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| Name | Class |
|---|---|
| Boston Medical Center | OTHER |
| Rush University | OTHER |
| University of Denver | OTHER |
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This study is a prospective, randomized, open label trial to compare the safety and efficacy of linagliptin (an oral anti diabetic medication) given orally once daily to an insulin regimen of glargine once daily plus rapid-acting insulin before meals. Both of these treatment groups will be given corrective doses of rapid-acting insulin analogs (aspart, lispro or glulisine) before meals if their blood sugars are > 140 mg/dl.
The patients will be monitored for their blood sugars while the hospital.
If patients are agreeable to participate in the discharge part of the study, the investigators will randomized them to a treatment group based on their admission HbA1c. The investigators will follow these patients for 3 months with phone calls and clinic visits, and will monitor their blood sugars. This is to compare the efficacy of linagliptin and our discharge treatment algorithm in controlling blood sugars as out patients.
Specific Aim 1: To determine whether in-hospital glycemic control, as measured by mean daily glucose concentration and frequency of hypoglycemic events, is different between treatment with linagliptin (Tradjenta®) plus correction doses with a rapid-acting insulin analog before meals and a basal bolus regimen with glargine once daily and rapid-acting insulin analog before meals in general surgery patients with T2D.
Specific Aim 2: To determine the efficacy and safety of an A1C based discharge algorithm in controlling BG after discharge in patients with T2D. Patients who participate in the in-hospital arm (Aim 1) will be invited to enroll in this open label prospective outpatient study. The total duration of the study is 3 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Linagliptin In-hospital | Experimental | Linagliptin once daily+ correction doses of aspart or lispro if needed |
|
| Basal Bolus In-hospital | Active Comparator | Glargine once daily and rapid-acting insulin before meals + correction doses of aspart or lispro if needed |
|
| Linagliptin on discharge | Experimental | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day. If contraindication to oral anti-diabetics (OAD), discharge patient on linagliptin once daily. |
|
| Linagliptin+50%Glargine dose on d/c | Experimental | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. |
|
| Linagliptin+80%Glargine dose on d/c | Experimental | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Linagliptin | Drug | Linagliptin once daily + correction doses of rapid acting insulin if needed |
|
| Measure | Description | Time Frame |
|---|---|---|
| Differences in Glycemic Control | Determine differences in glycemic control as measured by mean daily BG concentration between linagliptin alone and basal bolus therapy group. | Inpatient (average 5 days) and outpatient up to 12 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Hypoglycemia <70 mg/dl | Subjects with Hypoglycemia <70 mg/dl | Inpatient (average 5 days) and outpatient up to 12 weeks |
| Hyperglycemia | Subjects with BG > 300 mg/dl |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Guillermo E Umpierrez, MD | Emory University SOM | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Colorado | Denver | Colorado | 80220 | United States | ||
| Emory University Hospital |
Of the 295 subjects consented, there were 15 screen failures. 30 (out of remaining 280 patients) were excluded from participation: 11 patients stayed <24 hours, 1 patient received corticosteroids, and 18 patients didn't receive medication. Therefore, 250 patients started the study.
Participants were recruited between February 2014 and October 2016. Patients who participated in the in-hospital study period were invited to enroll in the prospective outpatient study. Of 250 in-patient participants, 224 accepted enrollment into outpatient study.
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| ID | Title | Description |
|---|---|---|
| FG000 | Linagliptin In-hospital | Linagliptin once daily + correction doses of aspart or lispro if needed. Linagliptin: Linagliptin once daily + correction doses of rapid acting insulin if needed |
| FG001 | Basal Bolus In-hospital | Glargine once daily and rapid-acting insulin before meals + correction doses of aspart or lispro if needed Basal Bolus: Basal bolus regimen with glargine once daily and rapid-acting insulin (lispro or aspart) before meals + + correction doses of rapid acting insulin if needed |
| FG002 | Linagliptin on Discharge | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day. If contraindication to oral anti-diabetics (OAD), discharge patient on linagliptin once daily. Linagliptin: Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day for 3 months. |
| FG003 | Linagliptin+50%Glargine Dose on d/c | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 50% Glargine dose on discharge: Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose for 3 months. |
| FG004 | Linagliptin+80%Glargine Dose on d/c | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 80% Glargine: Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose for 3 months. |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| In-hospital |
| |||||||||||||
| On Discharge |
|
Participants are represented for the two stages of the study (in-hospital and discharge), and are counted more than once in the Total.
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| ID | Title | Description |
|---|---|---|
| BG000 | Linagliptin In-hospital | Linagliptin once daily+ correction doses of aspart or lispro if needed Linagliptin: Linagliptin once daily + correction doses of rapid acting insulin if needed |
| BG001 | Basal Bolus In-hospital |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Differences in Glycemic Control | Determine differences in glycemic control as measured by mean daily BG concentration between linagliptin alone and basal bolus therapy group. | Posted | Mean | Standard Deviation | mg/dl | Inpatient (average 5 days) and outpatient up to 12 weeks |
|
13 weeks (average 5 days in hospital and 12 weeks after discharge)
Adverse Events were monitored/assessed without regard to the specific Adverse Event Term
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Linagliptin In-hospital | Linagliptin once daily + correction doses of aspart or lispro if needed. Linagliptin: Linagliptin once daily + correction doses of rapid acting insulin if needed |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| ICU admission | Metabolism and nutrition disorders | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Gastrointestinal | Gastrointestinal disorders | Non-systematic Assessment |
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Priyathama Vellanki | Emory University | 404-778-1665 | priyathama.vellanki@emory.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jul 19, 2016 | May 2, 2018 | Prot_SAP_000.pdf |
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| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
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| ID | Term |
|---|---|
| D000069476 | Linagliptin |
| D000069036 | Insulin Glargine |
| D061267 | Insulin Aspart |
| D061268 | Insulin Lispro |
| ID | Term |
|---|---|
| D011687 | Purines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
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|
| Basal Bolus | Drug | Basal bolus regimen with glargine once daily and rapid-acting insulin (lispro or aspart) before meals + + correction doses of rapid acting insulin if needed |
|
|
| Linagliptin | Drug | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day for 3 months. |
|
|
| Linagliptin + 50% Glargine dose on discharge | Drug | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose for 3 months. |
|
|
| Linagliptin + 80% Glargine | Drug | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose for 3 months. |
|
|
| Inpatient (average 5 days) and outpatient up to 12 weeks |
| Daily Dose of Insulin | Total daily dose of insulin | Inpatient (average 5 days) and outpatient up to 12 weeks |
| Length of Hospital Stay | Length of hospital stay (ONLY for inpatient arms 1 and 2) | During Hospitalization |
| Number of Participants Requiring ICU Care During Hospitalization | Need for intensive care unit (ICU) care (transfer to ICU) during hospitalization | During Hospitalization-average 5 days |
| Hospital Complications | Subjects with composite complication (ONLY for inpatient arms 1 and 2) | During Hospitalization-average 5 days |
| Acute Renal Failure During Hospitalization | Subjects with Acute renal failure (ONLY for inpatient arms 1 and 2) | During Hospitalization-average 5 days |
| Hospital Mortality | Hospital mortality (ONLY in-patient). Mortality is defined as death occurring during hospital stay. | During Hospitalization-average 5 days |
| Fasting BG Concentration | Average - per hospital stay - fasting BG concentration (for in-hospital groups), and average - per outpatient follow-up period - fasting BG concentration (for discharge groups) | During Hospitalization (average 5 days) and outpatient up to 12 weeks |
| Subjects With Wound and Other Infections | Subjects with wound and other infections. | During Hospitalization and outpatient up to 12 weeks |
| HbA1c Level | HbA1c level at admission (for in-patient arms) and HbA1c level at 12-week follow-up outpatient visit (for discharge arms). | Admission to the hospital and 12-week follow-up outpatient visit |
| Hypoglycemia < 40 mg/dl | Subjects with Hypoglycemia < 40 mg/dl | Inpatient and up to 12 weeks outpatient |
| Emergency Room Visits | Number of ER visits ONLY for outpatient arms 3,4, and 5. | 3 months after discharge |
| Subjects With Surgical Reinterventions | Subjects with surgical re-interventions. | Inpatient and up to 12 weeks outpatient |
| Outpatient Mortality | Deaths among patients after hospital discharge. | 3 months after discharge |
| Atlanta |
| Georgia |
| 30322 |
| United States |
| Grady Memorial Hospital | Atlanta | Georgia | United States |
| Rush University Medical Center | Chicago | Illinois | 60612 | United States |
| Boston Medical Center | Boston | Massachusetts | 02118 | United States |
| COMPLETED |
|
| NOT COMPLETED |
|
Glargine once daily and rapid-acting insulin before meals + correction doses of aspart or lispro if needed
Basal Bolus: Basal bolus regimen with glargine once daily and rapid-acting insulin (lispro or aspart) before meals + + correction doses of rapid acting insulin if needed
| BG002 | Linagliptin on Discharge | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day. If contraindication to oral anti-diabetics (OAD), discharge patient on linagliptin once daily. Linagliptin: Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day for 3 months. |
| BG003 | Linagliptin+50%Glargine Dose on d/c | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 50% Glargine dose on discharge: Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose for 3 months. |
| BG004 | Linagliptin+80%Glargine Dose on d/c | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 80% Glargine: Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose for 3 months. |
| BG005 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
| OG002 | Linagliptin on Discharge | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day. If contraindication to oral anti-diabetics (OAD), discharge patient on linagliptin once daily. Linagliptin: Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day for 3 months. |
| OG003 | Linagliptin+50%Glargine Dose on d/c | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 50% Glargine dose on discharge: Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose for 3 months. |
| OG004 | Linagliptin+80%Glargine Dose on d/c | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 80% Glargine: Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose for 3 months. |
|
|
| Secondary | Hypoglycemia <70 mg/dl | Subjects with Hypoglycemia <70 mg/dl | Posted | Count of Participants | Participants | Inpatient (average 5 days) and outpatient up to 12 weeks |
|
|
|
| Secondary | Hyperglycemia | Subjects with BG > 300 mg/dl | Posted | Count of Participants | Participants | Inpatient (average 5 days) and outpatient up to 12 weeks |
|
|
|
| Secondary | Daily Dose of Insulin | Total daily dose of insulin | Posted | Mean | Standard Deviation | units/kg/day | Inpatient (average 5 days) and outpatient up to 12 weeks |
|
|
|
| Secondary | Length of Hospital Stay | Length of hospital stay (ONLY for inpatient arms 1 and 2) | Length of hospital stay is applicable ONLY for inpatient arms (1 and 2) | Posted | Median | Inter-Quartile Range | Days | During Hospitalization |
|
|
|
| Secondary | Number of Participants Requiring ICU Care During Hospitalization | Need for intensive care unit (ICU) care (transfer to ICU) during hospitalization | Transfer to ICU is applicable ONLY for inpatient arms (1 and 2) | Posted | Count of Participants | Participants | During Hospitalization-average 5 days |
|
|
|
| Secondary | Hospital Complications | Subjects with composite complication (ONLY for inpatient arms 1 and 2) | Composite complication during hospitalization is applicable ONLY for inpatient arms (1 and 2) | Posted | Count of Participants | Participants | During Hospitalization-average 5 days |
|
|
|
| Secondary | Acute Renal Failure During Hospitalization | Subjects with Acute renal failure (ONLY for inpatient arms 1 and 2) | Acute renal failure during hospitalization is applicable ONLY for inpatient arms (1 and 2) | Posted | Count of Participants | Participants | During Hospitalization-average 5 days |
|
|
|
| Secondary | Hospital Mortality | Hospital mortality (ONLY in-patient). Mortality is defined as death occurring during hospital stay. | Hospital mortality is applicable ONLY for inpatients arms (1 and 2) | Posted | Count of Participants | Participants | During Hospitalization-average 5 days |
|
|
|
| Secondary | Fasting BG Concentration | Average - per hospital stay - fasting BG concentration (for in-hospital groups), and average - per outpatient follow-up period - fasting BG concentration (for discharge groups) | Posted | Mean | Standard Deviation | mg/dl | During Hospitalization (average 5 days) and outpatient up to 12 weeks |
|
|
|
| Secondary | Subjects With Wound and Other Infections | Subjects with wound and other infections. | Posted | Count of Participants | Participants | During Hospitalization and outpatient up to 12 weeks |
|
|
|
| Secondary | HbA1c Level | HbA1c level at admission (for in-patient arms) and HbA1c level at 12-week follow-up outpatient visit (for discharge arms). | Posted | Mean | Standard Deviation | % DCCT | Admission to the hospital and 12-week follow-up outpatient visit |
|
|
|
| Secondary | Hypoglycemia < 40 mg/dl | Subjects with Hypoglycemia < 40 mg/dl | Posted | Count of Participants | Participants | Inpatient and up to 12 weeks outpatient |
|
|
|
| Secondary | Emergency Room Visits | Number of ER visits ONLY for outpatient arms 3,4, and 5. | Emergency visits reported only for outpatient time. Inpatient (hospital) patients cannot have ER visits | Posted | Number | Visits | 3 months after discharge |
|
|
|
| Secondary | Subjects With Surgical Reinterventions | Subjects with surgical re-interventions. | Posted | Count of Participants | Participants | Inpatient and up to 12 weeks outpatient |
|
|
|
| Secondary | Outpatient Mortality | Deaths among patients after hospital discharge. | Deaths after hospital discharge are applicable ONLY for outpatient arms (3, 4 and 5). | Posted | Count of Participants | Participants | 3 months after discharge |
|
|
|
| 0 |
| 128 |
| 1 |
| 128 |
| 25 |
| 128 |
| EG001 | Basal Bolus In-hospital | Glargine once daily and rapid-acting insulin before meals + correction doses of aspart or lispro if needed Basal Bolus: Basal bolus regimen with glargine once daily and rapid-acting insulin (lispro or aspart) before meals + + correction doses of rapid acting insulin if needed | 0 | 122 | 0 | 122 | 15 | 122 |
| EG002 | Linagliptin on Discharge | Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day. If contraindication to oral anti-diabetics (OAD), discharge patient on linagliptin once daily. Linagliptin: Patients with admission A1C < 7% will be discharged on same pharmacologic regimen (oral agents, insulin therapy) or linagliptin 5 mg/day for 3 months. | 0 | 92 | 12 | 92 | 3 | 92 |
| EG003 | Linagliptin+50%Glargine Dose on d/c | Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 50% Glargine dose on discharge: Patients with admission HbA1c between 7% and 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 50% of daily hospital dose for 3 months. | 0 | 93 | 14 | 93 | 1 | 93 |
| EG004 | Linagliptin+80%Glargine Dose on d/c | Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose. Patient who did not receive glargine in the hospital, discharge on previous OAD + linagliptin once daily, and consider starting glargine at 0.15 unit/kg/day. Linagliptin + 80% Glargine: Patients with admission HbA1c ≥ 9% will be discharged on previous oral anti-diabetic agents plus linagliptin, and consider glargine insulin at 80% of daily hospital dose for 3 months. | 0 | 39 | 9 | 39 | 0 | 39 |
| Pulmonary | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Resurgery | Surgical and medical procedures | Non-systematic Assessment |
|
| Infection | Infections and infestations | Non-systematic Assessment |
|
| Gastrointestinal | Gastrointestinal disorders | Non-systematic Assessment |
|
| Genitourinary | Renal and urinary disorders | Non-systematic Assessment |
|
| Metabolic | Metabolism and nutrition disorders | Non-systematic Assessment |
|
| Musculoskeletal | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Hematologic | Blood and lymphatic system disorders | Non-systematic Assessment |
|
| Pulmonary | Respiratory, thoracic and mediastinal disorders | Non-systematic Assessment |
|
| Skin | Skin and subcutaneous tissue disorders | Non-systematic Assessment |
|
| Musculoskeletal | Musculoskeletal and connective tissue disorders | Non-systematic Assessment |
|
| Surgical Reintervention | Surgical and medical procedures | Non-systematic Assessment |
|
| Renal | Renal and urinary disorders | Non-systematic Assessment |
|
| Infections | Infections and infestations | Non-systematic Assessment |
|
Not provided
Not provided
| D011799 | Quinazolines |
| D049528 | Insulin, Long-Acting |
| D061385 | Insulins |
| D010187 | Pancreatic Hormones |
| D036361 | Peptide Hormones |
| D006728 | Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D061266 | Insulin, Short-Acting |
| Male |
|