8. doi: 10.2337/dc10-2434. Epub 2011 Jun 23.

  PMID: 21700919 BACKGROUND

• Horton ES, Johnson C, Lebovitz HE. Carbohydrate metabolism in uremia. Ann Intern Med. 1968 Jan;68(1):63-74. doi: 10.7326/0003-4819-68-1-63. No abstract available.

  PMID: 5635331 BACKGROUND

• Moen MF, Zhan M, Hsu VD, Walker LD, Einhorn LM, Seliger SL, Fink JC. Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 2009 Jun;4(6):1121-7. doi: 10.2215/CJN.00800209. Epub 2009 May 7.

  PMID: 19423569 BACKGROUND

• Rave K, Heise T, Pfutzner A, Heinemann L, Sawicki PT. Impact of diabetic nephropathy on pharmacodynamic and Pharmacokinetic properties of insulin in type 1 diabetic patients. Diabetes Care. 2001 May;24(5):886-90. doi: 10.2337/diacare.24.5.886.

  PMID: 11347749 BACKGROUND

• Mak RH. Impact of end-stage renal disease and dialysis on glycemic control. Semin Dial. 2000 Jan-Feb;13(1):4-8. doi: 10.1046/j.1525-139x.2000.00007.x. No abstract available.

  PMID: 10740665 BACKGROUND

• Biesenbach G, Raml A, Schmekal B, Eichbauer-Sturm G. Decreased insulin requirement in relation to GFR in nephropathic Type 1 and insulin-treated Type 2 diabetic patients. Diabet Med. 2003 Aug;20(8):642-5. doi: 10.1046/j.1464-5491.2003.01025.x.

  PMID: 12873291 BACKGROUND

• Baldwin D, Zander J, Munoz C, Raghu P, DeLange-Hudec S, Lee H, Emanuele MA, Glossop V, Smallwood K, Molitch M. A randomized trial of two weight-based doses of insulin glargine and glulisine in hospitalized subjects with type 2 diabetes and renal insufficiency. Diabetes Care. 2012 Oct;35(10):1970-4. doi: 10.2337/dc12-0578. Epub 2012 Jun 14.

  PMID: 22699288 DERIVED

MeSH Terms

Conditions

Diabetes Mellitus, Type 2; Renal Insufficiency

Interventions

Insulin Glargine; insulin glulisine

Condition Hierarchy (Ancestors)

Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases

Intervention Hierarchy (Ancestors)

Insulin, Long-Acting; Insulins; Pancreatic Hormones; Peptide Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Peptides; Amino Acids, Peptides, and Proteins

Results Point of Contact

• Title: David Baldwin, MD
• Organization: Rush University Medical Center

david_baldwin@rush.edu

312-942-2813

Study Officials

• Mary Ann Emanuele, MD

  Loyola University

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Medicine

Model Details: Eligible participants are randomized to one of the two dosing groups using a 1:1 allocation

Study Record Dates

• First Submitted: May 29, 2009
• First Posted: June 2, 2009
• Study Start: January 21, 2009
• Primary Completion: June 30, 2011
• Study Completion: June 30, 2011
• Last Updated: April 6, 2017
• Results First Posted: March 10, 2017

Record last verified: 2017-03

Data Sharing

• IPD Sharing: Will not share

Locations

US (3)