A Study of Insulin Efsitora Alfa (LY3209590) Compared to Degludec in Adults With Type 2 Diabetes Who Are Starting Basal Insulin for the First Time
- Conditions
- DiabetesType 2 Diabetes
- Interventions
- Registration Number
- NCT05362058
- Lead Sponsor
- Eli Lilly and Company
- Brief Summary
The purpose of this study is to determine the effect and safety of insulin efsitora alfa (LY3209590) compared to degludec in adult participants with type 2 diabetes who are starting basal insulin for the first time. The study consists of a 1-week screening period, a 2-week lead-in period, a 52-week treatment period, and a 5-week safety follow-up period. The study will last up to 60 weeks.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 928
-
Have diagnosis of Type 2 diabetes (T2D) according to the World Health Organization Criteria
-
Have an Hemoglobin A1c (HbA1c) of 7.0 percent (%) - 10.5% inclusive, at screening
-
Are on a stable treatment with 1 to 3 antihyperglycemic medication for at least 3 months prior to screening and willing to continue the stable treatment for the duration of the study
-
These antihyperglycemic medications are accepted in the study
- dipeptidyl peptidase-4 (DPP-4) inhibitors
- sodium-glucose cotransporter 2 (SGLT2) inhibitors
- biguanides, such as metformin
- alpha-glucosidase inhibitors
- glucagon-like peptide-1 (GLP-1) receptor agonists, oral or injectable
- Sulfonylureas, or
- Thiazolidinediones.
-
Are insulin naïve.
Exceptions:
-
short-term insulin treatment for a maximum of 14 days, prior to screening, and prior insulin treatment for gestational diabetes
- Have a body mass index of less than or equal to (≤) 45 kilogram/square meter (kg/m²).
-
Have a diagnosis of Type 1 diabetes (T1D), latent autoimmune diabetes, or a specific type of diabetes other than T2D, for example, monogenic diabetes, diseases of the exocrine pancreas, or drug-induced or chemical-induced diabetes.
-
Have a history of greater than (>) 1 episode of ketoacidosis or hyperosmolar state or coma requiring hospitalization within 6 months prior to screening. Have had severe hypoglycemia episodes within 6 months prior to screening. Have a history of renal transplantation, are currently receiving renal dialysis, or have an estimated glomerular filtration rate.
-
Have known hemoglobinopathy, hemolytic anemia or sickle cell anemia, or any other traits of hemoglobin abnormalities known to interfere with the measurement of HbA1c.
-
Have had New York Heart Association Class IV heart failure or any of these cardiovascular conditions within 3 months prior to screening
- Acute myocardial infarction
- Cerebrovascular accident (stroke), or
- Coronary bypass surgery.
- Have had gastric bypass (bariatric) surgery, restrictive bariatric surgery, for example Lap-Band, or sleeve gastrectomy within 1 year prior to screening
- Have had significant weight gain or loss within 3 months prior to screening, for example, greater than or equal to (≥) 5%.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description 500 U/mL - Insulin Efsitora Alfa Insulin Efsitora Alfa * Participants received 500 units per milliliter (U/mL) of insulin efsitora alfa administered subcutaneously (SC) once weekly (QW) over a 52-week treatment period, followed by a 5-week safety follow-up period. * Participants continued their protocol-specified stable therapy with non-insulin antihyperglycemic medications throughout the study, at the discretion of the investigator. 100 U/mL - Insulin Degludec Insulin Degludec * Participants received 100 U/mL insulin degludec administered SC once daily (QD) over a 52-week treatment period, followed by a 5-week safety follow-up period. * Participants continued their protocol-specified stable therapy with non-insulin antihyperglycemic medications throughout the study, at the discretion of the investigator.
- Primary Outcome Measures
Name Time Method Change From Baseline in HbA1c at Week 52 [Noninferiority Analysis] Baseline, Week 52 * HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time.
* Least Squares (LS) mean was determined using Analysis of Covariance (ANCOVA) model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.
- Secondary Outcome Measures
Name Time Method Change From Baseline in HbA1c at Week 52 in Participants Using GLP-1 Receptor Agonists [Noninferiority Analysis] Baseline, Week 52 * HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time.
* LS mean was determined using ANCOVA model with Baseline + Country + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.Change From Baseline in HbA1c at Week 52 in Participants Not Using GLP-1 Receptor Agonists [Noninferiority Analysis] Baseline, Week 52 * HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time.
* LS mean was determined using ANCOVA model with Baseline + Country + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.Change From Baseline in HbA1c at Week 52 [Superiority Analysis] Baseline, Week 52 * HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time.
* LS mean was determined using ANCOVA model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.Percentage of Time in the Blood Glucose Range Between 70 and 180 mg/dL [3.9 and 10.0 mmol/L] - Week 48 to Week 52 Week 48 to Week 52 * Percentage of time spent within the blood glucose range of 70 to 180 milligrams per deciliter (mg/dL) \[3.9 to 10.0 millimoles per liter (mmol/L)\], as measured during the continuous glucose monitoring (CGM) session over a 24-hour period, from Week 48 to Week 52.
* LS mean was determined using ANCOVA model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization + SU Use at Randomization + Treatment (Type III sum of squares) as variables. Missing data at baseline were imputed using multiple imputation under the assumption of missing at random, while missing data at Week 48-52 were imputed using a return-to-baseline multiple imputation approach.Change From Baseline in HbA1c at Week 26 [Superiority Analysis] Baseline, Week 26 * HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time.
* LS mean was determined using ANCOVA model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 26 were imputed by return-to-baseline multiple imputations approach.Percentage of Time in the Blood Glucose Range Between 70 and 180 mg/dL [3.9 and 10.0 mmol/L] - Week 22 to Week 26 Week 22 to Week 26 * Percentage of time spent within the blood glucose range of 70 to 180 mg/dL (3.9 to 10.0 mmol/L), as measured during the CGM session over a 24-hour period, from Week 22 to Week 26.
* LS mean was determined using ANCOVA model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization + SU Use at Randomization + Treatment (Type III sum of squares) as variables. Missing data at baseline were imputed using multiple imputation under the assumption of missing at random, while missing data at Week 22-26 were imputed using a return-to-baseline multiple imputation approach.Change From Baseline in Fasting Blood Glucose (FBG) Baseline, Week 26, Week 52 Change from baseline in fasting blood glucose measured by self-monitoring blood glucose (SMBG).
Glucose Variability Week 22 to Week 26 and Week 48 to Week 52 * Glucose variability measured as coefficient of variation (CV) for blood glucose during the CGM session over a 24-hour period, between Week 22 to Week 26 and Week 48 to Week 52 was reported.
* LS mean was determined using Mixed Model Repeated Measures (MMRM) model with Baseline + Country +HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Basal Insulin Dose Week 26 and Week 52 * The insulin dose was calculated based on the participant's entry of daily or weekly insulin doses in an electronic diary. The average weekly basal insulin dose at Week 26 and Week 52 was reported.
* LS mean was determined using MMRM model with Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Hypoglycemia Event Rate Baseline up to Week 52 * A hypoglycemic event with blood glucose (BG) levels of less than (\<) 54 mg/dL (3.0 mmol/L) \[Level 2\] or Severe Hypoglycemia \[Level 3\] was reported. A severe hypoglycemic event was characterized by altered mental or physical status, requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions for the treatment of hypoglycemia.
* Group mean was reported and determined by Negative binomial model using Number of episodes = HbA1c at Baseline (%) + Treatment, with log (exposure in days/365.25) as an offset variable.Nocturnal Hypoglycemia Event Rate Baseline up to Week 52 * The event rate of participant-reported clinically significant nocturnal hypoglycemia (defined as blood glucose level \<54 mg/dL (3.0 mmol/L) or severe hypoglycemia and occurs at night and presumably during sleep between midnight and 6:00 AM), measured during treatment phase up to week 52.
* Group mean was reported and determined by Negative binomial model using Number of episodes = HbA1c at Baseline (%) + Treatment, with log (exposure in days/365.25) as an offset variable.Change From Baseline in Body Weight Baseline, Week 26, Week 52 Change from baseline in body weight was reported. LS mean was determined by MMRM model with Baseline + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Percentage of Time in Hypoglycemia Range With Blood Glucose <70 mg/dL (3.9 mmol/L) Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52 * Percentage of time spent in the hypoglycemia range with blood glucose \<70 mg/dL (3.9 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52 was reported.
* LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Percentage of Time in Hypoglycemia Range With Blood Glucose <54 mg/dL (3.0 mmol/L) Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52 * Percentage of time spent in the hypoglycemia range with blood glucose \< 54 mg/dL (3.0 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52, was reported.
* LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Percentage of Time in Hyperglycemia Range With Blood Glucose >180 mg/dL (10.0 mmol/L) Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52 * Percentage of time spent in the hyperglycemia range with blood glucose greater than (\>) 180 mg/dL (10.0 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52 was reported.
* LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Change From Baseline in Treatment-Related Impact Measures for Diabetes (TRIM-D) -Total Score at Week 26 and Week 52 Baseline, Week 26, Week 52 * The TRIM-D is a participant-reported measure designed to assess the impact of diabetes treatment on individuals' functioning and well-being across different diabetes treatments. The questionnaire includes 28 items grouped into 5 sub-domains: treatment burden, daily life, diabetes management, compliance, and psychological health. Each item is assessed on a 5-point scale, with higher scores indicating better health status. All items were summed to obtain a total raw score, which was transformed to a scale of 0 to 100 to obtain a total score. The total score range is 0-100, with a higher total score indicating better overall health and well-being, while a lower total score indicates worse health or well-being.
* LS mean was determined using MMRM model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.Change From Baseline in Short Form-36 Health Survey Version 2 (SF-36v2) Acute Form (Physical-Component and Mental-Component) Scores at Week 26 and Week 52 Baseline, Week 26, Week 52 The SF-36v2 is a participant-reported measure designed to assess health status using 36 items across 8 domains: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. Each domain is scored individually, and information from these 8 domains is further aggregated into 2 health component summary scores, the Physical Component Summary and Mental Component Summary. Scoring of each domain and both summary scores are norm based and presented in the form of T-scores, with a mean of 50 and a standard deviation of 10. Higher scores indicate better levels of function and/or better health. Range cannot be specified in norm-based scores.
Change From Baseline in EuroQuality of Life (EuroQol) - 5 Dimensions-5 Levels (EQ-5D-5L) Health State Index and EQ Visual Analog Scale (VAS) Scores at Week 26 and Week 52 Baseline, Week 26, Week 52 The EQ-5D-5L is a multidimensional, health-related, quality-of-life instrument. It includes 5 dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) that are assessed at 5 levels of response (no problems, slight problems, moderate problems, severe problems, and unable to perform or extreme problems). The scores in the 5 dimensions were summarized into a health state index score. A single health-state index value was derived, which ranges from less than 0 (health state equivalent to death, negative values are valued as worse than death) to 1 (perfect health). The EQ VAS rates the participants' perceived health from 0 (the worst imaginable health) to 100 (the best imaginable health). This score provides a composite picture of the respondent's health status.
Trial Locations
- Locations (113)
NorCal Medical Research, Inc
🇺🇸Greenbrae, California, United States
Catalina Research Institute, LLC
🇺🇸Montclair, California, United States
East Coast Institute for Research, LLC
🇺🇸Jacksonville, Florida, United States
Iowa Diabetes and Endocrinology Research Center
🇺🇸West Des Moines, Iowa, United States
MedStar Health Research Institute (MedStar Physician Based Research Network)
🇺🇸Hyattsville, Maryland, United States
Endocrine and Metabolic Consultants
🇺🇸Rockville, Maryland, United States
Great Lakes Medical Research, LLC
🇺🇸Westfield, New York, United States
Dallas Diabetes Research Center
🇺🇸Dallas, Texas, United States
New England Research Associates, LLC
🇺🇸Bridgeport, Connecticut, United States
Clarity Clinical Research
🇺🇸East Syracuse, New York, United States
Clinvest Research LLC
🇺🇸Springfield, Missouri, United States
Intend Research, LLC
🇺🇸Norman, Oklahoma, United States
Aggarwal and Associates Limited
🇨🇦Brampton, Ontario, Canada
Cline Research Center
🇧🇷Curitiba, Paraná, Brazil
CEPIC - Centro Paulista de Investigação Clínica
🇧🇷São Paulo, Brazil
LMC Diabetes & Endocrinology
🇨🇦Brampton, Ontario, Canada
LMC Manna Research
🇨🇦Ottawa, Ontario, Canada
Bluewater Clinical Research Group Inc.
🇨🇦Sarnia, Ontario, Canada
Centricity Research Etobicoke Endocrinology
🇨🇦Toronto, Ontario, Canada
Fadia El Boreky Medicine
🇨🇦Waterloo, Ontario, Canada
9109-0126 Quebec Inc.
🇨🇦Montreal, Quebec, Canada
Hebei Medical University - Harrison International Peace Hospital
🇨🇳Hengshui Shi, Hebei, China
The First People's Hospital of Yueyang
🇨🇳Yueyang, Hunan, China
The Second Affiliated Hospital of Nanjing Medical University
🇨🇳Nanjing, Jiangsu, China
The First Affiliated Hospital of Soochow University
🇨🇳Suzhou, Jiangsu, China
Juno Research
🇺🇸Houston, Texas, United States
The First Hospital of Harbin Medical University
🇨🇳Harbin, Heilongjiang, China
The Second Xiangya Hospital of Central South University
🇨🇳Changsha, Hunan, China
The First Affiliated Hospital of Henan University of Science &Technology
🇨🇳Luoyang Shi, Henan, China
Wuxi People's Hospital
🇨🇳Wuxi, Jiangsu, China
Jinan Central Hospital
🇨🇳Jinan, Shandong, China
Nanjing Medical University - Nanjing Jiangning Hospital
🇨🇳Nanjing, Jiangsu, China
The Affiliated Jiangyin Hospital of Southeast University Medical College
🇨🇳Wuxi Shi, Jiangsu, China
Shanghai Putuo District Center Hospital
🇨🇳Shanghai, Shanghai, China
Neighborhood Healthcare Institute of Health
🇺🇸Escondido, California, United States
Valley Research
🇺🇸Fresno, California, United States
Southern California Dermatology, Inc.
🇺🇸Santa Ana, California, United States
East Coast Institute for Research - Canton
🇺🇸Canton, Georgia, United States
Qualmedica Research, LLC
🇺🇸Evansville, Indiana, United States
Qualmedica Research
🇺🇸Bowling Green, Kentucky, United States
Monroe Biomedical Research
🇺🇸Monroe, North Carolina, United States
Lucas Research, Inc
🇺🇸Morehead City, North Carolina, United States
Southern Endocrinology Associates
🇺🇸Mesquite, Texas, United States
North Hills Family Medicine/North Hills Medical Research
🇺🇸North Richland Hills, Texas, United States
Multicare Institute for Research and Innovation
🇺🇸Spokane, Washington, United States
New West Physicians Clinical Research
🇺🇸Golden, Colorado, United States
CEDOES
🇧🇷Vitória, Espírito Santo, Brazil
Rophe Adult and Pediatric Medicine/SKYCRNG
🇺🇸Union City, Georgia, United States
Central Illinois Diabetes and Clinical Research a Division of Prairie Education and Research Cooperative
🇺🇸Springfield, Illinois, United States
Jefferson Clinical Research Institute (JCRI)
🇺🇸Philadelphia, Pennsylvania, United States
Tribe Clinical Research, LLC
🇺🇸Greenville, South Carolina, United States
Hospital São Lucas de Copacabana
🇧🇷Rio de Janeiro, Brazil
CPCLIN
🇧🇷Sao Paulo, Brazil
Beijing Pinggu District Hospital
🇨🇳Beijing, Beijing, China
Chongqing General Hospital
🇨🇳Chongqing, Chongqing, China
The Fourth Hospital of Harbin Medical University
🇨🇳Harbin, Heilongjiang, China
The Second Affiliated Hospital of Zhengzhou University
🇨🇳Zhengzhou, Henan, China
Nanjing First Hospital
🇨🇳Nanjing Shi, Jiangsu, China
Changzhou No.2 People's Hospital
🇨🇳Changzhou, Jiangsu, China
Affiliated Hospital of Jiangsu University
🇨🇳Zhenjiang, Jiangsu, China
The Third Hospital of Nanchang
🇨🇳Nanchang, Jiangxi, China
West China Hospital of Sichuan University
🇨🇳Cheng Du, Sichuan, China
Chengdu Fifth People's Hospital
🇨🇳Chengdu, Sichuan, China
Tianjin Medical University Zhu Xianyi Memorial Hospital
🇨🇳Tianjin, Tianjin, China
Zhejiang Hospital
🇨🇳Hangzhou, Zhejiang, China
Tianjin Medical University General Hospital
🇨🇳Tianjin, Tianjin, China
Ningbo First Hospital
🇨🇳Ningbo, Zhejiang, China
INTENDIA klinika s.r.o.
🇨🇿Chrudim III, Chrudim, Czechia
MUDr. Alena Vachova
🇨🇿Ceske Budejovice, Jihočeský, Czechia
MUDr. Tomas Edelsberger
🇨🇿Krnov, Moravskoslezský Kraj, Czechia
Milan Kvapil s.r.o., Diabetologicka ambulance
🇨🇿Praha, Praha 4, Czechia
Diacentrum Brandys n.L. s.r.o.
🇨🇿Brandys nad Labem, Praha-vých, Czechia
Diahelp s.r.o
🇨🇿Pardubice V, Pardubice, Czechia
MUDr. Tomas Hrdina
🇨🇿Opocno, Rychnov Nad Kněžnou, Czechia
Zentrum für klinische Studien
🇩🇪Saint Ingbert, Saarland, Germany
InnoDiab Forschung Gmbh
🇩🇪Essen, Nordrhein-Westfalen, Germany
Universitaetsklinikum Carl Gustav Carus Dresden
🇩🇪Dresden, Sachsen, Germany
Diabetologikum Ludwigshafen/Die Praxis am Ludwigsplatz
🇩🇪Ludwigshafen am Rhein, Rheinland-Pfalz, Germany
Diabeteszentrum Hamburg West
🇩🇪Hamburg, Germany
RED-Institut GmbH
🇩🇪Oldenburg, Schleswig-Holstein, Germany
Thermi Clinic
🇬🇷Thessaloniki, Thessaloníki, Greece
Athens Euroclinic
🇬🇷Athens, Greece
Kashiwa City Hospital
🇯🇵Kashiwa, Chiba, Japan
Tokuyama Clinic
🇯🇵Mihama-ku,Chiba City, Chiba, Japan
Nippon Kokan Fukuyama Hospital
🇯🇵Fukuyama-shi, Hiroshima, Japan
Hasegawa Medical Clinic
🇯🇵Chitose, Hokkaido, Japan
Manda Memorial Hospital
🇯🇵Sapporo, Hokkaido, Japan
MinamiAkatsukaClinic
🇯🇵Mito, Ibaraki, Japan
Nakakinen clinic
🇯🇵Naka, Ibaraki, Japan
Hayashi Diabetes Internal Medicine Clinic
🇯🇵Chigasaki, Kanagawa, Japan
Medical Corporation Yuga Tsuruma Kaneshiro Diabetes Clinic
🇯🇵Yamato-shi, Kanagawa, Japan
Kumanomae Nishimura Clinic
🇯🇵Arakawa-ku, Tokyo, Japan
Shimizu Clinic Fusa
🇯🇵Saitama-shi, Saitama, Japan
Fukuwa Clinic
🇯🇵Chuo-ku, Tokyo, Japan
Medical Corporation Sato Medical clinic
🇯🇵Ootaku, Tokyo, Japan
Hachioji Diabetes Clinic
🇯🇵Hachioji-shi, Tokyo, Japan
Tomonaga Clinic
🇯🇵Shinjuku, Tokyo, Japan
Yoshimura Clinic
🇯🇵Kumamoto, Japan
Abe Clinic
🇯🇵Oita, Japan
Kangwon National University Hospital
🇰🇷Chuncheon-si, Kang-won-do, Korea, Republic of
Hanyang University Guri Hospital
🇰🇷Guri-si, Kyǒnggi-do, Korea, Republic of
Severance Hospital, Yonsei University Health System
🇰🇷Seoul, Seoul-teuk, Korea, Republic of
Centro de Endocrinologia y Nutricion
🇵🇷Caguas, Puerto Rico
Investigacion En Salud Y Metabolismo Sc
🇲🇽Chihuahua, Mexico
Private Practice - Dr. Paola Mansilla-Letelier
🇵🇷Guaynabo, Puerto Rico
Praxis Sauter & Sauter & Vorbach
🇩🇪Wangen im Allgäu, Baden-Württemberg, Germany
Alexandra Hospital
🇬🇷Athens, Attikí, Greece
Iatriko Paleou Falirou Medical Center
🇬🇷Paleo Faliro, Attikí (Region), Greece
Centro de Pesquisa Sao Lucas
🇧🇷Campinas, São Paulo, Brazil
Medizentrum Essen Borbeck
🇩🇪Essen, Nordrhein-Westfalen, Germany
Tosaki Clinic for Diabetes and Endocrinology
🇯🇵Nagoya-shi, Aichi, Japan
CPQuali Pesquisa Clínica
🇧🇷São Paulo, Brazil
SKY Clinical Research Network Group-Quinn
🇺🇸Ridgeland, Mississippi, United States