Comparator Trial Using Insulin Glulisine vs. Insulin Lispro for Treatment of Gestational Diabetes

NCT ID: NCT01662921

Last Updated: 2018-04-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-04-30

Study Completion Date

2015-08-31

Brief Summary

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We hypothesize that insulin glulisine is non-inferior to currently proven rapid-acting insulin lispro when used in a basal/bolus regimen to treat hyperglycemia in patients with gestational diabetes mellitus.

Detailed Description

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To date, only two rapid-acting insulin analogs have been shown to be safe and effective for the treatment of diabetes during pregnancy: insulin aspart and insulin lispro.

The pharmacokinetics and pharmacodynamics of insulin glulisine are unique and insulin glulisine may be the best rapid-acting analog for the treatment of post-prandial hyperglycemia. We believe that insulin glulisine should be evaluated in women with gestational diabetes for its potential efficacy.

Conditions

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Diabetes During Pregnancy

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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NPH and insulin lispro

Patients diagnosed with diabetes during pregnancy will be randomized to long acting insulin NPH and short acting insulin lispro in a basal bolus regimen to treat post prandial hyperglycemia using a dosing schedule of 50% NPH calculated by the patients weight and gestational age and 50% lispro pending their last three SMPG average.

Group Type ACTIVE_COMPARATOR

NPH

Intervention Type DRUG

Long acting insulin NPH dosing will be titrated weekly derived from the patients current weight and gestational age

Insulin LISPRO

Intervention Type DRUG

Insulin lispro dosing will be titrated weekly based on the patient's average SMBG readings from each meal during the past three days

NPH and insulin glulisine

Patients with a diagnosis of diabetes during pregnancy will be randomized to using long acting insulin NPH and short acting insulin glulisine as treatment for post prandial hyperglycemia with a 50% NPH dosing schedule based on the weight and gestational age and 50% glulisine schedule based on their last three SMBG result average.

Group Type ACTIVE_COMPARATOR

NPH

Intervention Type DRUG

Long acting insulin NPH dosing will be titrated weekly derived from the patients current weight and gestational age

Insulin glulisine

Intervention Type DRUG

Insulin glulisine will be titrated weekly based on the patient's average SMBG readings from each meal during the past three days

Interventions

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NPH

Long acting insulin NPH dosing will be titrated weekly derived from the patients current weight and gestational age

Intervention Type DRUG

Insulin LISPRO

Insulin lispro dosing will be titrated weekly based on the patient's average SMBG readings from each meal during the past three days

Intervention Type DRUG

Insulin glulisine

Insulin glulisine will be titrated weekly based on the patient's average SMBG readings from each meal during the past three days

Intervention Type DRUG

Other Intervention Names

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Humulin N, Novolin N Humalog Apidra

Eligibility Criteria

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Inclusion Criteria

* Informed Consent to participate in clinical trial
* Pregnant and 20-30 weeks gestation
* Diagnosed with gestational diabetes
* Failed diet therapy (failed lifestyle modification will be defined as 10% or greater SMBG values above pre-meal \<90mg/dL and post prandial \< 120mg/dL
* Eat at least 2 meals per day

Exclusion Criteria

* Pregnant women \<18 years old
* Blood pressure \> 140/80 mmHg
* A1C equal to or greater than 6.5% at time of enrollment
* Pre-pregnancy BMI \> 40Kg/m squared
* Evidence of any fetal anomaly on any fetal ultrasound
* Currently using hypoglycemic agent
* Refusal to use insulin before meals
* Inability to understand instructions or to consent to participate
* Pregnant women with history of T1DM or T2DM
* Clinical judgment by investigator that patient is inappropriate for clinical trial or has a metabolic disorder that could interfere with results
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Sanofi

INDUSTRY

Sponsor Role collaborator

Sansum Diabetes Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Kristin Castorino, DO

Role: PRINCIPAL_INVESTIGATOR

Sansum Diabetes Research Institute

Leonie Mattison, PhD

Role: STUDY_DIRECTOR

Sansum Diabetes Research Institute

Locations

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William Sansum Diabetes Center

Santa Barbara, California, United States

Site Status

Countries

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United States

References

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1. Centers for Disease Control and Prevention: National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.

Reference Type BACKGROUND

Castorino K, Jovanovic L. Pregnancy and diabetes management: advances and controversies. Clin Chem. 2011 Feb;57(2):221-30. doi: 10.1373/clinchem.2010.155382. Epub 2010 Dec 9.

Reference Type BACKGROUND
PMID: 21148303 (View on PubMed)

HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991-2002. doi: 10.1056/NEJMoa0707943.

Reference Type BACKGROUND
PMID: 18463375 (View on PubMed)

Jovanovic L, Pettitt DJ. Treatment with insulin and its analogs in pregnancies complicated by diabetes. Diabetes Care. 2007 Jul;30 Suppl 2:S220-4. doi: 10.2337/dc07-s220. No abstract available.

Reference Type BACKGROUND
PMID: 17596476 (View on PubMed)

Arnolds S, Rave K, Hovelmann U, Fischer A, Sert-Langeron C, Heise T. Insulin glulisine has a faster onset of action compared with insulin aspart in healthy volunteers. Exp Clin Endocrinol Diabetes. 2010 Oct;118(9):662-4. doi: 10.1055/s-0030-1252067. Epub 2010 Apr 28.

Reference Type BACKGROUND
PMID: 20429049 (View on PubMed)

Manderson JG, Patterson CC, Hadden DR, Traub AI, Ennis C, McCance DR. Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial. Am J Obstet Gynecol. 2003 Aug;189(2):507-12. doi: 10.1067/s0002-9378(03)00497-6.

Reference Type BACKGROUND
PMID: 14520226 (View on PubMed)

Related Links

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http://www.sansum.org

Web page for Sansum Diabetes Research Institute

Other Identifiers

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APIDRL06229

Identifier Type: -

Identifier Source: org_study_id

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