A Phase 4 interventional study of pramlintide acetate (Symlin) and rapid acting insulin (Humalog® [insulin lispro], Novolog® [insulin aspart], or Apidra® [insulin glulisine]) in Type 2 Diabetes Mellitus, sponsored by AstraZeneca. Completed at 37 sites in United States. Open to participants aged 18 Years to 75 Years. Per ClinicalTrials.gov, last updated 2015-04-14.
Sponsored by AstraZeneca · Phase 4, Interventional, and Treatment
This will be a randomized, open label, parallel group, multicenter study. There will be two phases in the study. Phase 1 (Baseline to Week 24) will compare the efficacy and safety of regimens of basal insulin intensified with either Symlin or rapid acting insulin in patients with type 2 diabetes who have either been on a prior regimen of insulin for less than 6 months and were taking less than 50 U total of insulin per day OR are candidates for the initiation of insulin therapy. The purpose of Phase 2 (Week 24 to Week 36) is to explore further intensification of diabetes regimens in patients failing to achieve HbA1c \<=6.5% at Week 24.
10,925 studies on the registry are indexed under Diabetes Mellitus; 1,319 are open to participants now.
This study's enrollment of 112 is above the median of 80 across 8,367 interventional studies indexed under Diabetes Mellitus.
Browse Diabetes Mellitus studies →AstraZeneca is the lead sponsor of 3,429 studies on the registry; 270 are open to participants now.
Of its 357 completed or terminated interventional studies of FDA-regulated products, 173 (48%) have results posted.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Drug: pramlintide acetate (Symlin) · Drug: basal insulin (Lantus® [insulin glargine], or Levemir® [insulin detemir])
Drug: rapid acting insulin (Humalog® [insulin lispro], Novolog® [insulin aspart], or Apidra® [insulin glulisine]) · Drug: basal insulin (Lantus® [insulin glargine], or Levemir® [insulin detemir])
subcutaneous injection (60 mcg or 120 mcg), immediately prior to major meals
Also known as: Symlin
subcutaneous injection, dosing based on titration guidelines
subcutaneous injection, dosing based on titration guidelines
The Percentage of Patients Achieving HbA1c <=7% at Week 24 With no Gain in Body Weight From Baseline and no Incidence of Severe Hypoglycemia
A severe hypoglycemia is defined as an event during which the patient required the assistance of another individual (including aid in ingestion of oral carbohydrate); and/or required the administration of glucagon injection, intravenous glucose, or other medical intervention.
Time frame: 24 Weeks
Percentage of Patients Achieving HbA1c <=7% at Week 24
This is a component of the primary endpoint
Time frame: 24 Weeks
Percentage of Patients With no Weight Gain at Week 24
This is a component of the primary endpoint
Time frame: 24 Weeks
Percentage of Patients With a Severe Hypoglycemia Adverse Event
This is a component of the primary endpoint.
Time frame: 24 Weeks
Change in HbA1c From Baseline at Week 24
Baseline values are presented in the Baseline Characteristics section
Time frame: From Baseline to Week 24
Change in Body Weight From Baseline at Week 24
Baseline values are presented in the Baseline Characteristics section
Time frame: From Baseline to Week 24
Change in Waist Circumference From Baseline at Week 24
Baseline values are presented in the Baseline Characteristics section
Time frame: From Baseline to Week 24
Change in Fasting Plasma Glucose From Baseline at Week 24
Baseline values are presented in the Baseline Characteristics section
Time frame: From Baseline to Week 24
Fasting Serum Lipids Change From Baseline to Week 24
Time frame: Baseline, week 24
Phase 2: Change in HbA1c at Week 36
Two changes are calculated, the first by subtracting Week 36 value from the Phase 1 Baseline value (total change over 36 weeks), the second by subtracting the Week 36 value from the Phase 2 Baseline value (change from week 24 to week 36 only).
Time frame: Phase 1 Baseline, Phase 2 Baseline at Week 24, Week 36
Phase 2: Change in Body Weight at Week 36
Two changes are calculated, the first by subtracting Week 36 value from the Phase 1 Baseline value (total change over 36 weeks), the second by subtracting the Week 36 value from the Phase 2 Baseline value (change from week 24 to week 36 only).
Time frame: Phase 1 Baseline, Phase 2 Baseline at Week 24, Week 36
Hypoglycemia Adverse Events
MILD: patient reported symptoms consistent with hypoglycemia that may or may not have been documented by glucose monitoring at the time of symptoms. Symptoms did not greatly interrupt or interfere with the patients daily activities. Symptoms dissipated spontaneously or upon eating. MODERATE: Patient reported symptoms consistent with hypoglycemia that may or may not have been documented by glucose monitoring at the time of symptoms. Symptoms interrupted or interfered with the patients daily activities and required immediate self treatment (e.g. carbohydrate ingestion). SEVERE: Patient required the assistance of another individual (including aid in ingestion of oral carbohydrate): and/or required the administration of glucagon injection, intravenous glucose, or other medical intervention.
Time frame: 36 weeks
| Milestone | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|---|---|
| Started | 57 | 56 | 0 | 0 | 0 | 0 |
| Intent to treat | 56 | 56 | 0 | 0 | 0 | 0 |
| Completed | 48 | 50 | 0 | 0 | 0 | 0 |
| Not completed | 9 | 6 | 0 | 0 | 0 | 0 |
| Withdrew: Adverse event | 2 | 0 | 0 | 0 | 0 | 0 |
| Withdrew: Investigator decision | 1 | 0 | 0 | 0 | 0 | 0 |
| Withdrew: Lost to follow-up | 2 | 4 | 0 | 0 | 0 | 0 |
| Withdrew: Withdrawal of consent | 4 | 2 | 0 | 0 | 0 | 0 |
| Milestone | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|---|---|
| Started | 0 | 0 | 17 | 31 | 14 | 36 |
| Completed | 0 | 0 | 17 | 29 | 14 | 35 |
| Not completed | 0 | 0 | 0 | 2 | 0 | 1 |
| Withdrew: Lost to follow-up | 0 | 0 | 0 | 1 | 0 | 0 |
| Withdrew: Protocol violation | 0 | 0 | 0 | 1 | 0 | 0 |
| Withdrew: Withdrawal of consent | 0 | 0 | 0 | 0 | 0 | 1 |
A severe hypoglycemia is defined as an event during which the patient required the assistance of another individual (including aid in ingestion of oral carbohydrate); and/or required the administration of glucagon injection, intravenous glucose, or other medical intervention.
| Percent | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| The Percentage of Patients Achieving HbA1c <=7% at Week 24 With no Gain in Body Weight From Baseline and no Incidence of Severe Hypoglycemia | 30.4 | 10.7 |
This is a component of the primary endpoint
| Percent | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Percentage of Patients Achieving HbA1c <=7% at Week 24 | 44.6 | 55.4 |
This is a component of the primary endpoint
| Percent | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Percentage of Patients With no Weight Gain at Week 24 | 46.4 | 14.3 |
This is a component of the primary endpoint.
| Percent | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Percentage of Patients With a Severe Hypoglycemia Adverse Event | 0.0 | 0.0 |
Baseline values are presented in the Baseline Characteristics section
| Percent | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Change in HbA1c From Baseline at Week 24 | -1.11 ± 0.17 | -1.27 ± 0.17 |
Baseline values are presented in the Baseline Characteristics section
| kg | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Change in Body Weight From Baseline at Week 24 | 0.02 ± 0.68 | 4.65 ± 0.68 |
Baseline values are presented in the Baseline Characteristics section
| cm | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Change in Waist Circumference From Baseline at Week 24 | -0.63 ± 0.87 | 2.17 ± 0.86 |
Baseline values are presented in the Baseline Characteristics section
| mg/dL | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Change in Fasting Plasma Glucose From Baseline at Week 24 | -29.0 ± 7.32 | -37.8 ± 7.69 |
| mg/dL | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) |
|---|---|---|
| Total Cholesterol | -1.81 ± 5.826 | 5.27 ± 4.649 |
| HDL | 1.11 ± 1.190 | 1.65 ± 1.075 |
| LDL | 2.36 ± 4.456 | 9.12 ± 3.865 |
| Triglycerides | -28.96 ± 12.442 | -31.98 ± 13.883 |
Two changes are calculated, the first by subtracting Week 36 value from the Phase 1 Baseline value (total change over 36 weeks), the second by subtracting the Week 36 value from the Phase 2 Baseline value (change from week 24 to week 36 only).
| Percent | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|
| Phase 1 Baseline | 8.35 ± 0.214 | 8.03 ± 0.140 | 7.85 ± 0.183 | 8.38 ± 0.145 |
| Change From Phase 1 Baseline to Week 36 | -1.96 ± 0.238 | -0.68 ± 0.174 | -1.49 ± 0.189 | -0.99 ± 0.157 |
| Phase 2 Baseline at Week 24 | 6.26 ± 0.121 | 7.57 ± 0.171 | 6.14 ± 0.107 | 7.32 ± 0.170 |
| Change From Phase 2 Baseline to Week 36 | 0.14 ± 0.062 | -0.23 ± 0.123 | 0.22 ± 0.097 | 0.07 ± 0.113 |
Two changes are calculated, the first by subtracting Week 36 value from the Phase 1 Baseline value (total change over 36 weeks), the second by subtracting the Week 36 value from the Phase 2 Baseline value (change from week 24 to week 36 only).
| kg | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|
| Phase 1 Baseline | 109.98 ± 4.916 | 104.83 ± 3.959 | 104.42 ± 7.341 | 105.30 ± 2.210 |
| Change From Phase 1 Baseline to Week 36 | -0.80 ± 2.096 | 1.34 ± 0.933 | 3.90 ± 1.488 | 4.51 ± 0.761 |
| Phase 2 Baseline at Week 24 | 108.50 ± 5.656 | 105.67 ± 4.045 | 107.87 ± 7.801 | 110.68 ± 2.507 |
| Change From Phase 2 Baseline to Week 36 | 0.69 ± 0.654 | 0.50 ± 0.303 | 0.44 ± 0.518 | -0.86 ± 0.353 |
MILD: patient reported symptoms consistent with hypoglycemia that may or may not have been documented by glucose monitoring at the time of symptoms. Symptoms did not greatly interrupt or interfere with the patients daily activities. Symptoms dissipated spontaneously or upon eating. MODERATE: Patient reported symptoms consistent with hypoglycemia that may or may not have been documented by glucose monitoring at the time of symptoms. Symptoms interrupted or interfered with the patients daily activities and required immediate self treatment (e.g. carbohydrate ingestion). SEVERE: Patient required the assistance of another individual (including aid in ingestion of oral carbohydrate): and/or required the administration of glucagon injection, intravenous glucose, or other medical intervention.
| participants | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|---|---|
| Mild | 31 | 46 | 7 | 18 | 9 | 19 |
| Moderate | 12 | 13 | 0 | 1 | 2 | 3 |
| Severe | 0 | 0 | 0 | 0 | 0 | 0 |
Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Group A (Phase 1 SYMLIN) | — | 1/56 (1.8%) | 29/56 (51.8%) |
| Group B (Phase 1 RA Insulin) | — | 5/56 (8.9%) | 28/56 (50%) |
| Group C (Phase 2 SYMLIN) | — | 0/17 (0%) | 9/17 (52.9%) |
| Group D (Phase 2 SYMLIN+RA) | — | 0/31 (0%) | 11/31 (35.5%) |
| Group E (Phase 2 RA Insulin) | — | 0/14 (0%) | 4/14 (28.6%) |
| Group F (Phase 2 RA Insulin + SYMLIN) | — | 0/36 (0%) | 11/36 (30.6%) |
| Event | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|---|---|
| Coronary artery diseaseCardiac disorders | 1/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Biliary dyskinesiaHepatobiliary disorders | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| SyncopeNervous system disorders | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| CellulitisInfections and infestations | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Cardiac failure congestiveCardiac disorders | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Non-cardiac chest painGeneral disorders | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Ischaemic cerebral infarctionNervous system disorders | 0/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Event | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Group C (Phase 2 SYMLIN) | Group D (Phase 2 SYMLIN+RA) | Group E (Phase 2 RA Insulin) | Group F (Phase 2 RA Insulin + SYMLIN) |
|---|---|---|---|---|---|---|
| NauseaGastrointestinal disorders | 12/56 | 0/56 | 0/17 | 2/31 | 0/14 | 4/36 |
| Upper respiratory tract infectionInfections and infestations | 7/56 | 5/56 | 1/17 | 2/31 | 1/14 | 1/36 |
| BronchitisInfections and infestations | 0/56 | 0/56 | 0/17 | 3/31 | 0/14 | 0/36 |
| DiarrhoeaGastrointestinal disorders | 5/56 | 0/56 | 0/17 | 0/31 | 0/14 | 2/36 |
| NasopharyngitisInfections and infestations | 3/56 | 5/56 | 1/17 | 1/31 | 1/14 | 0/36 |
| SinusitisInfections and infestations | 2/56 | 5/56 | 1/17 | 1/31 | 0/14 | 1/36 |
| ArthralgiaMusculoskeletal and connective tissue disorders | 3/56 | 5/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Back painMusculoskeletal and connective tissue disorders | 5/56 | 0/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| HeadacheNervous system disorders | 5/56 | 1/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| CoughRespiratory, thoracic and mediastinal disorders | 2/56 | 5/56 | 0/17 | 0/31 | 0/14 | 0/36 |
| Age, Categorical(Participants) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 46 | 49 | 95 |
| >=65 years | 10 | 7 | 17 |
| Age, Continuous(years) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Mean | 55.0 ± 11.35 | 53.6 ± 9.70 | 54.3 ± 10.53 |
| Sex: Female, Male(Participants) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Female | 22 | 19 | 41 |
| Male | 34 | 37 | 71 |
| Region of Enrollment(participants) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| United States | 56 | 56 | 112 |
| Fasting Plasma Glucose(mg/dL) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Mean | 155.1 ± 39.60 | 164.3 ± 49.61 | 159.7 ± 44.92 |
| Fasting Serum Lipids(mg/dL) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Total Cholesterol | 167.53 ± 47.054 | 169.86 ± 49.121 | 168.70 ± 47.903 |
| HDL | 44.71 ± 11.893 | 41.77 ± 9.468 | 43.23 ± 10.790 |
| LDL | 89.15 ± 38.386 | 90.41 ± 34.114 | 89.78 ± 36.133 |
| Triglycerides | 174.13 ± 108.257 | 193.59 ± 159.508 | 183.95 ± 136.273 |
| HbA1c(Percent) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Mean | 8.19 ± 0.840 | 8.25 ± 0.816 | 8.22 ± 0.825 |
| Waist Circumference(cm) | Group A (Phase 1 SYMLIN) | Group B (Phase 1 RA Insulin) | Total |
|---|---|---|---|
| Mean | 116.31 ± 15.427 | 117.15 ± 13.198 | 116.73 ± 14.297 |
1 further baseline measures are reported on the registry.
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