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Flash Glucose Monitoring in Reduction of Hypoglycaemia in Diabetic Patients With Chronic Kidney Disease

Primary Purpose

Diabetes With Diabetic Chronic Kidney Disease (Diagnosis)

Status
Unknown status
Phase
Not Applicable
Locations
Hong Kong
Study Type
Interventional
Intervention
Abbott FreeStyle Libre
Patient Own SMBG
Sponsored by
Chinese University of Hong Kong
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional diagnostic trial for Diabetes With Diabetic Chronic Kidney Disease (Diagnosis)

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Type I or II diabetes mellitus diagnosed for at least 6 months
  2. Male or female age ≥ 18 years old and ≤ 75 years old.
  3. Women who are not pregnant, lactating or planning a pregnancy during their participation in the clinical study.
  4. Patients with CKD stage 3b, 4 or 5 as defined by estimated glomerular filtration rate less than 45ml/min/m2
  5. History of at least 1 episode of non-severe or severe hypoglycaemia in the 12 months prior to screening
  6. Willingness, ability and commitment to comply with the testing, procedure and follow-up outlined in this protocol including (but not limited to) and use of pre-specified glucose monitoring devices.
  7. Willingness to perform SMBG during the study period
  8. In the opinion of the investigator, absence of any physical limitations, addictive diseases, or underlying medical conditions (including mental health) that may preclude the patient from being a suitable study candidate.
  9. Written informed consent to participate in the study provided by the patient.
  10. Willing and capable of use of a flash glucose monitor as judged by the investigator

Exclusion Criteria:

  1. HbA1C >8.5% at screening
  2. Currently pregnant, as demonstrated by a positive pregnancy test at screening or planning pregnancy. Women of childbearing potential will also be asked to adopt adequate contraceptive measures throughout the study period, and to notify the study staff immediately if discovered pregnant. Participants who are unwilling to comply with these measures will be excluded.
  3. Any active acute or chronic disease or condition that, in the opinion of the investigator, might interfere with the performance of this study.
  4. Any active acute or chronic infectious disease that, in the opinion of the investigator, would pose an excessive risk to study staff.
  5. Current use or recent exposure to any medication that in the opinion of the investigator could have an influence on the patient's ability to participate in this study or on the performance of the test device.
  6. Extensive skin changes/diseases that preclude wearing the FGM on normal skin at the proposed application sites (e.g., extensive psoriasis, recent burns or severe sunburn, extensive eczema, extensive scarring, extensive tattoos, dermatitis herpetiformis).
  7. Have a known allergy to medical-grade adhesives
  8. Known current or recent alcohol or drug abuse
  9. Diabetic ketoacidosis, hyperosmolar hyperglycaemic state or myocardial infarction in the six months prior to screening
  10. Patients on renal replacement therapy
  11. Currently participating in another investigational study protocol where the testing or results may interfere with study compliance, diagnostic results, or data collection.
  12. An identified protected vulnerable patient (including but not limited to those in detention, or a prisoner).

Sites / Locations

  • Prince of Wales HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

SMBG

Flash CGMS

Arm Description

Patients use their own glucometers as control

Outcomes

Primary Outcome Measures

Difference in time in hypoglycaemia
Compare the difference in time in hypoglycaemia (<3.9mmol/l) on blinded CGM between intervention and control groups

Secondary Outcome Measures

CGM indices
Time-in-range (4-10mmol/l), time-in-hyperglycaemia (>10mmol), low blood glucose index, glycaemic variability (coefficient of variation). These CGM indices are defined in accordance with the latest International Consensus on Use of CGM
Glycated haemoglobin
Change in HbA1c
Incidence of hypoglycaemia
Numbers of hypoglycaemic episode reported by study subjects
Patient compliance to Flash CGMS
Frequency of sensor scans and time duration of sensor wear
Change in Diabetic treatment
Physician directed change in diabetes treatment (including insulin dosage)
Patient quality-of-life
Measures by questionnaire: Diabetes Distress Scale (DDS; total score from 17-102), comprising 3 subscales namely emotional, physician, regimen / social support. A lower score indicates better outcome.
Hypoglycaemia awareness
Measure by questionnaire: Gold Score Hypoglycaemia awareness (Total 7 grading, lowest score indicates better outcome)
Treatment satisfaction
Measured by questionnaire: IDTSQs (Total 8 questions with total score 0-48, highest score indicates better outcome)
Fear of hypoglycaemia
Measured by questionnaire: Hypoglycemia Fear Survey II (comprising 2 subscales namely behaviour (15 items) and worry (18 items). Each item has 5 categorical selection from "never" to "always".

Full Information

First Posted
June 25, 2019
Last Updated
January 19, 2021
Sponsor
Chinese University of Hong Kong
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1. Study Identification

Unique Protocol Identification Number
NCT04016155
Brief Title
Flash Glucose Monitoring in Reduction of Hypoglycaemia in Diabetic Patients With Chronic Kidney Disease
Official Title
Randomised Controlled Trial of Flash Glucose Monitoring in Reduction of Hypoglycaemia in Diabetes Patients With Chronic Kidney Disease
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
July 17, 2019 (Actual)
Primary Completion Date
March 30, 2021 (Anticipated)
Study Completion Date
April 30, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Chinese University of Hong Kong

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This will be a single centre study at the Prince of Wales Hospital, Hong Kong. Patients will be identified from an existing registry of diabetes patients with CKD. Potential subjects will be identified from patients attending diabetes, general medical and renal clinics. Following informed consent, patients will undergo screening where baseline HbA1c, renal function will be measured along withcomprehensive medical and drug history to confirm eligibility. All eligible patients will be fitted with a blinded CGM (Medtronic iPro2 professional CGM) on week-1 for baseline glucose profiles for capturing baseline CGM profile. In case of blinded CGM sensor loss or malfunction, the sensor will be replaced once. Patients with at least 50% sensor data during the blinded wear period will proceed to randomization. At week 0, patients will be randomized to the flash glucose monitoring or SMBG. Both groups will receive standardised education on diabetes self-management, prevention and treatment of hypoglycaemia. This will be accordance with the usual practice at the study site. In the FGM group, patients will receive training on insertion, operation of the device with access to the device software for viewing of ambulatory glucose profiles. Patients will be advised to confirm blood glucose readings with SMBG in the event of hypoglycaemic symptoms, if FGM displays glucose <3.9mmol or in event of glucose instability. Patients randomized to the control group will perform SMBG using dedicated blood glucose meter at least twice daily. Blinded CGM will again be worn in both groups at week 16 for assessment of primary and secondary outcomes. Subjects will compete a hypoglycaemia diary for documenting symptomatic or asymptomatic hypoglycaemia during the study period. Questionnaires on hypoglycaemia unawarenesss, fear of hypoglycaemia and patient-reported outcomes will be completed at baseline, week 8 and week 16 in both groups.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes With Diabetic Chronic Kidney Disease (Diagnosis)

7. Study Design

Primary Purpose
Diagnostic
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
SMBG
Arm Type
Active Comparator
Arm Description
Patients use their own glucometers as control
Arm Title
Flash CGMS
Arm Type
Experimental
Intervention Type
Device
Intervention Name(s)
Abbott FreeStyle Libre
Intervention Description
Flash CGMS
Intervention Type
Device
Intervention Name(s)
Patient Own SMBG
Intervention Description
Market SMBG
Primary Outcome Measure Information:
Title
Difference in time in hypoglycaemia
Description
Compare the difference in time in hypoglycaemia (<3.9mmol/l) on blinded CGM between intervention and control groups
Time Frame
week 16
Secondary Outcome Measure Information:
Title
CGM indices
Description
Time-in-range (4-10mmol/l), time-in-hyperglycaemia (>10mmol), low blood glucose index, glycaemic variability (coefficient of variation). These CGM indices are defined in accordance with the latest International Consensus on Use of CGM
Time Frame
week 16
Title
Glycated haemoglobin
Description
Change in HbA1c
Time Frame
week 16
Title
Incidence of hypoglycaemia
Description
Numbers of hypoglycaemic episode reported by study subjects
Time Frame
week 16
Title
Patient compliance to Flash CGMS
Description
Frequency of sensor scans and time duration of sensor wear
Time Frame
week 16
Title
Change in Diabetic treatment
Description
Physician directed change in diabetes treatment (including insulin dosage)
Time Frame
week 16
Title
Patient quality-of-life
Description
Measures by questionnaire: Diabetes Distress Scale (DDS; total score from 17-102), comprising 3 subscales namely emotional, physician, regimen / social support. A lower score indicates better outcome.
Time Frame
week 16
Title
Hypoglycaemia awareness
Description
Measure by questionnaire: Gold Score Hypoglycaemia awareness (Total 7 grading, lowest score indicates better outcome)
Time Frame
16 weeks
Title
Treatment satisfaction
Description
Measured by questionnaire: IDTSQs (Total 8 questions with total score 0-48, highest score indicates better outcome)
Time Frame
16 weeks
Title
Fear of hypoglycaemia
Description
Measured by questionnaire: Hypoglycemia Fear Survey II (comprising 2 subscales namely behaviour (15 items) and worry (18 items). Each item has 5 categorical selection from "never" to "always".
Time Frame
16 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Type I or II diabetes mellitus diagnosed for at least 6 months Male or female age ≥ 18 years old and ≤ 75 years old. Women who are not pregnant, lactating or planning a pregnancy during their participation in the clinical study. Patients with CKD stage 3b, 4 or 5 as defined by estimated glomerular filtration rate less than 45ml/min/m2 History of at least 1 episode of non-severe or severe hypoglycaemia in the 12 months prior to screening Willingness, ability and commitment to comply with the testing, procedure and follow-up outlined in this protocol including (but not limited to) and use of pre-specified glucose monitoring devices. Willingness to perform SMBG during the study period In the opinion of the investigator, absence of any physical limitations, addictive diseases, or underlying medical conditions (including mental health) that may preclude the patient from being a suitable study candidate. Written informed consent to participate in the study provided by the patient. Willing and capable of use of a flash glucose monitor as judged by the investigator Exclusion Criteria: HbA1C >8.5% at screening Currently pregnant, as demonstrated by a positive pregnancy test at screening or planning pregnancy. Women of childbearing potential will also be asked to adopt adequate contraceptive measures throughout the study period, and to notify the study staff immediately if discovered pregnant. Participants who are unwilling to comply with these measures will be excluded. Any active acute or chronic disease or condition that, in the opinion of the investigator, might interfere with the performance of this study. Any active acute or chronic infectious disease that, in the opinion of the investigator, would pose an excessive risk to study staff. Current use or recent exposure to any medication that in the opinion of the investigator could have an influence on the patient's ability to participate in this study or on the performance of the test device. Extensive skin changes/diseases that preclude wearing the FGM on normal skin at the proposed application sites (e.g., extensive psoriasis, recent burns or severe sunburn, extensive eczema, extensive scarring, extensive tattoos, dermatitis herpetiformis). Have a known allergy to medical-grade adhesives Known current or recent alcohol or drug abuse Diabetic ketoacidosis, hyperosmolar hyperglycaemic state or myocardial infarction in the six months prior to screening Patients on renal replacement therapy Currently participating in another investigational study protocol where the testing or results may interfere with study compliance, diagnostic results, or data collection. An identified protected vulnerable patient (including but not limited to those in detention, or a prisoner).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Elaine Chow, MBChB PhD
Phone
852 3505 1549
Email
e.chow@cuhk.edu.hk
First Name & Middle Initial & Last Name or Official Title & Degree
Cherry Chiu
Email
cherrychiu@cuhk.edu.hk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Elaine Chow
Organizational Affiliation
Chinese University of Hong Kong
Official's Role
Principal Investigator
Facility Information:
Facility Name
Prince of Wales Hospital
City
Sha Tin
Country
Hong Kong
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elaine Chow, PhD
Phone
852 3505 3149
Email
e.chow@cuhk.edu.hk
First Name & Middle Initial & Last Name & Degree
Cherry Chiu
Phone
852 3505 3897
Email
cherrychiu@cuhk.edu.hk

12. IPD Sharing Statement

Plan to Share IPD
No

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Flash Glucose Monitoring in Reduction of Hypoglycaemia in Diabetic Patients With Chronic Kidney Disease

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