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CompletedNCT03406663Updated Oct 22, 2020

The Korean TITRATION Study: Comparison of the Self-titration Methods for Glargine-300

An interventional study of Group 1 and Group 2 in Type 2 Diabetes Mellitus, sponsored by Seoul National University Hospital. Completed at 1 site in Korea, Republic of. Open to participants aged 19 Years and older. Per ClinicalTrials.gov, last updated 2020-10-22.

Sponsored by Seoul National University Hospital · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
130
Allocation
Randomized
Ages
19 Years and older
Sex
All
01

Study summary

The aim of this study is to demonstrate efficacy and safety of self-titration algorithm with Gla-300 using the INSIGHT algorithm (once daily by 1 unit) and the EDITION algorithm (once weekly by 3 units) in Korean patients with T2D.

Read the detailed description

The primary objective of this study is to obtain efficacy and safety descriptive data on two different titration algorithms: the INSIGHT titration algorithm (self-titration of 1 unit/day) and the EDITION trial algorithm with insulin glargine 300 units/mL (GLA-300) when given as basal insulin in uncontrolled T2DM patients on basal insulin with or without non-insulin anti-hyperglycemic agent (NIAHA) or in insulin naïve patients.

In a Korean, single-center, type 2 diabetes patients with basal insulin therapy will be enrolled. They will be randomly assigned to either titration algorithm for GLA-300. After 12 weeks, the glycemic control, patients' satisfaction to the titration methods and healthcare providers' satisfaction to titration methods will be assessed.

02

Conditions studied

  • Type 2 Diabetes Mellitus

Keywords

  • Insulin
03

Who can participate

Ages eligible
19 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Aged ≥ 19 years
  • Treated for T2D for at least 6 months
  • Uncontrolled T2D
  • Use of SMPG
  • HbA1c > 7% and ≤ 10% in patients with a basal insulin (Gla-100, Gla-300, neutral protamine Hagedorn (NPH), and detemir) or HbA1c > 7% and ≤ 11% in insulin naive patients
  • Signed informed consent

Exclusion criteria

Exclusion Criteria:

  • Type 1 diabetes mellitus
  • Pregnancy or lactation
  • Night-shift worker
  • Unwilling to inject insulin or perform SMPG
  • Treated with insulin other than basal insulin within the previous 3 months
  • Not on stable dose of basal insulin (±20%) in the last 3 months
  • Initiation or change in dose of oral anti-hyperglycemic agents in the last 3 months
  • History of alcohol or drug abuse
  • Active cancer or other significant comorbidities which the investigator would make the patients unsuitable for participating in the study
  • Any clinically significant laboratory finding which the which the investigator would make the patients unsuitable for participating in the study
  • Known drug allergy to insulin
  • Not signed informed consent
  • Incompletion of the study
  • Participating in another clinical trial
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
130 participants (actual)

Study arms

  • Experimental
    Group 1

    In group 1, the dose of Gla-300 will be titrated by the patients by 1 unit per day until achieving a fasting SMPG in the target range of 4.4 to 5.6 mmol/L (INSIGHT algorithm). Titration algorithms: Patients will be instructed to daily adjust their dose of Gla-300 based on fasting SMPG values. Fasting SMPG will be measured daily by the patient before breakfast and any intake of antihyperglycemic agents. Fasting SMPG in the range of 1. ≥ 5.6 mmol/L, increase 1 unit of Gla-300 dose 2. \> 4.4 and ≤ 5.6 mmol/L, no change 3. \< 4.4 mmol/L, reduce 1 unit of Gla-300 dose

    Behavioral: Group 1

  • Active comparator
    Group 2

    In group 2, the dose of Gla-300 will be titrated by the patients based on the SMPG values of the last 3 days at least weekly, but no more often than every 3 days to achieve a fasting SMPG in the target range of 4.4 to 5.6 mmol/L (EDITION algorithm). Fasting SMPG (median of the last 3 days including current day) in the range of 1. ≥ 7.8 mmol/L, increase 6 units of Gla-300 dose 2. \> 5.6 and \< 7.8 mmol/L, increase 3 units of Gla-300 dose 3. \> 4.4 and ≤ 5.6 mmol/L, no change 4. ≥ 3.3 and \< 4.4 mmol/L, reduce 3 units of Gla-300 dose 5. \< 3.3 mmol/L or occurrence of ≥ 2 symptomatic or 1 severe hypoglycemic episode in the preceding week, reduce 3 units of Gla-300 dose or at the discretion of the investigator

    Behavioral: Group 2

Interventions

  • BehavioralGroup 1

    Patients will be instructed to daily adjust their dose of Gla-300 based on fasting SMPG values. Fasting SMPG will be measured daily by the patient before breakfast and any intake of antihyperglycemic agents. Fasting SMPG in the range of ≥ 5.6 mmol/L, increase 1 unit of Gla-300 dose, \> 4.4 and ≤ 5.6 mmol/L, no change, \< 4.4 mmol/L, reduce 1 unit of Gla-300 dose

    Also known as: INSIGHT algorithm

  • BehavioralGroup 2

    Fasting SMPG (median of the last 3 days including current day) in the range of * 7.8 mmol/L, increase 6 units of Gla-300 dose, \> 5.6 and \< 7.8 mmol/L, increase 3 units of Gla-300 dose, \> 4.4 and ≤ 5.6 mmol/L, no change, * 3.3 and \< 4.4 mmol/L, reduce 3 units of Gla-300 dose, \< 3.3 mmol/L or occurrence of ≥ 2 symptomatic or 1 severe hypoglycemic episode in the preceding week, reduce 3 units of Gla-300 dose or at the discretion of the investigator

    Also known as: EDITION algorithm

05

What researchers measure

Primary outcomes

  1. Proportion of patients achieving fasting SMPG ≤ 5.6 mmol/L without hypoglycemia at 12 weeks

    Time frame: up to 12 weeks

Secondary outcomes

  1. Changes in HbA1c (%)

    Time frame: up to 12 weeks

  2. Fasting plasma glucose (mmol/L)

    Time frame: up to 12 weeks

  3. Fasting SMPG (mmol/L)

    Time frame: up to 12 weeks

  4. 7-point SMPG (mmol/L)

    Time frame: up to 12 weeks

  5. Proportion of patients at HbA1c ≤ 7%

    Time frame: up to 12 weeks

  6. Change in insulin dose (IU)

    Time frame: up to 12 weeks

  7. Change in body weight (kilogram)

    Time frame: up to 12 weeks

  8. Hypoglycemia (number of patients)

    Time frame: up to 12 weeks

  9. Adverse events

    Time frame: up to 12 weeks

  10. Patient satisfaction to the insulin titration method (evaluated by prespecified questionnaire: DTSQs)

    Time frame: up to 12 weeks

  11. Health care professionals' satisfaction to the insulin titration methods (evaluated by prespecirfied questionnaire: health care provider treatment satisfaction questionnaire)

    Time frame: up to 12 weeks

06

Study locations

1 site
  • Seoul National University Hospital
    Seoul, 110-744, Korea, Republic of
07

References and documents

Publications

  • Bae JH, Ahn CH, Yang YS, Moon SJ, Kwak SH, Jung HS, Park KS, Cho YM. Efficacy and Safety of Self-Titration Algorithms of Insulin Glargine 300 units/mL in Individuals with Uncontrolled Type 2 Diabetes Mellitus (The Korean TITRATION Study): A Randomized Controlled Trial. Diabetes Metab J. 2022 Jan;46(1):71-80. doi: 10.4093/dmj.2020.0274. Epub 2021 Jun 16. PubMed 34130445 ↗
08

Registry details

Key details

Study ID
NCT03406663
Lead sponsor
Seoul National University Hospital
Collaborators
Sanofi
Responsible party
Young Min Cho (Professor, Seoul National University Hospital) — Principal investigator
First posted
Jan 23, 2018
Start date
Oct 1, 2017
Primary completion
Jan 17, 2020
Completion
Jul 14, 2020
Last update
Oct 22, 2020

Study contacts

Young Min Cho, MD, PhD
principal investigator · Seoul National University Hospital

Oversight

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

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