MedPath

Empagliflozin as Adjunctive to Insulin Therapy Over 26 Weeks in Patients With T1DM (EASE-3)

Phase 3
Completed
Conditions
Diabetes Mellitus, Type 1
Interventions
Drug: Placebo
Registration Number
NCT02580591
Lead Sponsor
Boehringer Ingelheim
Brief Summary

The study will investigate the efficacy, safety, tolerability and Pharmacokinetic(PK) of 3 doses of empagliflozin compared with placebo over 26 weeks in 960 patients with type 1 diabetes mellitus as adjunctive therapy to insulin

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
977
Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Empagliflozin low dosePlacebo-
Empagliflozin high doseEmpagliflozin-
Empagliflozin high dosePlacebo-
Empagliflozin medium doseEmpagliflozin-
Empagliflozin medium dosePlacebo-
PlaceboPlacebo-
Empagliflozin low doseEmpagliflozin-
Primary Outcome Measures
NameTimeMethod
Change From Baseline in Glycated Hemoglobin (HbA1c) at Week 26 for Full Analysis Set (FAS) (Observed Cases [OC])Baseline to week 26

Change from baseline in Glycated hemoglobin (HbA1c) for full analysis set (FAS) (observed cases \[OC\]) is presented. With regards to efficacy and safety endpoints, the term 'baseline' referred to the last observed measurement prior to administration of any randomized trial medication. Least squares mean is adjusted mean change from baseline.

Change From Baseline in Glycated Hemoglobin (HbA1c) at Week 26 for Modified Intention-to-treat Population Set (mITT) (Observed Case (OC) - All Data (AD) (OC-AD))Baseline to week 26

Change from baseline in Glycated hemoglobin (HbA1c) for modified intention-to-treat population set (mITT) (observed case - all data \[OC-AD\]) is presented. With regards to efficacy and safety endpoints, the term 'baseline' referred to the last observed measurement prior to administration of any randomized trial medication. Least squares mean is adjusted mean change from baseline.

Secondary Outcome Measures
NameTimeMethod
Rate Per Patient-year of Investigator-reported Symptomatic Hypoglycemic Adverse Events (AEs) With Confirmed Plasma Glucose (PG)Week 5 to Week 26, Week 1 to Week 26

Rate per patient-year of investigator-reported symptomatic hypoglycemic adverse events (AEs) with confirmed plasma glucose (PG) \<54 milligram per deciliter (mg/dL) (\<3.0 millimoles per litre (mmol/L)) and/or severe hypoglycemic AEs (i.e. all investigator-reported AEs that had confirmed PG \<54 mg/dL \[\<3.0 mmol/L\] with symptoms reported and all severe hypoglycemic events that were confirmed by adjudication) is presented for (i) From week 5 to 26 and (ii) From week 1 to 26. Least squares mean is actually an adjusted event rate. This is key secondary endpoints.

Change From Baseline in Body Weight at Week 26Baseline to week 26

Change from baseline in body weight is presented With regards to efficacy and safety endpoints, the term 'baseline' referred to the last observed measurement prior to administration of any randomized trial medication. Least squares mean is adjusted mean change from baseline.

Change From Baseline in Total Daily Insulin Dose (TDID) at Week 26Baseline to week 26

Change from baseline in Total daily insulin dose (TDID) is presented. With regards to efficacy and safety endpoints, the term 'baseline' referred to the last observed measurement prior to administration of any randomized trial medication. Least squares mean is adjusted mean change from baseline.

Change From Baseline in Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) at Week 26Baseline to week 26

Change from baseline in Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) is presented. With regards to efficacy and safety endpoints, the term 'baseline' referred to the last observed measurement prior to administration of any randomized trial medication. Least squares mean is adjusted mean change from baseline.

Trial Locations

Locations (189)

International Research Associates, LLC

đŸ‡ºđŸ‡¸

Hialeah, Florida, United States

University of Maryland School of Medicine

đŸ‡ºđŸ‡¸

Baltimore, Maryland, United States

Sestron Clinical Research

đŸ‡ºđŸ‡¸

Marietta, Georgia, United States

MODEL Clinical Research

đŸ‡ºđŸ‡¸

Baltimore, Maryland, United States

University Diabetes and Endocrine Consultants

đŸ‡ºđŸ‡¸

Chattanooga, Tennessee, United States

Dallas Diabetes and Endocrine Center

đŸ‡ºđŸ‡¸

Dallas, Texas, United States

Coffs Endocrine & Diabetes Services

đŸ‡¦đŸ‡º

Coffs Harbour, New South Wales, Australia

FinnMedi Oy, Tampere

đŸ‡«đŸ‡®

Tampere, Finland

Nicodiab SRL, Bucharest

đŸ‡·đŸ‡´

Bucharest, Romania

Inrca-Irccs

đŸ‡®đŸ‡¹

Ancona, Italy

General Hospital of Nikaia

đŸ‡¬đŸ‡·

Nikaia, Greece

TREAD Research

đŸ‡¿đŸ‡¦

Cape Town, South Africa

Hospital A Coruña

đŸ‡ªđŸ‡¸

A Coruña, Spain

Research Institute of Dallas

đŸ‡ºđŸ‡¸

Dallas, Texas, United States

Eagle's Landing Diabetes and Endocrinology

đŸ‡ºđŸ‡¸

Stockbridge, Georgia, United States

Holston Medical Group

đŸ‡ºđŸ‡¸

Bristol, Tennessee, United States

Richmond Road and Diagnostic Treatment Centre

đŸ‡¨đŸ‡¦

Calgary, Alberta, Canada

AM Diabetes and Endocrinology Center

đŸ‡ºđŸ‡¸

Bartlett, Tennessee, United States

Texas Health Physicians Group

đŸ‡ºđŸ‡¸

Dallas, Texas, United States

University Hospital Brno

đŸ‡¨đŸ‡¿

Brno, Czechia

John Muir Physician Network Clinical Research Center

đŸ‡ºđŸ‡¸

Concord, California, United States

TYKS

đŸ‡«đŸ‡®

Turku, Finland

HOP Jean Minjoz

đŸ‡«đŸ‡·

Besancon, France

Valley Research

đŸ‡ºđŸ‡¸

Fresno, California, United States

Solutions Through Advanced Research, Inc.

đŸ‡ºđŸ‡¸

Jacksonville, Florida, United States

Suncoast Clinical Research, Inc.

đŸ‡ºđŸ‡¸

New Port Richey, Florida, United States

Physicians Research Associates, LLC

đŸ‡ºđŸ‡¸

Lawrenceville, Georgia, United States

Diabetes Endocrinology Research Center of Western New York

đŸ‡ºđŸ‡¸

Williamsville, New York, United States

Mehiläinen Jyväskylä

đŸ‡«đŸ‡®

Jyväskylä, Finland

Clinique des maladies Lipidiques de Quebec

đŸ‡¨đŸ‡¦

Quebec, Canada

Eastern Health (MUN)

đŸ‡¨đŸ‡¦

St. John's, Newfoundland and Labrador, Canada

Eastern Clinical Research Unit

đŸ‡¦đŸ‡º

East Ringwood, Victoria, Australia

HOP Paris Saint-Joseph

đŸ‡«đŸ‡·

Paris, France

Satakunnan Diabetesasema, Pori

đŸ‡«đŸ‡®

Pori, Finland

St. Michael's Hospital

đŸ‡¨đŸ‡¦

Toronto, Ontario, Canada

Holzer Clinic LLC

đŸ‡ºđŸ‡¸

Gallipolis, Ohio, United States

HUS, Lihavuustutkimusyksikkö Biomedicum Helsinki

đŸ‡«đŸ‡®

Helsinki, Finland

ResTrial s.r.o.Diabetology Ambulance,Prague

đŸ‡¨đŸ‡¿

Prague, Czechia

Lyell McEwin Hospital

đŸ‡¦đŸ‡º

Elizabeth Vale, South Australia, Australia

HOP de Poitiers

đŸ‡«đŸ‡·

Poitiers, France

Univ. Hospital Kralovske Vinohrady

đŸ‡¨đŸ‡¿

Prague, Czechia

Diahaza s.r.o.Intern.Med.Outpat.Clin.Dep.Diabetology,Holesov

đŸ‡¨đŸ‡¿

Holesov, Czechia

HOP Le Creusot

đŸ‡«đŸ‡·

Le Creusot, France

InnoDiab Forschung GmbH

đŸ‡©đŸ‡ª

Essen, Germany

AIDIN VK s.r.o.,Department Diabetology, Hranice

đŸ‡¨đŸ‡¿

Hranice, Czechia

Universitetssykehuset Nord-Norge, Tromsø

đŸ‡³đŸ‡´

Tromsø, Norway

DiabSerwis S.C., Chorzow

đŸ‡µđŸ‡±

Chorzow, Poland

Oslo Universitetssykehus HF, Lipidklinikken

đŸ‡³đŸ‡´

Oslo, Norway

Medical Centre Pratia Gdynia

đŸ‡µđŸ‡±

Gdynia, Poland

Medical Centre Pratia Katowice I

đŸ‡µđŸ‡±

Katowice, Poland

Medical Centre Pratia Krakow

đŸ‡µđŸ‡±

Krakow, Poland

Reg.Spec.Hosp.Olsztyn,Clin,Endocrinology,Diabetics.&Int.Med.

đŸ‡µđŸ‡±

Olsztyn, Poland

SC Pelican Impex SRL, Cabinet Nr. 201, Diabetes Dept.

đŸ‡·đŸ‡´

Oradea, Bihor County, Romania

CRU Hungary Ltd, Private Practice, Miskolc

đŸ‡­đŸ‡º

Miskolc, Hungary

CJSC"Polyclinic complex",Dep.Endocrinology,St.Petersburg

đŸ‡·đŸ‡º

St. Petersburg, Russian Federation

M3 Helse AS

đŸ‡³đŸ‡´

Hamar, Norway

University Hospital in Krakow

đŸ‡µđŸ‡±

Krakow, Poland

Omedica Medical Centre, Poznan

đŸ‡µđŸ‡±

Poznan, Poland

Csongrad Country Dr Bugyi Istvan Hosp.

đŸ‡­đŸ‡º

Szentes, Hungary

Sigulda Hospital, Outpatient department

đŸ‡±đŸ‡»

Sigulda, Latvia

Stavanger Helseforskning

đŸ‡³đŸ‡´

Stavanger, Norway

SC Medical Centre "Sanatatea Ta" SRL, Bucharest

đŸ‡·đŸ‡´

Bucharest, Romania

Centrul Medical Dr Negrisanu SRL

đŸ‡·đŸ‡´

Timisoara, Romania

Policlinic No. 1 of Russian Academy of Sciences, St. Petersburg

đŸ‡·đŸ‡º

St. Petersburg, Russian Federation

Diabetes Care Centre

đŸ‡¿đŸ‡¦

Pretoria, South Africa

Independent Public Clin.Hosp.no1Lublin,Dep.Internal Diseases

đŸ‡µđŸ‡±

Lublin, Poland

CTC Sahlgrenska Universitetssjukhuset

đŸ‡¸đŸ‡ª

Göteborg, Sweden

LCS Clinical Research Unit

đŸ‡¿đŸ‡¦

Bryanston, South Africa

VX Pharma (Pty) Ltd Pretoria

đŸ‡¿đŸ‡¦

Pretoria, South Africa

Queen's Medical Centre

đŸ‡¬đŸ‡§

Nottingham, United Kingdom

Witold Chodzko Institute Rural Medic,Dep.Diabetology,Lublin

đŸ‡µđŸ‡±

Lublin, Poland

Clinical Research Center Medicome, Oswiecim

đŸ‡µđŸ‡±

Oswiecim, Poland

Hospital de Braga-Escala Braga

đŸ‡µđŸ‡¹

Braga, Portugal

Dr Hilton Kaplan

đŸ‡¿đŸ‡¦

Cape Town, South Africa

Medical Academy named after I. Mechnikov, St. Petersburg

đŸ‡·đŸ‡º

St. Petersburg, Russian Federation

City Clinical Hospital no. 67, Moscow

đŸ‡·đŸ‡º

Moscow, Russian Federation

Hospital ClĂ­nico de Valencia

đŸ‡ªđŸ‡¸

Valencia, Spain

Hospital General Universitario Gregorio MaraĂ±Ă³n

đŸ‡ªđŸ‡¸

Madrid, Spain

Dr. L. A.Distiller

đŸ‡¿đŸ‡¦

Johannesburg, South Africa

S3 Clinical Research Centers

đŸ‡¸đŸ‡ª

Vällingby, Sweden

Ängelholms Sjukhus

đŸ‡¸đŸ‡ª

Ängelholm, Sweden

Endo-Diabesidad-ClĂ­nica DurĂ¡n & Asociados

đŸ‡ªđŸ‡¸

Sevilla, Spain

City Hospital Saint Elizaveta, Dept. Endocrinology

đŸ‡·đŸ‡º

St. Petersburg, Russian Federation

Leicester General Hospital

đŸ‡¬đŸ‡§

Leicester, United Kingdom

CM Avances Médicos

đŸ‡ªđŸ‡¸

Granada, Spain

George Eliot Hospital

đŸ‡¬đŸ‡§

Nuneaton, United Kingdom

Hull Royal Infirmary

đŸ‡¬đŸ‡§

Hull, United Kingdom

Hospital Virgen Macarena

đŸ‡ªđŸ‡¸

Sevilla, Spain

Ipswich Hospital

đŸ‡¬đŸ‡§

Ipswich, United Kingdom

Hospital Universitario Infanta Leonor

đŸ‡ªđŸ‡¸

Madrid, Spain

Karlskoga lasarett

đŸ‡¸đŸ‡ª

Karlskoga, Sweden

SkĂ¥nes universitetssjukhus, Lund

đŸ‡¸đŸ‡ª

Lund, Sweden

University of Miami

đŸ‡ºđŸ‡¸

Miami, Florida, United States

Palm Research Center

đŸ‡ºđŸ‡¸

Las Vegas, Nevada, United States

COR Clinical Research, LLC

đŸ‡ºđŸ‡¸

Oklahoma City, Oklahoma, United States

Endeavor Clinical Trials, PA

đŸ‡ºđŸ‡¸

San Antonio, Texas, United States

King's College Hospital

đŸ‡¬đŸ‡§

London, United Kingdom

St Mary's Hospital

đŸ‡¬đŸ‡§

London, United Kingdom

Royal Victoria Infirmary

đŸ‡¬đŸ‡§

Newcastle Upon Tyne, United Kingdom

The Bailey Clinic

đŸ‡¨đŸ‡¦

Red Deer, Alberta, Canada

Omnispec Recherche Clinique Inc.

đŸ‡¨đŸ‡¦

Mirabel, Quebec, Canada

Applied Medical Informatics Research INC.

đŸ‡¨đŸ‡¦

Westmount, Quebec, Canada

Diabetes-Klinik Bad Mergentheim GmbH & Co. KG

đŸ‡©đŸ‡ª

Bad Mergentheim, Germany

Praxis Dr. Busch, Dortmund

đŸ‡©đŸ‡ª

Dortmund, Germany

ZKS SĂ¼dbrandenburg GmbH

đŸ‡©đŸ‡ª

Elsterwerda, Germany

Clinexpert Kft.

đŸ‡­đŸ‡º

Budapest, Hungary

Zala Country Hospital, Diabetic Outpatient Clinic

đŸ‡­đŸ‡º

Zalaegerszeg, Hungary

Endocrine Associates of Long Island, PC

đŸ‡ºđŸ‡¸

Smithtown, New York, United States

Osp. S. Giovanni Calibita Fatebenefratelli

đŸ‡®đŸ‡¹

Roma, Italy

VSV Centrs, Stalte Private Practice, Talsi

đŸ‡±đŸ‡»

Talsi, Latvia

Synexus Magyarorszag Kft.

đŸ‡­đŸ‡º

Budapest, Hungary

William Sansum Diabetes Center

đŸ‡ºđŸ‡¸

Santa Barbara, California, United States

Pacific Research Partners, LLC

đŸ‡ºđŸ‡¸

Oakland, California, United States

Healthscan Clinical Trials LLC

đŸ‡ºđŸ‡¸

Montgomery, Alabama, United States

NorCal Endocrinology and Internal Medicine

đŸ‡ºđŸ‡¸

San Ramon, California, United States

Marin Endocrine Care and Research

đŸ‡ºđŸ‡¸

Greenbrae, California, United States

Atlanta Diabetes Associates

đŸ‡ºđŸ‡¸

Atlanta, Georgia, United States

Northwest Endo Diabetes Research, LLC

đŸ‡ºđŸ‡¸

Arlington Heights, Illinois, United States

Desert Endocrinology Clinical Research Center

đŸ‡ºđŸ‡¸

Henderson, Nevada, United States

Diabetes and Endocrinology Consultants, PC

đŸ‡ºđŸ‡¸

Morehead City, North Carolina, United States

Virginia Endocrinology Research

đŸ‡ºđŸ‡¸

Chesapeake, Virginia, United States

Strand Physician Specialists dba Carolina Health Specialists

đŸ‡ºđŸ‡¸

Myrtle Beach, South Carolina, United States

Centre for Studies in Family Medicine

đŸ‡¨đŸ‡¦

London, Ontario, Canada

SA Endocrine Research P/L

đŸ‡¦đŸ‡º

Keswick, South Australia, Australia

Milan Kvapil s.r.o.,Diabetology ambulance,Prague

đŸ‡¨đŸ‡¿

Prague, Czechia

DiaGolfova s.r.o., Department Diabetology, Prague

đŸ‡¨đŸ‡¿

Prague, Czechia

HOP Bichat

đŸ‡«đŸ‡·

Paris, France

HOP Rangueil

đŸ‡«đŸ‡·

Toulouse Cédex 04, France

HOP Civil

đŸ‡«đŸ‡·

Strasbourg, France

Praxis Dr. Kaiser, Frankfurt

đŸ‡©đŸ‡ª

Frankfurt, Germany

Diabetologische Schwerpunktpraxis, Bosenheim

đŸ‡©đŸ‡ª

Bosenheim, Germany

GWT-TUD GmbH

đŸ‡©đŸ‡ª

Dresden, Germany

Diabetologische Schwerpunktpraxis

đŸ‡©đŸ‡ª

MĂ¼nster, Germany

"Korgialeneio-Benakeio" Hellenic Red Cross Hospital

đŸ‡¬đŸ‡·

Athens, Greece

Institut fĂ¼r Diabetesforschung MĂ¼nster GmbH

đŸ‡©đŸ‡ª

MĂ¼nster, Germany

Praxis Dr. Behnke, Neuwied

đŸ‡©đŸ‡ª

Neuwied, Germany

Praxis Dr. Hilgenberg

đŸ‡©đŸ‡ª

Rehburg-Loccum, Germany

Univ. Gen. Hosp. of Ioannina

đŸ‡¬đŸ‡·

Ioannina, Greece

General Hospital of Athens "Laiko"

đŸ‡¬đŸ‡·

Athens, Greece

General Hospital of Thessaloniki "G. Papanikolaou"

đŸ‡¬đŸ‡·

Thessaloniki, Greece

General Hopsital of Thessaloniki "Ippokrateio"

đŸ‡¬đŸ‡·

Thessaloniki, Greece

University Debrecen Hospital

đŸ‡­đŸ‡º

Debrecen, Hungary

Clinfan SMO Ltd.

đŸ‡­đŸ‡º

Szekszard, Hungary

Mater Misericordiae University Hospital

đŸ‡®đŸ‡ª

Dublin, Ireland

A.O. Spedali Civili di Brescia

đŸ‡®đŸ‡¹

Brescia, Italy

Policlinico Gemelli

đŸ‡®đŸ‡¹

Roma, Italy

Osp. Campo di Marte

đŸ‡®đŸ‡¹

Lucca, Italy

Azienda Ospedaliera Universitaria "Federico II"

đŸ‡®đŸ‡¹

Napoli, Italy

IRCCS Gruppo Multimedica

đŸ‡®đŸ‡¹

Sesto San Giovanni (MI), Italy

A.O.U. Senese Policlinico Santa Maria alle Scotte

đŸ‡®đŸ‡¹

Siena, Italy

Hospital Cardiologica Aguascalientes

đŸ‡²đŸ‡½

Aguascalientes, Mexico

Dace Teterovska Doctor's Practice in Endocrinology,Ogre

đŸ‡±đŸ‡»

Ogre, Latvia

Ospedale Molinette, AO CittĂ  della Salute e della

đŸ‡®đŸ‡¹

Torino, Italy

Zemgales Center of diabetes, Jelgava

đŸ‡±đŸ‡»

Jelgava, Latvia

A. Lucenko's Internist & Endocrinologist Doctor's Practice

đŸ‡±đŸ‡»

Liepaja, Latvia

P. Stradins Clinical University Hospital, Riga

đŸ‡±đŸ‡»

Riga, Latvia

ClĂ­nica EndocrInol en Diabetes Obesidad y Tiroides (DOT)

đŸ‡²đŸ‡½

Aguascalientes, Mexico

Noordwest Ziekenhuisgroep

đŸ‡³đŸ‡±

Alkmaar, Netherlands

Gelre Ziekenhuizen Apeldoorn

đŸ‡³đŸ‡±

Apeldoorn, Netherlands

Ziekenhuisgroep Twente locatie Almelo

đŸ‡³đŸ‡±

Almelo, Netherlands

EB Utrecht Research

đŸ‡³đŸ‡±

Utrecht, Netherlands

Meander Medisch Centrum

đŸ‡³đŸ‡±

Amersfoort, Netherlands

Universitair Medisch Centrum Utrecht

đŸ‡³đŸ‡±

Utrecht, Netherlands

South Pacific Clinical Trials

đŸ‡³đŸ‡¿

Auckland, New Zealand, New Zealand

Lipid and Diabetes Research Group

đŸ‡³đŸ‡¿

Christchurch, New Zealand

Milit. Cent. Emerg. Univ. Hosp. Dr. Davila, Met. Dis. Dept.

đŸ‡·đŸ‡´

Bucharest, Romania

City Outpatient dep.no.107;clinc.pharmacology,st.petersburg

đŸ‡·đŸ‡º

St. Petersburg, Russian Federation

Hospital de la Inmaculada ConcepciĂ³n

đŸ‡ªđŸ‡¸

Granada, Spain

Bradford Royal Infirmary

đŸ‡¬đŸ‡§

Bradford, United Kingdom

Royal Bournemouth and Christchurch Hospital

đŸ‡¬đŸ‡§

Bournemouth, United Kingdom

James Cook University Hospital

đŸ‡¬đŸ‡§

Middlesbrough, United Kingdom

Medical Centre Pratia Warszawa

đŸ‡µđŸ‡±

Warsaw, Poland

NZOZ Med-Art.Specialist Clinics, Zory

đŸ‡µđŸ‡±

Zory, Poland

APDP - AssociaĂ§Ă£o Protectora dos DiabĂ©ticos de Portugal

đŸ‡µđŸ‡¹

Lisboa, Portugal

H. Santo AntĂ³nio - Centro Hospitalar do Porto

đŸ‡µđŸ‡¹

Porto, Portugal

ULSAM, EPE - Hospital de Santa Luzia

đŸ‡µđŸ‡¹

Viana do Castelo, Portugal

Unidad de Investigacion Clinica Cardiometabolica de Occident

đŸ‡²đŸ‡½

Guadalajara, Mexico

Riga Health Center, Private Practice

đŸ‡±đŸ‡»

Riga, Latvia

Instituto Jaliscience de Inv. en Diabetes y Obesidad, S.C.

đŸ‡²đŸ‡½

Guadalajara, Mexico

Centro Hospitalar da Cova da Beira Hospital PĂªro da CovilhĂ£

đŸ‡µđŸ‡¹

CovilhĂ£, Portugal

Centro Hospitalar SĂ£o JoĂ£o,EPE

đŸ‡µđŸ‡¹

Porto, Portugal

Centro Hospitalar de Vila Nova de Gaia

đŸ‡µđŸ‡¹

Vila Nova de Gaia, Portugal

Unidad de Patologia Clinica

đŸ‡²đŸ‡½

Guadalajara, Mexico

University of Colorado Denver

đŸ‡ºđŸ‡¸

Aurora, Colorado, United States

Kentucky Diabetes Endocrinology Center

đŸ‡ºđŸ‡¸

Lexington, Kentucky, United States

Clinical Research Consultants, LLC

đŸ‡ºđŸ‡¸

Kansas City, Missouri, United States

Endocrine-Diabetes Care and Resource Center

đŸ‡ºđŸ‡¸

Rochester, New York, United States

Texas Diabetes & Endocrinology PA

đŸ‡ºđŸ‡¸

Austin, Texas, United States

Guy's Hospital

đŸ‡¬đŸ‡§

London, United Kingdom

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