Perioperative Insulin Glargine Dosing Study

NCT ID: NCT00309465

Last Updated: 2012-12-03

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

402 participants

Study Classification

INTERVENTIONAL

Study Start Date

2005-10-31

Study Completion Date

2009-10-31

Brief Summary

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The main objective of this study is to compare three strategies of evening insulin glargine dosing to preoperative glucose values in patients with diabetes undergoing surgery to determine which dosing strategies most often achieves the admission target study values of 100-179 mg/dl.

Detailed Description

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There are no evidence-based guidelines for insulin glargine (Lantus) dosing in the perioperative setting. Insulin glargine provides peakless 24-hour coverage of basal insulin needs for people with both Type 1 and Type 2 diabetes. Insulin glargine may be used as the sole insulin or in combination with other rapid-acting insulin to achieve glycemic control.

Anesthesia literature recommends that blood sugar values on insulin-dependent patients be maintained between 120-180 mg/dl in most surgeries. Symptoms of low blood sugar are undetectable in anesthetized patients, and blood glucose is tested at least hourly. Since patients are still awake and alert toward hypoglycemic symptoms in the preoperative area, the admission target study values are 100-179 mg/dl. Glucose values greater than 200 mg/dl have been associated with increased rates of infection, and exacerbated complications if a major cardiovascular event happens.

Frequently insulin glargine is administered in the evening. Patients who are scheduled for surgery in the morning are asked not to eat or drink after midnight. Some endocrinology experts recommend that all or part of the patient's usual insulin glargine should be given to avoid high blood sugar; however, whenever insulin is given without food, the possibility of low blood sugar exists.

1. Patients in Group 1 will administer 80% of their usual insulin glargine dose.
2. Group 2 patients will contact their own diabetes care physician and follow those recommendations for the dose.
3. Group 3 patients will take 50%, 80%, or 100% of their usual insulin glargine dose. Which of those three percentages will be determined by the midpoint of the patient's usual self-reported fasting blood sugar (FBS) range and whether the patients is also taking a rapid-acting insulin.

Conditions

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Diabetes Surgery

Keywords

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Diabetes Insulin Glargine Surgery

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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1

Patients in Group 1 will administer 80% of their usual insulin glargine dose.

Group Type EXPERIMENTAL

Lantus

Intervention Type DRUG

Patients in Group 1 will administer 80% of their usual insulin glargine dose.

2

Group 2 patients will contact their own diabetes care physician and follow those recommendations for the dose.

Group Type ACTIVE_COMPARATOR

Insulin

Intervention Type OTHER

Group 2 patients will contact their own diabetes care physician and follow those recommendations for the dose

3

Group 3 patients will take 50%, 80%, or 100% of their usual insulin glargine dose. Which of those three percentages will be determined by the midpoint of the patient's usual self-reported fasting blood sugar (FBS) range and whether the patients is also taking a rapid-acting insulin.

Group Type EXPERIMENTAL

Lantus

Intervention Type DRUG

Group 3 patients will take 50%, 80%, or 100% of their usual insulin glargine dose. Which of those three percentages will be determined by the midpoint of the patient's usual self-reported fasting blood sugar (FBS) range and whether the patients is also taking a rapid-acting insulin.

Interventions

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Lantus

Patients in Group 1 will administer 80% of their usual insulin glargine dose.

Intervention Type DRUG

Insulin

Group 2 patients will contact their own diabetes care physician and follow those recommendations for the dose

Intervention Type OTHER

Lantus

Group 3 patients will take 50%, 80%, or 100% of their usual insulin glargine dose. Which of those three percentages will be determined by the midpoint of the patient's usual self-reported fasting blood sugar (FBS) range and whether the patients is also taking a rapid-acting insulin.

Intervention Type DRUG

Other Intervention Names

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Lantus, Insulin As directed by regular physician

Eligibility Criteria

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Inclusion Criteria

* Scheduled for Surgical Procedure
* Self Management of Diabetes
* Currently on Evening Insulin Glargine prescribed by Primary Care Physician
* Age 18 or over
* Able to Communicate Clearly over the Phone
* Pre-screened by Anesthesia Department \> 48 hours prior to Surgery

Exclusion Criteria

* On Glucocorticoid Medication
* On Insulin Glargine Dual Dosing or Sliding Scale Regimen
* History of Hypoglycemia Unawareness
* Pregnancy or Lactating Female
* On Insulin Glargine for \< 3 months
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sanofi

INDUSTRY

Sponsor Role collaborator

Tamra Dukatz

OTHER

Sponsor Role lead

Responsible Party

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Tamra Dukatz

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Tamra Dukatz, MSN, CRNA

Role: PRINCIPAL_INVESTIGATOR

William Beaumont Hospitals

Locations

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William Beaumont Hospital

Royal Oak, Michigan, United States

Site Status

William Beaumont Hospital

Troy, Michigan, United States

Site Status

Countries

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United States

Other Identifiers

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HIC 2005-080

Identifier Type: -

Identifier Source: org_study_id