Diabetes in the Elderly: Prospective Study

NCT ID: NCT01131052

Last Updated: 2014-12-31

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-03-31

Study Completion Date

2013-12-31

Brief Summary

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Diabetes is highly prevalent in the elderly, afflicting about 20% of older adults aged 65-75 years and 40% of adults \>80years of age. It is expected that the number of elderly people suffering from diabetes will increase in the future, as general life expectancy is increasing.

Nursing home residents with diabetes have higher rates of serious comorbidities and have greater activity of daily living dependencies than other residents without diabetes. In addition, persons with diabetes have higher risk of hypertension, heart disease, stroke depression, cognitive impairment, and cardiovascular mortality than individuals without diabetes.

There are a few retrospective studies in elderly patients analyzing quality of diabetes care and glycemic control adjusted for medications and presence of co-morbidities in long-term care facilities; however, no previous randomized controlled trials have demonstrated benefits of glycemic control on clinical outcome, quality of life, and rate of acute metabolic complications (hyperglycemia and hypoglycemic events) in long-term care facilities. In addition, it is not known whether the use of basal insulin is superior to treatment with sliding scale insulin (SSI) in long-term care facility residents with type 2 diabetes.

Accordingly, the investigators propose to conduct a prospective randomized control trial comparing the efficacy and safety of the basal (glargine) insulin regimen and sliding scale regular insulin in the management of nursing home patients with T2DM.

Detailed Description

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Conditions

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Diabetes Hyperglycemia

Keywords

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elderly populations diabetes

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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BASAL PLUS

Diabetic subjects receive insulin glargine once daily plus corrective doses of insulin glulisine before meals and bedtime as needed

Group Type ACTIVE_COMPARATOR

Insulin Glargine

Intervention Type DRUG

glargine once a day

Insulin glulisine

Intervention Type DRUG

glulisine given as needed before meals

sliding scale regular insulin (SSRI)

Diabetic subjects receive sliding scale regular insulin (SSRI) before meals and at bedtime as needed

Group Type ACTIVE_COMPARATOR

Insulin

Intervention Type DRUG

sliding scale regular insulin (SSRI) given before meals and at bedtime as needed

Interventions

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Insulin Glargine

glargine once a day

Intervention Type DRUG

Insulin

sliding scale regular insulin (SSRI) given before meals and at bedtime as needed

Intervention Type DRUG

Insulin glulisine

glulisine given as needed before meals

Intervention Type DRUG

Other Intervention Names

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Lantus Novolin R Apridra

Eligibility Criteria

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Inclusion Criteria

1. Males or females \> 60 years of age.
2. Blood glucose \> 150 mg/dl and A1C \> 7.5%.
3. A known history of T2DM, receiving either diet alone, oral monotherapy, or with any combination of oral antidiabetic agents (metformin, sulfonylureas, repaglinide, nateglinide, pioglitazone, rosiglitazone, sitagliptin).
4. Patients admitted for non-cardiac elective or emergency surgery or trauma.

Exclusion Criteria

1. Subjects with increased blood glucose concentration, but without a known history of diabetes (stress hyperglycemia).
2. Subjects with a history of diabetic ketoacidosis and hyperosmolar hyperglycemic state (26).
3. Patients with clinically relevant hepatic disease (diagnosed liver cirrhosis and portal hypertension), corticosteroid therapy, or impaired renal function (creatinine ≥ 3.5 mg/dl).
4. Patients with recognized or suspected endocrine disorders associated with increased insulin resistance, acromegaly, or hyperthyroidism
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Guillermo Umpierrez

OTHER

Sponsor Role lead

Responsible Party

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Guillermo Umpierrez

Professor of Medicine

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Guillermo Umpierrez, MD

Role: PRINCIPAL_INVESTIGATOR

Emory SOM

Locations

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Guillermo Umpierrez

Atlanta, Georgia, United States

Site Status

Countries

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United States

References

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Pasquel FJ, Powell W, Peng L, Johnson TM, Sadeghi-Yarandi S, Newton C, Smiley D, Toyoshima MT, Aram P, Umpierrez GE. A randomized controlled trial comparing treatment with oral agents and basal insulin in elderly patients with type 2 diabetes in long-term care facilities. BMJ Open Diabetes Res Care. 2015 Aug 28;3(1):e000104. doi: 10.1136/bmjdrc-2015-000104. eCollection 2015.

Reference Type DERIVED
PMID: 26336609 (View on PubMed)

Other Identifiers

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IRB00038789

Identifier Type: -

Identifier Source: org_study_id