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CompletedNCT03400501Updated Nov 5, 2021

Reducing the Risk of Metabolic Decompensation in Diabetic Adolescents by Supervised School Administration of Insulin

An Early Phase 1 interventional study of Insulin Degludec and Insulin Glargine in Type 1 Diabetes Mellitus, sponsored by Yale University. Completed at 1 site in United States. Open to participants aged 8 Years to 18 Years. Per ClinicalTrials.gov, last updated 2021-11-05.

Sponsored by Yale University · Early Phase 1, Interventional, and Treatment

Phase
Early Phase 1
Study type
Interventional
Enrollment
32
Allocation
Randomized
Ages
8 Years to 18 Years
Sex
All
01

Study summary

This is a pilot study to examine and compare the efficacy of supervised injections of long acting insulins degludec and glargine to protect youth with poorly controlled type 1 diabetes (T1D) from development of ketones.

Read the detailed description

This study will compare the proportion of days with fasting β-hydroxybutyrate levels ≥0.6 mmol/L at the start of the school week following weekend/holiday breaks in subjects who have been randomized to receive daily injections of I-deg or I-glar. Hypothesis: β-hydroxybutyrate levels will be lower in the morning of the first day of the school week in subjects receiving I-deg than in subjects receiving I-glar, since the long half-life of I-deg will compensate for missed insulin doses over the weekend/holidays. To remove variability due to potential non-compliance during the school week, this study will utilize our routine clinical practice of supervised insulin administration and monitoring of blood glucose and ketones during the school day.

02

Conditions studied

  • Type 1 Diabetes Mellitus
03

Who can participate

Ages eligible
8 Years to 18 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Clinical diagnosis of T1D, diagnosed at least 12 months prior to enrollment
  • HbA1c ≥8.5%9 and \<14% on enrollment
  • Taking no medications known to affect blood glucose levels other than insulin.
  • Ability to provide participant written informed consent if age 18 years, or parental written informed consent and participant assent if participant is \< age 18 before any trial-related activities
  • Current regimen includes insulin detemir or I-glar, as long acting insulin
  • Willingness to use either I-glar or I-deg pens as basal insulin, and have school personnel supervise administration
  • Willingness to have school personnel supervise fasting blood β-hydroxybutyrate levels first thing in the morning at the beginning and end of each school week
  • Willingness to have school personnel supervise fasting blood glucose checks daily in the morning on school days, and eat breakfast after the fasting check

Exclusion criteria

Exclusion Criteria:

  • Female participants who are pregnant, breast-feeding or planning on becoming pregnant
  • Participant (and parent if age \<18) unable to read, write, and speak English.
  • Adolescents who are home schooled or no longer attending secondary school
  • Participant's school is unable to provide personnel to supervise injections of long-acting insulin or measurement blood glucose and β-hydroxybutyrate levels
  • Known or suspected allergy to trial medication(s), excipients, or related products.
  • Contraindications to study medications, including hypersensitivity to I-deg or one of its excipients, hypersensitivity to I-glar or one of its excipients, and administration of either during episodes of hypoglycaemia
04

Study design

Phase
Early Phase 1
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
32 participants (actual)

Study arms

  • Experimental
    subjects receiving insulin degludec

    Youth aged 8-18 years with T1D whose diabetes is poorly-controlled (A1c ≥8.5%) will receive insulin degludec injections.

    Drug: Insulin Degludec

  • Active comparator
    Subjects receiving insulin glargine

    Youth aged 8-18 years with T1D whose diabetes is poorly-controlled (A1c ≥8.5%) will receive insulin glargine injections.

    Drug: Insulin Glargine

Interventions

  • DrugInsulin Degludec

    Single daily dose of insulin degludec based on their fasting blood glucose levels and current long acting insulin dose

    Also known as: I-degludec

  • DrugInsulin Glargine

    Single daily dose of insulin glargine based on their fasting blood glucose levels and current long acting insulin dose

    Also known as: I-glar

05

What researchers measure

Primary outcomes

  1. Lower beta hydroxybutyrate levels

    Will test the the hypothesis that β-hydroxybutyrate levels will be lower in the morning (≥0.6 mmol/L) of the first day of the school week in subjects receiving I-deg, since the long half-life of I-deg will compensate for missed insulin doses over the weekend/holidays.

    Time frame: 4 months

Secondary outcomes

  1. Control of HbA1c levels

    Test the hypothesis that the longer duration of action of I-deg will lead to improvements in glycemic control measured by HbA1c (a secondary aim) and fasting glucose.

    Time frame: 4 months

  2. Measure of beta hydroxybutyrate levels between the 2 groups.

    Test the differences in frequency of elevated β-hydroxybutyrate levels when receiving supervised injections of basal insulin versus when not receiving supervised injections between the I-deg and I-glar groups

    Time frame: 4 months

06

Study locations

1 site
  • Yale University
    New Haven, Connecticut 06511, United States
07

Registry details

Key details

Study ID
NCT03400501
Lead sponsor
Yale University
Responsible party
Sponsor
First posted
Jan 17, 2018
Start date
Oct 1, 2017
Primary completion
Jun 7, 2021
Completion
Jun 7, 2021
Last update
Nov 5, 2021

Study contacts

William Tamborlane, PhD
principal investigator · MED School of Medicine

Oversight

FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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