INSPIRE Diabetes Study
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 5/3/2014 |
| Start Date: | July 2010 |
| End Date: | June 2012 |
| Contact: | Jay H Shubrook, D.O. |
| Email: | shubrook@ohio.edu |
| Phone: | 740-566-4873 |
A Pilot Study of Intensive Insulin Regimen as a Primary Treatment of New Onset of Type 2 DM
T2DM has become an American Epidemic. Currently 8% of the US population has diabetes and
rates may be as high as 33% by the year 2050 (1). Although there are many treatment options
for people with T2DM, none have been proven in humans to prevent the defects in insulin
secretion (2) and insulin action (3) and beta cell dysfunction (4) that result with very
high glucose levels and typically worsen as the disease progresses. Any treatment that
could delay the progression of pancreatic beta cell failure (as measured by the need for
rescue therapy with oral agents) would be a significant advancement in diabetes treatment.
Insulin therapy is appropriate at any point in T2DM disease progression, but it is commonly
only used as a rescue therapy after failure of oral therapies. A number of outpatient
insulin titration protocols have been shown to be safe and effective and speed patient's
ability to gain glucose control (5-8). Recent studies have shown that initiation of insulin
at onset of T2DM is beneficial at achieving early and long-term glucose control (6-9).
However these protocols have used intravenous human insulin in the in-patient setting,
continuous subcutaneous insulin by insulin pump or older human insulins in the out-patient
setting. Many of these protocols are unlikely to be utilized in routine patient care. To
date, no "insulin first" studies have been published with analog insulins in an outpatient
basal-bolus regimen with patient driven titration.
rates may be as high as 33% by the year 2050 (1). Although there are many treatment options
for people with T2DM, none have been proven in humans to prevent the defects in insulin
secretion (2) and insulin action (3) and beta cell dysfunction (4) that result with very
high glucose levels and typically worsen as the disease progresses. Any treatment that
could delay the progression of pancreatic beta cell failure (as measured by the need for
rescue therapy with oral agents) would be a significant advancement in diabetes treatment.
Insulin therapy is appropriate at any point in T2DM disease progression, but it is commonly
only used as a rescue therapy after failure of oral therapies. A number of outpatient
insulin titration protocols have been shown to be safe and effective and speed patient's
ability to gain glucose control (5-8). Recent studies have shown that initiation of insulin
at onset of T2DM is beneficial at achieving early and long-term glucose control (6-9).
However these protocols have used intravenous human insulin in the in-patient setting,
continuous subcutaneous insulin by insulin pump or older human insulins in the out-patient
setting. Many of these protocols are unlikely to be utilized in routine patient care. To
date, no "insulin first" studies have been published with analog insulins in an outpatient
basal-bolus regimen with patient driven titration.
Insulin, when used as an initial treatment of T2DM, has a great potential to produce glucose
control faster than any other treatment regimen. However, it is typically used as the
treatment of last resort in T2DM. In this study, the investigators offer a novel approach to
use insulin as the initial therapy in new-onset T2DM with the aim of determining its
efficacy toward producing lasting glucose control.
Hypothesis: Treating newly diagnosed T2DM patients with insulin therapy versus standard of
care for a short period of time will lead to improvement in glycemic control that is durable
beyond the length of time taking the insulin and it may improve beta cell function.
Primary endpoints: Time to need rescue therapy, Need for rescue therapy at all time points.
A1C change at 3, 6, 9 and 12 months.
Secondary endpoints: Mean glucose and mean fasting glucose at 3, 6, 12 months. C-peptide,
HOMA-B, HOMA-IR, A1C the same time points, OGTT at week 12 and 56. Total number of
hypoglycemic events (minor and major) and tolerability based on side effects.
Treatment arm: Weight based protocol of insulin Glargine and Glulisine. Control arm: oral
medications per ADA 2009 recommended treatment algorithm. Rescue group available for both
arms after initial 12 weeks.
control faster than any other treatment regimen. However, it is typically used as the
treatment of last resort in T2DM. In this study, the investigators offer a novel approach to
use insulin as the initial therapy in new-onset T2DM with the aim of determining its
efficacy toward producing lasting glucose control.
Hypothesis: Treating newly diagnosed T2DM patients with insulin therapy versus standard of
care for a short period of time will lead to improvement in glycemic control that is durable
beyond the length of time taking the insulin and it may improve beta cell function.
Primary endpoints: Time to need rescue therapy, Need for rescue therapy at all time points.
A1C change at 3, 6, 9 and 12 months.
Secondary endpoints: Mean glucose and mean fasting glucose at 3, 6, 12 months. C-peptide,
HOMA-B, HOMA-IR, A1C the same time points, OGTT at week 12 and 56. Total number of
hypoglycemic events (minor and major) and tolerability based on side effects.
Treatment arm: Weight based protocol of insulin Glargine and Glulisine. Control arm: oral
medications per ADA 2009 recommended treatment algorithm. Rescue group available for both
arms after initial 12 weeks.
Inclusion Criteria:
- Newly diagnosed T2DM (≤ 6 months since diagnosis)
- Drug naïve (less than 2 weeks of insulin and OHAs)
- A1C ≥ 8%
- Age ≥ 18 years
- Normal to high baseline C-peptide (≥ 0.5 ug/dL)
- FBG > 180 mg/dL, A1C > 8%.
Exclusion Criteria:
- Pregnancy
- Clinically evident heart failure
- Nephrotic syndrome
- Allergy to insulin or any of the oral medications in the study
- Presence of anti-GAD antibodies
- Islet cell antibodies
- Anti-insulin antibodies
- Any physical disabilities that would preclude self-administration of injectable
insulin.
- Evidence of hypoglycemia during screening phase.
- History of lactic acidosis, allergy to metformin or history of chronic renal disease
or a serum creatinine > 1.5 in men or > 1.4 in women
We found this trial at
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