Transition to Hospital Discharge in Insulinized Patients With Type 2 Diabetes Mellitus

NCT ID: NCT07061301

Last Updated: 2026-01-23

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

RECRUITING

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-08-01

Study Completion Date

2026-07-31

Brief Summary

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This clinical study explores whether adding technological tools during hospital discharge can help people with type 2 diabetes who are starting insulin therapy achieve better treatment adherence and blood glucose control once they return home. The discharge transition period includes both the final days of hospitalization and the first weeks to months after returning home.

When people with type 2 diabetes are hospitalized, they sometimes need to begin insulin therapy. After discharge, managing insulin properly is essential to avoid high or low blood sugar levels. However, many patients forget or delay insulin doses, which can lead to poor control of their diabetes.

This study will compare two groups of patients. All participants will be adults with type 2 diabetes, between 18 and 70 years old, who are newly starting insulin during their hospital stay.

Group 1 ("technological group") will use a continuous glucose monitor (CGM) and a smart insulin pen cap called Insulclock. These tools show real-time blood glucose data and record when and how much insulin is injected. Patients and doctors can use this information to better adjust treatment. Insulclock also includes alarms to remind patients of their doses.

Group 2 ("control group") will use the same devices, but they will not see the data in real time. Instead, they will manage their insulin based on standard finger-prick blood sugar checks four times a day, as typically done in standard care.

Both groups will be followed for 12 weeks after hospital discharge. Medical check-ins will occur in weeks 1, 2, 4, 8, and 12. Blood tests and treatment adjustments will be performed as needed.

The main goals are:

To measure if the use of technology helps patients stick to their insulin schedule (fewer missed or mistimed injections).

To see if it leads to better blood glucose control (e.g., more time within the recommended range, fewer episodes of low or high glucose).

To evaluate patient satisfaction with this technology and check if the number of unplanned hospital readmissions decreases.

The study will take place at Hospital Universitari i Politècnic La Fe in Valencia, Spain. Around 80 patients will participate.

This study is important because real-world data about the use of CGM and smart insulin devices during the hospital-to-home transition are limited. It may help improve diabetes care for people starting insulin after hospitalization.

Detailed Description

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The transition from hospital to home is a clinically vulnerable phase for patients with type 2 diabetes mellitus (T2DM), particularly for those who are newly initiated on insulin therapy during hospitalization. This period is characterized by increased therapeutic complexity, limited patient confidence with insulin use, and heightened risk of poor glycemic outcomes. Suboptimal adherence to insulin regimens-including missed or delayed doses-is common and has been associated with adverse clinical events, reduced quality of life, and higher healthcare utilization, including unplanned readmissions.

While continuous glucose monitoring (CGM) systems and smart insulin pen caps have individually shown promise in improving glycemic control and treatment adherence, there is a lack of robust data regarding their effectiveness when introduced in the peri-discharge period. Importantly, the transition from inpatient to outpatient care has been highlighted as a critical moment to implement structured, technology-supported interventions aimed at improving self-management and continuity of care.

This study investigates whether the combination of CGM and Insulclock® technology, initiated during hospitalization and continued after discharge, improves glycemic control and adherence in insulin-treated T2DM patients. Unlike prior studies, this trial evaluates these devices not only as monitoring tools but also as real-time decision-making supports during a period of high clinical risk.

In addition to assessing standard glycemic metrics - including time in range (TIR), time below and above range (TBR, TAR), coefficient of variation, and HbA1c - the study will measure patient-reported treatment satisfaction and unplanned hospital readmissions within 30 days. The outcomes of this research may inform future protocols for diabetes discharge planning and support the integration of connected technologies into standard care pathways for insulin initiation in hospitalized patients.

Conditions

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Type 2 Diabetes Mellitus (T2DM) Continuous Glucose Monitoring CGM Transition to Discharge Smart Insulin Pen Cap

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This is a pilot, randomized, open-label, parallel-group, single-center clinical trial. Adults with type 2 diabetes who start insulin therapy during hospitalization are randomized prior to discharge into two arms. The intervention group uses a real-time continuous glucose monitor (CGM) and Insulclock® smart cap, while the control group uses both blinded CGM and blinded Insulclock® smart cap and adjusts insulin based on capillary glucose tests. Both groups are followed for 12 weeks with scheduled visits at weeks 1, 2, 4, 8, and 12. The study evaluates adherence to insulin therapy and glycemic control during the hospital discharge transition period. Data are collected digitally in an electronic CRD. Glycemic control is assessed using time in range (TIR), time below range (TBR), time above range (TAR), coefficient of variation, mean glucose, and HbA1c.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Use of blind continuous glucose sensor and smart insulin pen cap.

From discharge, use of a blind continuous glucose sensor and a smart insulin pen cap. Insulin therapy decision-making based on capillary blood glucose.

Group Type ACTIVE_COMPARATOR

Usual Care group

Intervention Type DEVICE

Participants will use the same CGM and Insulclock® devices, but in blinded mode (no data available to the patient). Insulin therapy will be adjusted using capillary blood glucose measurements (4 times daily). Device data will be collected retrospectively but not used for treatment decisions.

Use of continuous glucose sensor and smart insulin pen cap and is able to see the parameters.

From discharge, a continuous glucose sensor and smart insulin pen cap are used, and the subject is able to see its parameters. Insulin therapy decision-making is based on the continuous glucose sensor and smart cap parameters.

Group Type EXPERIMENTAL

Technological group

Intervention Type DEVICE

Participants will use a real-time continuous glucose monitoring device (e.g., FreeStyle Libre 2) and the Insulclock® smart insulin pen cap. Both devices provide real-time feedback and data on insulin administration and glucose levels. Patients will adjust their insulin therapy based on these data.

Interventions

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Usual Care group

Participants will use the same CGM and Insulclock® devices, but in blinded mode (no data available to the patient). Insulin therapy will be adjusted using capillary blood glucose measurements (4 times daily). Device data will be collected retrospectively but not used for treatment decisions.

Intervention Type DEVICE

Technological group

Participants will use a real-time continuous glucose monitoring device (e.g., FreeStyle Libre 2) and the Insulclock® smart insulin pen cap. Both devices provide real-time feedback and data on insulin administration and glucose levels. Patients will adjust their insulin therapy based on these data.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18 to 70 years.
* Hospitalized patients with a diagnosis of type 2 diabetes mellitus (T2DM), either newly diagnosed during admission or previously known but not previously treated with insulin.
* Initiation of insulin therapy (basal, basal-plus, or basal-bolus regimen) during hospitalization, with planned continuation post-discharge.
* Independent in basic activities of daily living.
* Adequate cognitive and functional capacity to manage the required devices: insulin pen, glucometer, continuous glucose monitoring (CGM) sensor, and Insulclock® cap.

Exclusion Criteria

* Dependence in basic activities of daily living.
* Any medical condition or functional limitation precluding the use of the CGM or the Insulclock® system.
* Pregnancy or intention to become pregnant.
* Diagnosis of type 1 diabetes mellitus.
* Patients undergoing dialysis.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto de Investigacion Sanitaria La Fe

OTHER

Sponsor Role lead

Responsible Party

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Juan Francisco Merino Torres

Chief of Endocrinology, Professor of Medicine, and Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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JUAN FRANCISCO MERINO TORRES, Medicine

Role: PRINCIPAL_INVESTIGATOR

IIS La Fe

DARIO LARA GALVEZ, Medicine

Role: STUDY_CHAIR

IIS La Fe

MATILDE RUBIO ALMANZA, Medicine

Role: STUDY_CHAIR

IIS La Fe

Locations

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Hospital La Fe, Valencia

Valencia, Valencia, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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JUAN FRANCISCO MERINO TORRES, MEDICINE

Role: CONTACT

+34617951330

DARIO LARA GALVEZ, Medicine

Role: CONTACT

+34618205199

Facility Contacts

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DARIO LARA GALVEZ, Medicine

Role: primary

+34618205199

JUAN FRANCISCO MERINO TORRES, Medicine

Role: backup

+34617951330

References

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Tian T, Aaron RE, Seley JJ, Longo R, Nayberg I, Umpierrez GE, Levy CJ, Klonoff DC. Use of Continuous Glucose Monitors Upon Hospital Discharge of People With Diabetes: Promise, Barriers, and Opportunity. J Diabetes Sci Technol. 2024 Jan;18(1):207-214. doi: 10.1177/19322968231200847. Epub 2023 Oct 2.

Reference Type BACKGROUND
PMID: 37784246 (View on PubMed)

Peyrot M, Barnett AH, Meneghini LF, Schumm-Draeger PM. Insulin adherence behaviours and barriers in the multinational Global Attitudes of Patients and Physicians in Insulin Therapy study. Diabet Med. 2012 May;29(5):682-9. doi: 10.1111/j.1464-5491.2012.03605.x.

Reference Type BACKGROUND
PMID: 22313123 (View on PubMed)

Robinson S, Newson RS, Liao B, Kennedy-Martin T, Battelino T. Missed and Mistimed Insulin Doses in People with Diabetes: A Systematic Literature Review. Diabetes Technol Ther. 2021 Dec;23(12):844-856. doi: 10.1089/dia.2021.0164. Epub 2021 Oct 26.

Reference Type BACKGROUND
PMID: 34270324 (View on PubMed)

Tejera-Perez C, Chico A, Azriel-Mira S, Lardies-Sanchez B, Gomez-Peralta F; Area de Diabetes-SEEN. Connected Insulin Pens and Caps: An Expert's Recommendation from the Area of Diabetes of the Spanish Endocrinology and Nutrition Society (SEEN). Diabetes Ther. 2023 Jul;14(7):1077-1091. doi: 10.1007/s13300-023-01417-1. Epub 2023 May 15.

Reference Type BACKGROUND
PMID: 37188930 (View on PubMed)

Galindo RJ, Ramos C, Cardona S, Vellanki P, Davis GM, Oladejo O, Albury B, Dhruv N, Peng L, Umpierrez GE. Efficacy of a Smart Insulin Pen Cap for the Management of Patients with Uncontrolled Type 2 Diabetes: A Randomized Cross-Over Trial. J Diabetes Sci Technol. 2023 Jan;17(1):201-207. doi: 10.1177/19322968211033837. Epub 2021 Jul 22.

Reference Type BACKGROUND
PMID: 34293955 (View on PubMed)

Vinagre I, Mata-Cases M, Hermosilla E, Morros R, Fina F, Rosell M, Castell C, Franch-Nadal J, Bolibar B, Mauricio D. Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain). Diabetes Care. 2012 Apr;35(4):774-9. doi: 10.2337/dc11-1679. Epub 2012 Feb 16.

Reference Type BACKGROUND
PMID: 22344609 (View on PubMed)

Other Identifiers

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2024-0338-1

Identifier Type: -

Identifier Source: org_study_id

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