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Type 2 diabetes mellitus (T2DM) is characterized by wide fluctuations of glucose. The long-acting insulin has showed to improve glycemic variability however the behavior of insulin glargine versus insulin degludec is unknown.
Cross-over, double dummy, randomized, clinical trial was carried out. The sample size was calculated using the formula for clinical trials of mean differences with an "n" of 6 patients per group was obtained. Patients between 30 and 65 years of age will be included with T2DM, without hyperglycemic drugs, hemoglobin A1c (A1C) 6.5 to 11.0 % and with written signature consent. They were assigned randomly by sealed envelope either to received insulin Degludec (Novo Nordisk A/S. Bagsvaerd, Denmark) or insulin Glargine (Sanofi-Aventis Deutschland GmbH. Frankfurt, Germany) [10 international units (IU) subcutaneous (SC) every 24 hours for six days], patients who were administered initially insulin Degludec corresponded then insulin Glargine and vice versa, with a washout period of 14 days between each intervention.
The clinical findings and laboratory tests included a metabolic profile and biosafety, which will be made at baseline. Body weight, body mass index and blood pressure were performed during the initial visit, likewise, interstitial glucose concentrations by ambulatory continuous glucose monitoring system (Guardian®, Medtronic MiniMed, Northridge), through which the mean amplitude of glucose excursions (MAGE) and area under the curve of glucose were calculated, which served to assess the glycemic variability. Adverse events and adherence to treatment are documented. Statistical analysis: Mann-Whitney U test, Chi2, Fisher exact test. It is considered with significance at p <0.05.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Insulin Degludec - Insulin Glargine | Active Comparator | Insulin Degludec 10 IU SC every 24 hours for 6 days Washout for 14 days Insulin Glargine 10 IU SC every 24 hours for 6 days |
|
| Insulin Glargine - Insulin Degludec | Active Comparator | Insulin Glargine 10 IU SC every 24 hours for 6 days Washout for 14 days Insulin Degludec 10 IU SC every 24 hours for 6 days |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Insulin Degludec | Drug | Insulin Degludec 10 IU SC every 24 hours for 6 days |
|
| Measure | Description | Time Frame |
|---|---|---|
| Glycemic Variability: Mean Amplitude of Glucose Excursion (MAGE) | Mean amplitude of interstitial glucose excursions (MAGE) during the last 48 h of the ambulatory continuous glucose monitoring of 3 days (Guardian®, Medtronic MiniMed, Northridge); starting in the day 3 of the administration of insulin degludec or glargine | 2 days |
| Measure | Description | Time Frame |
|---|---|---|
| Glycemic Variability: Area Under the Curve of Glucose | Area under the curve of glucose of the second day of continuous ambulatory glucose monitoring of 3 days (Guardian®, Medtronic MiniMed, Northridge) | Every 5 min for 24 hours on day 5 post-dose |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| MANUEL GONZALEZ, PhD | University of Guadalajara | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Instituto de Terapeútica Experimental y Clínica. Centro Universitario de Ciencias de la Salud. Universidad de Guadalajara | Guadalajara | Jalisco | 44340 | Mexico |
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Total number of patients: 12 in a crossover intervention. Interventions: 2. Washout period before the cross-over intervention. Protocol violations were detected at the end of the study in patients of both groups
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| ID | Title | Description |
|---|---|---|
| FG000 | Insulin Degludec - Insulin Glargine | Insulin Degludec: 10 IU subcutaneous (SC) every 24 hours for 6 days Washout period for 14 days Insulin Glargine 10 IU SC every 24 hours for 6 days |
| FG001 | Insulin Glargine - Insulin Degludec | Insulin Glargine: 10 IU subcutaneous (SC) every 24 hours for 6 days Washout period for 14 days Insulin Degludec 10 IU SC every 24 hours for 6 days |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Initial Intervention |
| |||||||||||||
| Washout Period |
| |||||||||||||
| Cross-over Intervention |
|
Characteristics of the entire group
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| ID | Title | Description |
|---|---|---|
| BG000 | Insulin Total Group | Total Group of Patients with Type 2 Diabetes mellitus |
| 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 | Glycemic Variability: Mean Amplitude of Glucose Excursion (MAGE) | Mean amplitude of interstitial glucose excursions (MAGE) during the last 48 h of the ambulatory continuous glucose monitoring of 3 days (Guardian®, Medtronic MiniMed, Northridge); starting in the day 3 of the administration of insulin degludec or glargine | Comparison between both interventions. There are not baseline values of this measurements due to a design error. There were technical problems with the measurements. | Posted | Mean | Standard Deviation | mg/dl | 2 days |
|
From the beginning of the study until a month after the end of the intervention for each patient, an average of 2 months
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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 | Insulin Degludec | Patients with Type 2 Diabetes mellitus Insulin Degludec: 10 IU SC every 24 hours for 6 days |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Headache | Nervous system disorders | Systematic Assessment |
There were technical problems with the measurement of the outcomes. Design errors and protocol violations were detected at the end of the study. Therefore, the results are considered unreliable.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Manuel González Ortiz | Instituto de Terapéutica Experimental y Clínica, Universidad de Guadalajara | +52 3310585200 | 34212 | uiec@prodigy.net.mx |
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| ID | Term |
|---|---|
| D003924 | Diabetes Mellitus, Type 2 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| C571886 | insulin degludec |
| D000069036 | Insulin Glargine |
| ID | Term |
|---|---|
| D049528 | Insulin, Long-Acting |
| D061385 | Insulins |
| D010187 | Pancreatic Hormones |
| D036361 | Peptide Hormones |
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| Insulin Glargine | Drug | Insulin Glargine 10 IU SC every 24 hours for 6 days |
|
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| NOT COMPLETED |
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| NOT COMPLETED |
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| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Weight | Mean | Standard Deviation | kg |
|
| Body Mass Index | Mean | Standard Deviation | kg/m^2 |
|
| Systolic Blood Pressure | Mean | Standard Deviation | mmHg |
|
| Diastolic Blood Pressure | Mean | Standard Deviation | mmHg |
|
| Hemoglobin A1c | Mean | Standard Deviation | % of Hemoglobin A1c |
|
| Fasting Plasma Glucose | Mean | Standard Deviation | mg/dl |
|
| Uric Acid | Mean | Standard Deviation | mg/dl |
|
| Creatinine | Mean | Standard Deviation | mg/dl |
|
| Total Cholesterol | Mean | Standard Deviation | mg/dl |
|
| High-density lipoprotein-cholesterol (HDL-C) | Mean | Standard Deviation | mg/dl |
|
| Low-density lipoprotein-cholesterol (LDL-C) | Mean | Standard Deviation | mg/dl |
|
| Triglycerides | Mean | Standard Deviation | mg/dl |
|
| Aspartate aminotransferase (AST) | Mean | Standard Deviation | mg/dl |
|
| Alanine aminotransferase (ALT) | Mean | Standard Deviation | mg/dl |
|
Patients who received: Insulin Glargine: 10 IU SC every 24 hours for 6 days, from both arms of the study |
|
|
|
| Secondary | Glycemic Variability: Area Under the Curve of Glucose | Area under the curve of glucose of the second day of continuous ambulatory glucose monitoring of 3 days (Guardian®, Medtronic MiniMed, Northridge) | Area Under the Curve of Glucose in a patient (Insulin Degludec group) could not be calculated. There are not baseline values of this measurements due to a design error. There were technical problems with the measurements. | Posted | Mean | Standard Deviation | mg*h/dL | Every 5 min for 24 hours on day 5 post-dose |
|
|
|
|
| 0 |
| 12 |
| 0 |
| 12 |
| 6 |
| 12 |
| EG001 | Insulin Glargine | Patients with Type 2 Diabetes mellitus Insulin Glargine: 10 IU SC every 24 hours for 6 days | 0 | 12 | 0 | 12 | 9 | 12 |
| Lower limb paresthesias | Nervous system disorders | Systematic Assessment |
|
| Flatulence | Gastrointestinal disorders | Systematic Assessment |
|
| Mild hypoglycemia | Endocrine disorders | Systematic Assessment |
|
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| D004700 | Endocrine System Diseases |
| D006728 |
| Hormones |
| D006730 | Hormones, Hormone Substitutes, and Hormone Antagonists |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |