search
Back to results

Long Acting Insulin Glargine Titration Web Tool (LTHome) vs Enhanced Usual Therapy of Glargine Titration (INNOVATE)

Primary Purpose

Type 2 Diabetes Mellitus

Status
Completed
Phase
Not Applicable
Locations
Canada
Study Type
Interventional
Intervention
Long-acting insulin glargine titration web tool (LTHome)
Diabetes Education
Sponsored by
LMC Diabetes & Endocrinology Ltd.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes Mellitus focused on measuring Type 2 diabetes, T2DM

Eligibility Criteria

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

Inclusion Criteria:

  • Patient with type 2 diabetes mellitus (T2DM) between 18 and 75 years old (inclusively) with BMI ≤ 45 kg/m2.
  • Signed written informed consent
  • Patients scheduled to: initiate basal insulin treatment or increase their dose of current basal insulin therapy, independently of study participation, because of :

    • inadequate blood glucose control

  • If on basal therapy at screening, must be using a stable dose of insulin glargine x 1 week prior to randomization
  • Patients with poor blood glucose control defined by:

    • HbA1c level between > 7% at screening AND
    • mean FPG > 7 mmol/l as determined by most recent self-measured blood glucose in 3 of 7 days prior to randomization
  • Patients proficient in computer literacy
  • Patient is able and willing to monitor glucose with a home glucose monitor, and consistently record his/her blood glucose and insulin doses in a patient diary/web tool.

Exclusion Criteria:

  • Any technical/administrative reason that makes it impossible to include the patient in the study, including closing enrollment due to full enrollment
  • Patient who has previously participated in any clinical trial investigating the LTHome algorithm
  • Patient who withdraws consent during screening (starting from signed informed consent form)
  • Use of systemic steroids in the last 90 days
  • Conditions/situations:

    • Patients with short life expectancy (less than 1 year)
    • Type 1 diabetes mellitus
    • Patients with conditions/concomitant diseases making them non-evaluable for the primary efficacy endpoint
    • Clinically significant cardiac disease, retinopathy, hepatic, renal dysfunction or relevant other major diseases as determined by Principal Investigator or designee.
    • Unstable oral antihyperglycemic drugs and/or Glucagon-Like Peptide Receptor (GLP-1R) Agonists therapy during the 4 week period prior to screening
    • Impossibility to meet specific protocol requirements (e.g. ability to perform blood glucose measurements, manage their own insulin glargine administration or deemed unlikely to safely manage insulin dosage on guidance by their HCP)
    • Patient is a primary relative of the Investigator or any Sub-Investigator, research assistant, pharmacist, study coordinator, or other staff or is directly involved in the conduct of the protocol
    • Patients with hypoglycemia unawareness, severe hypoglycemic episode in the last 90 days or hospitalization (for any reason) in the last 30 days
    • Cognitive disorder, dementia or any neurologic disorder, that would affect patient's ability to participate in the study, or patients who have no legal capacity or are under guardianship
  • Pregnant or breastfeeding women, or women of child-bearing potential not protected by highly effective method(s) of birth control (as defined in the informed consent form and/or in a local protocol addendum) and who are unwilling or unable to be tested for pregnancy.
  • Patients who are using, or need to start using, mealtime (Bolus) insulin during the timeframe of the study.
  • Night shift workers

Sites / Locations

  • LMC Diabetes & Endocrinology

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

LTHome web tool

Enhanced Usual Therapy (EUT)

Arm Description

The long-acting insulin glargine titration web tool (LTHome) will provide insulin glargine titration suggestions based on user inputted blood glucose readings.

The Enhanced Usual Therapy arm will receive insulin glargine titration instructions that are the usual therapy provided by the physician/HCP, in addition to diabetes education.

Outcomes

Primary Outcome Measures

Percentage of subjects reaching fasting plasma glucose (FPG) target
The primary outcome is defined as all of the following At least 4 out of 7 FPG readings done within a 10 day period are within the target range of 5-7.2 mmol/L Mean glucose for three consecutive prior FPG values is between 5-7.2 mmol/L There is no severe hypoglycemia during the 7-10 day period (Severe hypoglycemia is defined as third party intervention in management of the hypoglycemia).

Secondary Outcome Measures

Number of days to first reach fasting plasma glucose target
The number of days in the study until the first day the target is reached.
Number of days in target range after reaching fasting plasma glucose target
The number of days after reaching target where the FPG was between 5.0 and 7.2 mmol/L (inclusive)
Fasting plasma glucose
Fasting plasma glucose values over the entire study period will be summarized by mean and standard deviation
Hemoglobin A1c (HbA1c)
The change in HbA1c will be evaluated as an expression of overall glycemic control in the two treatment arms and compared.
Rate of documented hypoglycemia in subjects that reach target
Rate of documented hypoglycemia in subjects that do not reach target
Proportion of all patients with hypoglycemia
A summary of any hypoglycemia, severe hypoglycemia, nocturnal hypoglycemia, day-time hypoglycemia, symptomatic hypoglycemia, probable symptomatic hypoglycemia, and asymptomatic hypoglycemia will be summarized
Frequency of contact with physician/HCP
The number of times subjects contacted their physician/HCP during the study
Diabetes Treatment Satisfaction Questionnaire (DTSQ)
A questionnaire to assess subject's overall satisfaction with their diabetes treatment
Hypoglycemia Fear Survey (HFS)
A questionnaire to assess the subject's behaviours to avoid hypoglycemia and to measure the subjects' worries about hypoglycemia and its consequences
WHO-5 Well-Being Index
A questionnaire to measure emotional well-being to screening for likely depression in subjects with diabetes
Diabetes Distress Scale
A questionnaire to assess diabetes-related emotional distress
LTHome Patient Satisfaction Survey
LTHome arm only; a questionnaire to measure satisfaction of the use of the LTHome
Number of days subjects self-monitored their fasting plasma glucose
Number of dose recommendations prior to reaching target - LTHome only
Number of dose recommendations after target is reached - LTHome only
Number of days insulin glargine was taken - LTHome only
Reasons for disregarding LTHome advice - LTHome only
A summary of the reasons that subjects gave for not taking the insulin glargine dose recommendation given by the LTHome web tool when the recommendation was not followed
Adverse events
Serious adverse events

Full Information

First Posted
August 21, 2015
Last Updated
September 1, 2015
Sponsor
LMC Diabetes & Endocrinology Ltd.
Collaborators
Sanofi
search

1. Study Identification

Unique Protocol Identification Number
NCT02540486
Brief Title
Long Acting Insulin Glargine Titration Web Tool (LTHome) vs Enhanced Usual Therapy of Glargine Titration
Acronym
INNOVATE
Official Title
A 12 Week, Parallel, Open-label, Randomized, Multi-center Study Evaluating Use, Safety and Effectiveness of a Web Based Tool vs. Enhanced Usual Therapy of Glargine Titration in T2DM Patients With a 4 Week Safety Extension
Study Type
Interventional

2. Study Status

Record Verification Date
September 2015
Overall Recruitment Status
Completed
Study Start Date
December 2013 (undefined)
Primary Completion Date
March 2015 (Actual)
Study Completion Date
March 2015 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
LMC Diabetes & Endocrinology Ltd.
Collaborators
Sanofi

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Evaluating patients with type 2 diabetes either starting once daily basal insulin or requiring increased basal titrations in order to compare the LTHome web based tool with the usual standard of practice for insulin glargine dosing adjustment.
Detailed Description
INNOVATE is a 12 week, parallel, open-label, randomized, multi-center study evaluating use, safety and effectiveness of a web based tool (LTHome) vs. enhanced usual therapy (EUT) of glargine titration in T2DM patients. The primary objective of this study is to compare the effectiveness LTHome versus EUT of glargine titration in people with T2DM patients on basal insulin not meeting local targets or patients requiring basal initiation. Success will be measured by the percentage of subjects reaching Canadian Diabetes Association (CDA) guideline targets. The efficacy objective is to demonstrate that the percentage (%) of subjects to reach FPG target by titration of insulin glargine using the LTHome tool with dose adjustment advice is not inferior to the % of subjects to reach FPG target using Enhanced Usual Therapy glargine titration during study participation (LTHome vs. EUT treatments). The secondary objectives of this study are to assess safety, effectiveness, satisfaction and adherence of LTHome use versus Enhanced Usual Therapy glargine titration.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes Mellitus
Keywords
Type 2 diabetes, T2DM

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
139 (Actual)

8. Arms, Groups, and Interventions

Arm Title
LTHome web tool
Arm Type
Experimental
Arm Description
The long-acting insulin glargine titration web tool (LTHome) will provide insulin glargine titration suggestions based on user inputted blood glucose readings.
Arm Title
Enhanced Usual Therapy (EUT)
Arm Type
Active Comparator
Arm Description
The Enhanced Usual Therapy arm will receive insulin glargine titration instructions that are the usual therapy provided by the physician/HCP, in addition to diabetes education.
Intervention Type
Other
Intervention Name(s)
Long-acting insulin glargine titration web tool (LTHome)
Intervention Description
The LTHome study arm will receive insulin glargine titration instructions from the LTHome web-based tool
Intervention Type
Other
Intervention Name(s)
Diabetes Education
Intervention Description
Individual diabetes education, detailed instructions on the use of the blood glucose monitor and unlimited availability of blood glucose monitoring supplies.
Primary Outcome Measure Information:
Title
Percentage of subjects reaching fasting plasma glucose (FPG) target
Description
The primary outcome is defined as all of the following At least 4 out of 7 FPG readings done within a 10 day period are within the target range of 5-7.2 mmol/L Mean glucose for three consecutive prior FPG values is between 5-7.2 mmol/L There is no severe hypoglycemia during the 7-10 day period (Severe hypoglycemia is defined as third party intervention in management of the hypoglycemia).
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
Number of days to first reach fasting plasma glucose target
Description
The number of days in the study until the first day the target is reached.
Time Frame
12 weeks
Title
Number of days in target range after reaching fasting plasma glucose target
Description
The number of days after reaching target where the FPG was between 5.0 and 7.2 mmol/L (inclusive)
Time Frame
12 weeks
Title
Fasting plasma glucose
Description
Fasting plasma glucose values over the entire study period will be summarized by mean and standard deviation
Time Frame
12 weeks
Title
Hemoglobin A1c (HbA1c)
Description
The change in HbA1c will be evaluated as an expression of overall glycemic control in the two treatment arms and compared.
Time Frame
12 weeks
Title
Rate of documented hypoglycemia in subjects that reach target
Time Frame
12 weeks
Title
Rate of documented hypoglycemia in subjects that do not reach target
Time Frame
12 weeks
Title
Proportion of all patients with hypoglycemia
Description
A summary of any hypoglycemia, severe hypoglycemia, nocturnal hypoglycemia, day-time hypoglycemia, symptomatic hypoglycemia, probable symptomatic hypoglycemia, and asymptomatic hypoglycemia will be summarized
Time Frame
12 weeks
Title
Frequency of contact with physician/HCP
Description
The number of times subjects contacted their physician/HCP during the study
Time Frame
12 weeks
Title
Diabetes Treatment Satisfaction Questionnaire (DTSQ)
Description
A questionnaire to assess subject's overall satisfaction with their diabetes treatment
Time Frame
12 weeks
Title
Hypoglycemia Fear Survey (HFS)
Description
A questionnaire to assess the subject's behaviours to avoid hypoglycemia and to measure the subjects' worries about hypoglycemia and its consequences
Time Frame
12 weeks
Title
WHO-5 Well-Being Index
Description
A questionnaire to measure emotional well-being to screening for likely depression in subjects with diabetes
Time Frame
12 weeks
Title
Diabetes Distress Scale
Description
A questionnaire to assess diabetes-related emotional distress
Time Frame
12 weeks
Title
LTHome Patient Satisfaction Survey
Description
LTHome arm only; a questionnaire to measure satisfaction of the use of the LTHome
Time Frame
12 weeks
Title
Number of days subjects self-monitored their fasting plasma glucose
Time Frame
12 weeks
Title
Number of dose recommendations prior to reaching target - LTHome only
Time Frame
12 weeks
Title
Number of dose recommendations after target is reached - LTHome only
Time Frame
12 weeks
Title
Number of days insulin glargine was taken - LTHome only
Time Frame
12 weeks
Title
Reasons for disregarding LTHome advice - LTHome only
Description
A summary of the reasons that subjects gave for not taking the insulin glargine dose recommendation given by the LTHome web tool when the recommendation was not followed
Time Frame
12 weeks
Title
Adverse events
Time Frame
12 weeks
Title
Serious adverse events
Time Frame
12 weeks
Other Pre-specified Outcome Measures:
Title
Body weight (kg)
Time Frame
12 weeks
Title
List of concomitant medications initiated after randomization
Time Frame
12 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: Patient with type 2 diabetes mellitus (T2DM) between 18 and 75 years old (inclusively) with BMI ≤ 45 kg/m2. Signed written informed consent Patients scheduled to: initiate basal insulin treatment or increase their dose of current basal insulin therapy, independently of study participation, because of : • inadequate blood glucose control If on basal therapy at screening, must be using a stable dose of insulin glargine x 1 week prior to randomization Patients with poor blood glucose control defined by: HbA1c level between > 7% at screening AND mean FPG > 7 mmol/l as determined by most recent self-measured blood glucose in 3 of 7 days prior to randomization Patients proficient in computer literacy Patient is able and willing to monitor glucose with a home glucose monitor, and consistently record his/her blood glucose and insulin doses in a patient diary/web tool. Exclusion Criteria: Any technical/administrative reason that makes it impossible to include the patient in the study, including closing enrollment due to full enrollment Patient who has previously participated in any clinical trial investigating the LTHome algorithm Patient who withdraws consent during screening (starting from signed informed consent form) Use of systemic steroids in the last 90 days Conditions/situations: Patients with short life expectancy (less than 1 year) Type 1 diabetes mellitus Patients with conditions/concomitant diseases making them non-evaluable for the primary efficacy endpoint Clinically significant cardiac disease, retinopathy, hepatic, renal dysfunction or relevant other major diseases as determined by Principal Investigator or designee. Unstable oral antihyperglycemic drugs and/or Glucagon-Like Peptide Receptor (GLP-1R) Agonists therapy during the 4 week period prior to screening Impossibility to meet specific protocol requirements (e.g. ability to perform blood glucose measurements, manage their own insulin glargine administration or deemed unlikely to safely manage insulin dosage on guidance by their HCP) Patient is a primary relative of the Investigator or any Sub-Investigator, research assistant, pharmacist, study coordinator, or other staff or is directly involved in the conduct of the protocol Patients with hypoglycemia unawareness, severe hypoglycemic episode in the last 90 days or hospitalization (for any reason) in the last 30 days Cognitive disorder, dementia or any neurologic disorder, that would affect patient's ability to participate in the study, or patients who have no legal capacity or are under guardianship Pregnant or breastfeeding women, or women of child-bearing potential not protected by highly effective method(s) of birth control (as defined in the informed consent form and/or in a local protocol addendum) and who are unwilling or unable to be tested for pregnancy. Patients who are using, or need to start using, mealtime (Bolus) insulin during the timeframe of the study. Night shift workers
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ronnie Aronson, MD
Organizational Affiliation
LMC Diabetes & Endocrinology Ltd.
Official's Role
Principal Investigator
Facility Information:
Facility Name
LMC Diabetes & Endocrinology
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4G 3E8
Country
Canada

12. IPD Sharing Statement

Citations:
PubMed Identifier
15855602
Citation
Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005 May;28(5):1245-9. doi: 10.2337/diacare.28.5.1245. No abstract available.
Results Reference
background
PubMed Identifier
19885117
Citation
Strange P. Treat-to-target insulin titration algorithms when initiating long or intermediate acting insulin in type 2 diabetes. J Diabetes Sci Technol. 2007 Jul;1(4):540-8. doi: 10.1177/193229680700100412.
Results Reference
background
PubMed Identifier
21949161
Citation
Morrison F, Shubina M, Turchin A. Encounter frequency and serum glucose level, blood pressure, and cholesterol level control in patients with diabetes mellitus. Arch Intern Med. 2011 Sep 26;171(17):1542-50. doi: 10.1001/archinternmed.2011.400.
Results Reference
background
PubMed Identifier
18945920
Citation
Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B; American Diabetes Association; European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009 Jan;32(1):193-203. doi: 10.2337/dc08-9025. Epub 2008 Oct 22.
Results Reference
background
PubMed Identifier
12136392
Citation
Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of Type I and Type II diabetes. Diabetologia. 2002 Jul;45(7):937-48. doi: 10.1007/s00125-002-0822-9. Epub 2002 Apr 26.
Results Reference
background
PubMed Identifier
16306561
Citation
Zammitt NN, Frier BM. Hypoglycemia in type 2 diabetes: pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care. 2005 Dec;28(12):2948-61. doi: 10.2337/diacare.28.12.2948. No abstract available.
Results Reference
background
Citation
Briscoe VJ, Davis SN. Hypoglycemia in type 1 and type 2 diabetes: physiology, pathophysiology, and management. Clinical Diabetes 24(3): 115-121, 2006.
Results Reference
background
PubMed Identifier
22179956
Citation
Seaquist ER, Miller ME, Bonds DE, Feinglos M, Goff DC Jr, Peterson K, Senior P; ACCORD Investigators. The impact of frequent and unrecognized hypoglycemia on mortality in the ACCORD study. Diabetes Care. 2012 Feb;35(2):409-14. doi: 10.2337/dc11-0996. Epub 2011 Dec 16.
Results Reference
background
PubMed Identifier
19875560
Citation
Swinnen SG, Hoekstra JB, DeVries JH. Insulin therapy for type 2 diabetes. Diabetes Care. 2009 Nov;32 Suppl 2(Suppl 2):S253-9. doi: 10.2337/dc09-S318. No abstract available.
Results Reference
background
PubMed Identifier
21791495
Citation
Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassai B, Erpeldinger S, Wright JM, Gueyffier F, Cornu C. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011 Jul 26;343:d4169. doi: 10.1136/bmj.d4169.
Results Reference
background
PubMed Identifier
2012085
Citation
Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med. 1991 Apr;90(4):450-9.
Results Reference
background
PubMed Identifier
17927832
Citation
Bradley C, Plowright R, Stewart J, Valentine J, Witthaus E. The Diabetes Treatment Satisfaction Questionnaire change version (DTSQc) evaluated in insulin glargine trials shows greater responsiveness to improvements than the original DTSQ. Health Qual Life Outcomes. 2007 Oct 10;5:57. doi: 10.1186/1477-7525-5-57.
Results Reference
background
PubMed Identifier
3677982
Citation
Cox DJ, Irvine A, Gonder-Frederick L, Nowacek G, Butterfield J. Fear of hypoglycemia: quantification, validation, and utilization. Diabetes Care. 1987 Sep-Oct;10(5):617-21. doi: 10.2337/diacare.10.5.617.
Results Reference
background
PubMed Identifier
23072401
Citation
Hajos TR, Pouwer F, Skovlund SE, Den Oudsten BL, Geelhoed-Duijvestijn PH, Tack CJ, Snoek FJ. Psychometric and screening properties of the WHO-5 well-being index in adult outpatients with Type 1 or Type 2 diabetes mellitus. Diabet Med. 2013 Feb;30(2):e63-9. doi: 10.1111/dme.12040.
Results Reference
background
PubMed Identifier
15735199
Citation
Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, Jackson RA. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005 Mar;28(3):626-31. doi: 10.2337/diacare.28.3.626.
Results Reference
background
PubMed Identifier
21766768
Citation
Petznick A. Insulin management of type 2 diabetes mellitus. Am Fam Physician. 2011 Jul 15;84(2):183-90.
Results Reference
background
PubMed Identifier
24070926
Citation
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Cheng AY. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada. Introduction. Can J Diabetes. 2013 Apr;37 Suppl 1:S1-3. doi: 10.1016/j.jcjd.2013.01.009. Epub 2013 Mar 26. No abstract available.
Results Reference
background

Learn more about this trial

Long Acting Insulin Glargine Titration Web Tool (LTHome) vs Enhanced Usual Therapy of Glargine Titration

We'll reach out to this number within 24 hrs