A Phase 3 interventional study of LY2963016 and Lantus® in Type 2 Diabetes, sponsored by Eli Lilly and Company. Completed at 32 sites in China. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2021-05-25.
Sponsored by Eli Lilly and Company · Phase 3, Interventional, and Treatment
The purpose of this study is to compare long-acting basal insulin analog LY2963016 to Lantus® in insulin naïve adult Chinese participants with Type 2 Diabetes Mellitus (T2DM) on 2 or more oral antihyperglycemic medications (OAMs). Participants will continue their OAMs throughout the study.
Exclusion Criteria:
Insulin naive participants started on 10 units (U) LY2963016 given subcutaneously (SC) once a day (QD) for 24 weeks. Participants-driven titration was supervised by investigators through the course of the study to maintain the fasting blood glucose (FBG) ≤100 milligram per deciliter (mg/dL) (5.6 millimoles per litre \[mmol/L\]) while avoiding hypoglycemia. Participants were allowed to continue oral antihyperglycemic medication (OAM).
Drug: LY2963016
Insulin naive participants started on 10 U Lantus® given SC QD for 24 weeks. Participants-driven titration was supervised by investigators through the course of the study to maintain the FBG ≤100 mg/dL (5.6 mmol/L) while avoiding hypoglycemia. Participants were allowed to continue oral OAM.
Drug: Lantus®
Administered SC
Administered SC
Change From Baseline in Hemoglobin A1c (HbA1c) (LY2963016 to Lantus®)
HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. Least square (LS) mean was calculated by mixed-effects model for repeated measures (MMRM) with baseline, insulin secretagogues at study entry, treatment, visit and treatment\*visit in the model.
Time frame: Baseline, Week 24
Change From Baseline in HbA1c (Lantus® to LY2963016)
HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, treatment, visit and treatment\*visit in the model.
Time frame: Baseline, Week 24
Change From Baseline in 7-Point Self-Monitored Blood Glucose (SMBG) Values
Seven-point SMBG are completed at the following timepoints: Before Morning Meal, 2 Hours After Morning Meal, Before Mid-Day Meal, 2 Hours After Mid-Day Meal, Before Evening Meal, 2 Hours After Evening Meal and Bed Time. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: Baseline, Week 24
Percentage of Participants With HbA1c <7% at Week 24
The percentage of participants was calculated by dividing the number of participants reaching target HbA1c by the total number of participants analyzed, multiplied by 100.
Time frame: Week 24
Percentage of Participants With HbA1c ≤6.5% at Week 24
The percentage of participants was calculated by dividing the number of participants reaching target HbA1c by the total number of participants analyzed, multiplied by 100.
Time frame: Week 24
Change From Baseline in Glycemic Variability of Fasting Blood Glucose
Glycemic variability is measured by the intra-participant standard deviation (SD) value of fasting blood glucose as measured by the actual morning and daily pre-meal blood glucose value from the 7-point self-monitoring blood glucose \[SMBG\] profiles. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: Baseline, Week 24
Basal Insulin Dose Units Per Day
Units of basal insulin dose taken per day (U/day). LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: At Week 24
Change From Baseline in Basal Insulin Dose Units Per Day
Units of basal insulin dose taken per day (U/day). LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: Baseline, Week 24
Change From Baseline in Body Weight
Change from baseline in body weight was evaluated. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: Baseline, Week 24
Insulin Treatment Satisfaction Questionnaire (ITSQ)
ITSQ is a validated instrument containing 22 items that assess treatment satisfaction for participants with diabetes and on insulin. Items divided into 5 domains of satisfaction: Inconvenience of Regimen \[(IR) 5 items: domain scores range (DSR) 5-35\], Lifestyle Flexibility \[(LF) 3 items: DSR 3-21\], Glycemic Control \[(GC) 3 items: DSR 3-21\], Hypoglycemic Control \[(HC) 5 items: DSR 5-35\], Insulin Delivery Device \[(IDD) 6 items: DSR 6-42\]. All items measured on a 7-point scale: 1 (no bother at all) to 7 (a tremendous bother), with lower scores reflecting better outcomes. ITSQ Total Overall Raw Scores range from 22-154. Both raw domain and overall scores are transformed on a scale of 0-100, where transformed score=100\*\[(7-mean raw score)/6\]. Higher scores indicate better treatment satisfaction. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
Time frame: At Week 24
Number of Participants With Detectable Anti-Glargine Antibodies
Number of participants with detectable anti-glargine antibodies were reported.
Time frame: Baseline through 24 weeks
Rate of Total Symptomatic and Nocturnal Hypoglycemia Events (Adjusted by 1 Year)
Hypoglycemic episodes are defined as events that are associated with reported signs and symptoms of hypoglycemia and/or documented blood glucose (BG) concentrations of ≤70 mg/dL (3.9 mmol/L). The overall yearly rates (events/participant/year) of those hypoglycemic events, calculated as, for each participant, the number of episodes times 365.25 and then divided by the participants treatment duration, will be summarized, and analyzed by a negative-binomial regression model with treatment as fixed effects and log of (participant's treatment duration/365.25) as an offset variable. A nocturnal hypoglycemic event is defined as any total hypoglycemia event that occurred between bedtime and waking.
Time frame: Baseline through 24 weeks
| Milestone | LY2963016 | Lantus® |
|---|---|---|
| Started | 359 | 177 |
| Received at least one dose of study drug | 359 | 177 |
| Completed | 336 | 159 |
| Not completed | 23 | 18 |
| Withdrew: Withdrawal by subject | 14 | 8 |
| Withdrew: Lost to follow-up | 4 | 2 |
| Withdrew: Adverse event | 3 | 2 |
| Withdrew: Physician decision | 2 | 2 |
| Withdrew: Non-compliance with study drug | 0 | 3 |
| Withdrew: Protocol violation | 0 | 1 |
HbA1c is the glycosylated fraction of hemoglobin A. HbA1c is measured primarily to identify average plasma glucose concentration over prolonged periods of time. Least square (LS) mean was calculated by mixed-effects model for repeated measures (MMRM) with baseline, insulin secretagogues at study entry, treatment, visit and treatment\*visit in the model.
| Percentage of HbA1c | LY2963016 | Lantus® |
|---|---|---|
| Change From Baseline in Hemoglobin A1c (HbA1c) (LY2963016 to Lantus®) | -1.27 ± 0.043 | -1.23 ± 0.062 |
HbA1c is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, treatment, visit and treatment\*visit in the model.
| Percentage of HbA1c | LY2963016 | Lantus® |
|---|---|---|
| Change From Baseline in HbA1c (Lantus® to LY2963016) | -1.27 ± 0.043 | -1.23 ± 0.062 |
Seven-point SMBG are completed at the following timepoints: Before Morning Meal, 2 Hours After Morning Meal, Before Mid-Day Meal, 2 Hours After Mid-Day Meal, Before Evening Meal, 2 Hours After Evening Meal and Bed Time. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| milligrams per deciliter (mg/dL) | LY2963016 | Lantus® |
|---|---|---|
| Before Morning Meal Glucose | -48.7 ± 1.09 | -49.7 ± 1.59 |
| 2 Hours After Morning Meal Glucose | -56.3 ± 2.34 | -52.7 ± 3.39 |
| Before Mid-Day Meal Glucose | -43.2 ± 2.03 | -39.9 ± 2.93 |
| 2 Hours After Mid-Day Meal Glucose | -31.0 ± 2.31 | -35.9 ± 3.33 |
| Before Evening Meal Glucose | -32.1 ± 2.21 | -33.0 ± 3.19 |
| 2 Hours After Evening Meal Glucose | -29.7 ± 2.46 | -32.0 ± 3.55 |
| Bedtime Glucose | -31.6 ± 2.35 | -33.0 ± 3.40 |
The percentage of participants was calculated by dividing the number of participants reaching target HbA1c by the total number of participants analyzed, multiplied by 100.
| Percentage of participants | LY2963016 | Lantus® |
|---|---|---|
| Percentage of Participants With HbA1c <7% at Week 24 | 43.7 | 44.9 |
The percentage of participants was calculated by dividing the number of participants reaching target HbA1c by the total number of participants analyzed, multiplied by 100.
| Percentage of participants | LY2963016 | Lantus® |
|---|---|---|
| Percentage of Participants With HbA1c ≤6.5% at Week 24 | 23.4 | 16.5 |
Glycemic variability is measured by the intra-participant standard deviation (SD) value of fasting blood glucose as measured by the actual morning and daily pre-meal blood glucose value from the 7-point self-monitoring blood glucose \[SMBG\] profiles. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| milligrams per deciliter (mg/dL) | LY2963016 | Lantus® |
|---|---|---|
| Morning Pre-meal Standard Deviation | -2.17 ± 0.606 | -2.49 ± 0.879 |
| Daily Mean Standard Deviation | -4.1 ± 0.85 | -4.5 ± 1.22 |
Units of basal insulin dose taken per day (U/day). LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| units per day (U/day) | LY2963016 | Lantus® |
|---|---|---|
| Basal Insulin Dose Units Per Day | 16.0 ± 0.43 | 15.7 ± 0.61 |
Units of basal insulin dose taken per day (U/day). LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| U/day | LY2963016 | Lantus® |
|---|---|---|
| Change From Baseline in Basal Insulin Dose Units Per Day | 7.0 ± 0.43 | 6.8 ± 0.61 |
Change from baseline in body weight was evaluated. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| kilogram (kg) | LY2963016 | Lantus® |
|---|---|---|
| Change From Baseline in Body Weight | 1.1 ± 0.13 | 1.2 ± 0.19 |
ITSQ is a validated instrument containing 22 items that assess treatment satisfaction for participants with diabetes and on insulin. Items divided into 5 domains of satisfaction: Inconvenience of Regimen \[(IR) 5 items: domain scores range (DSR) 5-35\], Lifestyle Flexibility \[(LF) 3 items: DSR 3-21\], Glycemic Control \[(GC) 3 items: DSR 3-21\], Hypoglycemic Control \[(HC) 5 items: DSR 5-35\], Insulin Delivery Device \[(IDD) 6 items: DSR 6-42\]. All items measured on a 7-point scale: 1 (no bother at all) to 7 (a tremendous bother), with lower scores reflecting better outcomes. ITSQ Total Overall Raw Scores range from 22-154. Both raw domain and overall scores are transformed on a scale of 0-100, where transformed score=100\*\[(7-mean raw score)/6\]. Higher scores indicate better treatment satisfaction. LS mean was calculated by MMRM with baseline, insulin secretagogues at study entry, baseline HbA1c, treatment, time and treatment\*time in the model.
| units on a scale | LY2963016 | Lantus® |
|---|---|---|
| IR | 89.36 ± 0.80 | 90.31 ± 1.16 |
| LF | 83.70 ± 1.05 | 87.69 ± 1.52 |
| HC | 89.07 ± 0.79 | 90.86 ± 1.15 |
| GC | 87.80 ± 0.84 | 87.83 ± 1.21 |
| IDD | 86.84 ± 0.86 | 88.29 ± 1.24 |
| ITSQ Overall Total | 87.32 ± 0.75 | 88.99 ± 1.08 |
Number of participants with detectable anti-glargine antibodies were reported.
| participants | LY2963016 | Lantus® |
|---|---|---|
| Number of Participants With Detectable Anti-Glargine Antibodies | 69 | 31 |
Hypoglycemic episodes are defined as events that are associated with reported signs and symptoms of hypoglycemia and/or documented blood glucose (BG) concentrations of ≤70 mg/dL (3.9 mmol/L). The overall yearly rates (events/participant/year) of those hypoglycemic events, calculated as, for each participant, the number of episodes times 365.25 and then divided by the participants treatment duration, will be summarized, and analyzed by a negative-binomial regression model with treatment as fixed effects and log of (participant's treatment duration/365.25) as an offset variable. A nocturnal hypoglycemic event is defined as any total hypoglycemia event that occurred between bedtime and waking.
| events/participant/year | LY2963016 | Lantus® |
|---|---|---|
| Total hypoglycemia | 1.37 ± 0.228 | 1.15 ± 0.280 |
| Nocturnal Hypoglycemia | 0.47 ± 0.132 | 0.39 ± 0.110 |
Collected over Baseline Up To 28 Weeks. Non-serious events are listed at a 1% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| LY2963016 | 0/359 (0%) | 28/359 (7.8%) | 194/359 (54%) |
| Lantus® | 0/177 (0%) | 14/177 (7.9%) | 95/177 (53.7%) |
| Event | LY2963016 | Lantus® |
|---|---|---|
| Cerebral infarctionNervous system disorders | 5/359 | 2/177 |
| PneumoniaInfections and infestations | 3/359 | 1/177 |
| AnaemiaBlood and lymphatic system disorders | 0/359 | 1/177 |
| Cardiac failure congestiveCardiac disorders | 0/359 | 1/177 |
| Coronary artery diseaseCardiac disorders | 1/359 | 1/177 |
| ColitisGastrointestinal disorders | 0/359 | 1/177 |
| Gastrointestinal polypGastrointestinal disorders | 0/359 | 1/177 |
| Large intestine polypGastrointestinal disorders | 1/359 | 1/177 |
| Hepatitis eInfections and infestations | 0/359 | 1/177 |
| Soft tissue infectionInfections and infestations | 1/359 | 1/177 |
| Event | LY2963016 | Lantus® |
|---|---|---|
| Upper respiratory tract infectionInfections and infestations | 73/359 | 32/177 |
| Weight increasedInvestigations | 14/359 | 11/177 |
| HypertensionVascular disorders | 20/359 | 7/177 |
| Injection site painGeneral disorders | 15/359 | 5/177 |
| NasopharyngitisInfections and infestations | 8/359 | 7/177 |
| CoughRespiratory, thoracic and mediastinal disorders | 13/359 | 5/177 |
| BronchitisInfections and infestations | 3/359 | 6/177 |
| Diabetic neuropathyNervous system disorders | 1/359 | 5/177 |
| DiarrhoeaGastrointestinal disorders | 10/359 | 4/177 |
| ToothacheGastrointestinal disorders | 9/359 | 1/177 |
All randomized participants who received at least one dose of study drug.
| Age, Continuous(years) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| Mean | 58.3 ± 9.6 | 59.5 ± 8.9 | 58.7 ± 9.4 |
| Sex: Female, Male(Participants) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| Female | 150 | 79 | 229 |
| Male | 209 | 98 | 307 |
| Race (NIH/OMB)(Participants) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 359 | 177 | 536 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 0 | 0 | 0 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(Participants) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| China | 359 | 177 | 536 |
| Baseline Hemoglobin A1c (HbA1c)(Percentage of HbA1c) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| Mean | 8.42 ± 1.04 | 8.39 ± 0.92 | 8.41 ± 1.00 |
| Duration of Diabetes(years) | LY2963016 | Lantus® | Total |
|---|---|---|---|
| Mean | 10.09 ± 5.47 | 10.69 ± 5.94 | 10.29 ± 5.63 |
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — Anonymized individual patient level data will be provided in a secure access environment upon approval of a research proposal and a signed data sharing agreement.
Supporting information: Study protocol, Sap, Csr
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