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The GLITTER Study 2 is a cluster randomized trial that will evaluate the impact of comprehensive and intensive management, comprising a team, technology, education, and peer resources, on metabolic control and psychological outcomes in patients with type 1 diabetes.
Type 1 diabetes (T1D) is a lifelong metabolic disease with an increasing disease burden. Despite continuous advancements in diagnostic and treatment technologies, patients of all age groups fail to meet the glycemic targets. Currently, there is a common deficiency in the management of T1D both domestically and internationally, which is specifically manifested as: the disconnection between blood glucose monitoring and insulin adjustment, low utilization rate of new technologies, insufficient patient self-management training, and the absence of psychological intervention, etc.
This GLITTER Study 2 extends the GLITTER Study (Glycemic Improvement with Team, Technology, Education and Peer Resources in type 1 diabetes) by implementing its philosophy (Team, Technology, Education, Peer Resources) to develop a comprehensive T1D management model, integrating these components to enhance management and evaluate effectiveness.
This multicentre, cluster-randomized controlled trial will be conducted across 10 hospitals. It aims to enroll patients with T1D aged ≥6 years who have had the disease for >3 months. Five hospitals were randomly assigned to the comprehensive management intervention group, and five to the usual care group. A total of 400 individuals were recruited into the study. The intervention for the intervention group includes: T1D team (dedicated T1D physicians, certified diabetes educators, registered dietitians), centralized structured education (courses, short videos, and structured educational materials), peer support (volunteer matching, camp, volunteer peer live streaming), and diabetes technologies (insulin pumps and continuous glucose monitoring). The control group received usual care, with the five assigned hospitals continuing their clinical practice. This 52-week trial includes assessments at the following timepoints: screening, week 13 (visit 2), week 26 (visit 3), week 39 (visit 4), and week 52 (visit 5). Throughout the study period, we will evaluate the model's impact on glycemic control and psychosocial outcomes, aiming to establish an evidence-based clinical practice paradigm for T1D management.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Patients with T1D in the intervention group will undergo comprehensive management. |
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| Control group | Other | Patients with T1D in the control group will receive routine management. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| T1D team, structured education, peer support , and diabetes technologies | Behavioral | Patients with T1D will use insulin pumps and CGM , while undergoing structured education courses under the management of a specialized T1D team and engaging in peer support activities. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in HbA1c | The primary outcome is the Change in Glycated Hemoglobin A1C (HbA1c) before and after the 52 weeks intervention. HbA1c is a physiological marker of the percentage of red blood cells that have glycated (bonded with a sugar). HbA1c is used to measure changes in average blood sugar over the past three months. | Baseline, 13, 26, and 52 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Percentage of patients in each group with HbA1c <7.0% | HbA1c serves as a crucial physiological marker for assessing average blood sugar levels over the preceding three months. Values below 7.0 are deemed optimal for long-term health. Consequently, a higher number or percentage of individuals achieving an HbA1c level below 7.0 is indicative of a positive outcome, reflecting better glycemic control and reduced risk of complications. |
| Measure | Description | Time Frame |
|---|---|---|
| Severe hypoglycemic episodes | Frequency of severe hypoglycemic episodes | 52 weeks intervention period |
| Diabetes ketoacidosis | Frequency of diabetes ketoacidosis |
Eligibility criteria for study hospitals:
Eligibility criteria of study participants:
Exclusion Criteria of study participants:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Xia Li | Contact | +86 13974885753 | lixia2014@vip.163.com |
| Name | Affiliation | Role |
|---|---|---|
| Xia Li, MD, PhD | Second Xiangya Hospital of Central South University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Endocrinology and Metabolism, Peking University People's Hospital | Not yet recruiting | Beijing | Beijing Municipality | China |
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| Routine Management | Behavioral | Patients with T1D will be managed according to the routine diagnosis and education model of each hospital. |
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| 52 weeks |
| Percentage of patients in each group with HbA1c <7.5% | HbA1c serves as a crucial physiological marker for assessing average blood sugar levels over the preceding three months. Values below 7.5 are deemed optimal for long-term health. Consequently, a higher number or percentage of individuals achieving an HbA1c level below 7.5 is indicative of a positive outcome, reflecting better glycemic control and reduced risk of complications. | 52 weeks |
| CGM-measured Percentage Time 70-180 mg/dL (3.9-10.0 mmol/L) | The CGM-measured percentage time 70-180 mg/dL (3.9-10.0 mmol/L) refers to the proportion of time during which an individual's blood glucose levels, as continuously monitored by a CGM device. This metric is crucial for assessing glycemic control in individuals with diabetes. Maintaining blood glucose within this target range is associated with better health outcomes and reduced risk of complications. | Baseline, 13, 26, and 52 weeks |
| CGM-measured Percentage Time >180 mg/dL (>10.0 mmol/L) | Smaller percentages of CGM-measured time above 180 mg/dL is considered a positive outcome. | Baseline, 13, 26, and 52 weeks |
| CGM-measured Percentage Time >250 mg/dL (>13.9 mmol/L) | CGM measured blood sugar values above 250 mg/dL are considered to be undesirable. Thus, less time spent above 250mg/dL is considered a positive outcome. | Baseline, 13, 26, and 52 weeks |
| CGM-Measured Percentage Time <70 mg/dL (<3.9 mmol/L) | Blood sugar values measured by CGM that fall below 70 mg/dL are considered potentially hazardous, as they may lead to unconsciousness and, in severe cases, even death. Therefore, minimizing the time spent below 70 mg/dL is regarded as a highly positive outcome, reflecting better management of low blood sugar episodes and enhanced safety for the individual. | Baseline, 13, 26, and 52 weeks |
| CGM-Measured Percentage Time <60 mg/dL (<3.3 mmol/L) | Blood sugar values measured by CGM that fall below 60 mg/dL are considered potentially hazardous, as they may lead to unconsciousness and, in severe cases, even death. Therefore, minimizing the time spent below 60 mg/dL is regarded as a highly positive outcome, reflecting better management of low blood sugar episodes and enhanced safety for the individual. | Baseline, 13, 26, and 52 weeks |
| CGM-measured Glucose Standard Deviation (SD) | Standard Deviation represents how much glucose levels fluctuate over time from a given average. | Baseline, 13, 26, and 52 weeks |
| CGM-Measured Glucose Coefficient of Variation | The Coefficient of Variability (CV) is calculated as the ratio of the standard deviation to the mean of blood sugar values for each participant, as measured by CGM. The reported CV value is derived by multiplying the ratio of the standard deviation to the mean by 100, providing a percentage that reflects the degree of variability in blood sugar levels across the population. A higher CV value, which can range up to 100, signifies greater dispersion of CGM values, indicating more significant fluctuations in blood sugar levels. This increased variability is generally considered an unfavorable outcome, as it may suggest less stable glucose control. Conversely, the minimum CV value is 0, which would indicate no variability in blood sugar levels, representing perfect stability. | Baseline, 13, 26, and 52 weeks |
| CGM-Measured Glucose Risk Index (GRI) | The CGM-Measured Glucose Risk Index (GRI) is a comprehensive metric derived from CGM data, designed to quantify the overall risk associated with blood glucose variability. It integrates multiple aspects of glucose levels, including the frequency and severity of both hypo- and hyperglycemic events, as well as the duration of time spent outside the target glucose range. A lower GRI score indicates better glucose stability and lower risk of adverse outcomes related to blood sugar fluctuations. | Baseline, 13, 26, and 52 weeks |
| Self-Management of Type 1 Diabetes for Chinese Adults | The Self-Management of Type 1 Diabetes for Chinese Adults (SMOD-CA) scale is a validated instrument specifically designed to assess the self-management behaviors and capabilities of adults with type 1 diabetes in the Chinese population. The SMOD-CA consists of 30 items. Responses are rated on a five-point scale, with higher scores indicating better self-management ability. The total score ranges from 0 to 120. | Baseline and 52 weeks |
| 23-item Chinese Version of Self-Report Measure of Self-Management of Type 1 Diabetes for Adolescents | The 23-item Chinese Version of Self-Report Measure of Self-Management of Type 1 Diabetes for Adolescents (C-SMOD-A-23) is a validated and simplified instrument designed to assess the self-management behaviors and capabilities of adolescents with type 1 diabetes. | Baseline and 52 weeks |
| Assessment of sleep quality: Pittsburgh Sleep Quality Index | Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire comprising seven component scores (subjective sleep quality, sleep latency, duration of sleep, sleep efficiency habits, sleep disturbances, use of sleeping medication, and daytime dysfunction), is used to evaluate sleep quality over the last month. | Baseline and 52 weeks |
| Hypoglycemic Fear Scale | The Hypoglycemic Fear Scale is a widely used and validated assessment tool designed to measure the level of fear and anxiety that individuals with diabetes, particularly those with type 1 diabetes, experience in relation to hypoglycemia (low blood sugar). | Baseline and 52 weeks |
| Diabetes Technology Attitude Scale | The Diabetes Technology Attitude Scale is a specialized assessment tool designed to evaluate individuals' attitudes toward diabetes-related technologies. Tool lists statement and participants reports how much they agree with the statement. | Baseline and 52 weeks |
| Barriers to Technology | The Barriers to Technology Questionnaire typically consists of several key sections, each designed to capture different aspects of technology adoption and use. | Baseline and 52 weeks |
| Diabetes Treatment Satisfaction Questionnaire | The Diabetes Treatment Satisfaction Questionnaire (DTSQ) is a comprehensive and widely utilized tool designed to assess the level of satisfaction that individuals with diabetes have with their current treatment regimens. The DTSQ is usually administered as a self-report questionnaire, allowing patients to rate their responses on a Likert scale, typically ranging from "very dissatisfied" to "very satisfied." The total score is calculated by summing the responses to all relevant items, with higher scores indicating greater satisfaction with the treatment. | Baseline and 52 weeks |
| Diagnosis and measurement of the severity of depression: Patient Health Questionnaire | The Patient Health Questionnaire (PHQ-9) will be used to assess depressive symptoms, including suicidal ideation, over the last two weeks (9 questions). Items are scored 0-3, resulting in a total score of 0-27. Higher scores indicate more symptoms of depression. | Baseline and 52 weeks |
| Depression Self-Rating Scale for Children | The Depression Self-Rating Scale for Children (DSRSC) is a standardized psychological assessment tool designed to measure depressive symptoms in children and adolescents. This self-report inventory allows young individuals to rate the frequency and severity of various depressive feelings and behaviors they may be experiencing. | Baseline and 52 weeks |
| Generalized Anxiety Disorder 7-item scale | The Generalized Anxiety Disorder 7-item scale (GAD-7) consists of seven items. Each item asks respondents to rate how often they have been bothered by specific anxiety-related symptoms over the past two weeks. | Baseline and 52 weeks |
| WHO-5 Well-Being Index | The WHO-5 Well-Being Index (WHO-5) is a brief, self-report questionnaire designed to assess subjective well-being. The WHO-5 consists of five simple and straightforward items. Each item is rated on a 6-point Likert scale, ranging from 0 (not present) to 5 (constantly present). The total score is calculated by summing the responses to all five items, resulting in a score that ranges from 0 to 25. Higher scores indicate better well-being. | Baseline and 52 weeks |
| Evaluation of the perception of hypoglycemia in the population tested with Clarke score | Clarke Hypoglycemia Awareness Scores (0-7 score with higher scores associated with impaired awareness). | Baseline and 52 weeks |
| Evaluation of the perception of hypoglycemia in the population tested with Gold score | The Gold method is used to assess impaired awareness of hypoglycemia. The scale is from 1 to 7. A score of 4 or more indicates impaired awareness of hypoglycemia. | Baseline and 52 weeks |
| 52 weeks intervention period |
| Serious Adverse Events | Number, nature and severity of serious adverse events | 52 weeks intervention period |
| Department of Endocrinology, Quanzhou First Hospital Affiliated to Fujian Medical University | Not yet recruiting | Quanzhou | Fujian | China |
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| Department of Endocrinology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University | Not yet recruiting | Shenzhen | Guangdong | China |
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| Second Department of Endocrinology and Metabolism, Tangshan Gongren Hospital | Not yet recruiting | Tangshan | Hebei | China |
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| Endocrinology and Metabolism Center, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology | Recruiting | Luoyang | Henan | 471003 | China |
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| Department of Endocrinology, Zhongnan Hospital of Wuhan University | Not yet recruiting | Wuhan | Hubei | China |
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| Institute of Metabolism and Endocrinology, Second Xiangya Hospital of Centra South University | Recruiting | Changsha | Hunan | 410011 | China |
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| Department of Endocrinology and Metabolism, Institute of Endocrinology, The First Affiliated Hospital of China Medical University | Not yet recruiting | Shenyang | Liaoning | China |
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| Department of Endocrinology and Metabolism, Laboratory of Diabetes and metabolism research, West China Hospital, Sichuan University | Not yet recruiting | Chengdu | Sichuan | China |
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| Department of Endocrinology, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health | Not yet recruiting | Hangzhou | Zhejiang | China |
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| ID | Term |
|---|---|
| D003922 | Diabetes Mellitus, Type 1 |
| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
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