Evaluation of the Effectiveness and Safety of Physician Versus Patient-led of Insulin Glargine Initiation and Titration in Type 2 Diabetes Mellitus (ATLAS)
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Purpose
Primary Objective:
To compare patient-led titration (intervention group) versus physician-led titration (usual standard of care) in optimizing the clinical use of insulin glargine in an Asian population of patients with Type 2 diabetes mellitus (T2DM) uncontrolled on oral antidiabetic drugs (OADs).
Secondary Objectives:
To determine the difference in glycemic control, safety, quality of life and treatment satisfaction between patient-led titration and usual care.
| Condition | Intervention | Phase |
|---|---|---|
|
Diabetes Mellitus, Type 2 |
Drug: Insulin Glargine |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Asian Treat to Target Lantus Study: A Randomized, Multicentre, Multinational, Open-Label, Parallel-Group, 24-Week Phase IV Study Evaluating the Effectiveness and Safety of Physician Versus Patient-led Initiation and Titration of Insulin Glargine in Type 2 Diabetes Mellitus |
- Change (decrease) in mean hemoglobin glycosylated (HbA1c) level [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Percentage of patients achieving HbA1c levels < 7.0% without experiencing severe hypoglycemia [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Percentage of patients achieving target HbA1c levels (< 7.0% and <6.5%) [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Number of patients having a drop of 1% in HbA1c levels and/or a drop of at least 0.5%. [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Mean change in Fasting Plasma glucose (FPG) and Post Prandial blood Glucose (PPG) [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Evolution of Blood Glucose profiles [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Incidence of symptomatic hypoglycemia [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: Yes ]
- Incidence of nocturnal hypoglycemia [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: Yes ]
- Incidence of asymptomatic hypoglycemia [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: Yes ]
- Mean change in body weight in patients [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- Mean insulin dose [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
- PROMs (patient reported outcome measures) scores from the DTSQs/c (diabetes treatment satisfaction questionnaire status) and EQ-5D (European quality of life - 5 dimensions) [ Time Frame: from week 0 (baseline) to week 24 (end of study) ] [ Designated as safety issue: No ]
| Enrollment: | 521 |
| Study Start Date: | August 2010 |
| Study Completion Date: | June 2012 |
| Primary Completion Date: | June 2012 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Intervention group
Initiation on a fixed dose of insulin glargine, then subjects will self-adjusted their basal insulin dose every 3 days
|
Drug: Insulin Glargine
Pharmaceutical form: solution for injection Route of administration: subcutaneous Dose regimen: initial: once a day in the evening at bedtime. Titration will occur each time the middle FPG (Fasting Plasma Glucose) value is above target Other Name: Solostar
|
|
Active Comparator: Usual standard of care group
Initiation on a fixed dose of insulin glargine, then basal insulin dose is adjusted at each visit by a physician
|
Drug: Insulin Glargine
Pharmaceutical form: solution for injection Route of administration: subcutaneous Dose regimen: initial: once a day in the evening at bedtime. Titration will occur each time the middle FPG (Fasting Plasma Glucose) value is above target Other Name: Solostar
|
Eligibility| Ages Eligible for Study: | 40 Years to 75 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion criteria:
- Diagnosed with T2DM duration of T2DM > 2 years
- Insulin naïve
- Continuous treatment with stable doses of 2 OADs (sulphonylureas, biguanides, alpha-glucosidase inhibitors, DPP-IV inhibitors, and glinides) for > three months prior to randomization
- HbA1c levels 7% and 11 %
- Body mass index (BMI) 20 and 40 kg/m2
- Willing and able to perform blood glucose monitoring using a blood glucose meter
Exclusion criteria:
- Diabetes other than type 2 diabetes (e.g. secondary to pancreatic disorders, drug or chemical agent intake),
- Current or previous use of insulin (except for previous treatment of gestational diabetes or brief treatment with insulin for < 1 week),
- Current treatment with thiazolidinediones,
- Current or previous use (within the last 3 months) of GLP-1 receptor agonists or GLP-1 analogues,
- Current or previous (within the last 3 months) use of any treatment for weight lost,
- Active proliferative diabetic retinopathy,
- Patient without any history of eye examination in the past 6 months,
- Treatment with systemic corticosteroids in the 3 months prior to study entry,
- Currently receiving treatment with monoamine oxidase inhibitors,
- Currently receiving treatment with non-selective -blockers,
- Treatment with any investigational product and/or device in the 2 months prior to study entry,
- Likelihood of requiring treatment during the study period with drugs not permitted by the clinical trial protocol,
- History of ketoacidosis or hyperosmolar hyperglycemic state,
- History of stroke, myocardial infarction, angina pectoris, coronary artery bypass graft or percutaneous transluminal coronary angioplasty within the previous 12 months,
- History of congestive heart failure,
- History of hypoglycemia unawareness,
- Unexplained hypoglycemia in the past 6 months,
- Impaired renal function defined as, but not limited to, serum creatinine 1.5 mg/dL (133 mol/L) males or 1.4 mg/dL (124 mol/L) females or presence of macroproteinuria (>2gr/day),
- Active liver disease (alanine transaminase ALAT greater than two times the upper limit of the reference range, as defined by the local laboratory),
- Have any condition (including known substance or alcohol abuse or psychiatric disorder) that precludes the patient from following and completing the study protocol,
- Had a blood transfusion or severe blood loss within the 3 months before screening, or have known hemoglobinopathy, hemolytic anemia or sickle cell anemia,
- Known hypersensitivity / intolerance to insulin glargine or any of its excipients,
- History of pancreatitis,
- Currently undergoing therapy or planned radiological examinations requiring the administration of contrasting agents for malignancy (other than non-metastatic / early stage basal cell or squamous cell carcinoma),
- Pregnant or lactating women (women of childbearing potential must have a negative pregnancy test at study entry and a medically approved contraception method),
- Any medical condition that may have an influence on HbA1c rate.
The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.
Contacts and Locations| China | |
| Administrative office | |
| Shanghai, China | |
| India | |
| Administrative office | |
| Mumbai, India | |
| Japan | |
| Administrative office | |
| Tokyo, Japan | |
| Pakistan | |
| Administrative office | |
| Karachi, Pakistan | |
| Philippines | |
| Administrative office | |
| Makati City, Philippines | |
| Russian Federation | |
| Administrative office | |
| Moscow, Russian Federation | |
| Study Director: | Clinical Sciences & Operations | Sanofi |
More Information
No publications provided
| Responsible Party: | Sanofi |
| ClinicalTrials.gov Identifier: | NCT01169818 History of Changes |
| Other Study ID Numbers: | LANTU_R_04889, U1111-1116-2247 |
| Study First Received: | July 22, 2010 |
| Last Updated: | November 21, 2012 |
| Health Authority: | Japan: Pharmaceuticals and Medical Devices Agency |
Additional relevant MeSH terms:
|
Diabetes Mellitus Diabetes Mellitus, Type 2 Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Glargine |
Insulin Insulin, Long-Acting Hypoglycemic Agents Physiological Effects of Drugs Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 19, 2013