Comparative Trial Between Insulin Glargine Plus Supplemental Glulisine (Apidra) Versus Sliding Scale Regular Insulin In Hospitalized Patients With Type 2 Diabetes
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 130
- 试验地点
- 1
- 主要终点
- blood glucose control
研究概览
简要总结
High blood glucose levels in hospitalized patients with diabetes are associated with increased risk of medical complications. Improved glucose control with insulin injections may improve clinical outcome and prevent some of the hospital complications. It is not known; however, what is the best insulin regimen in hospitalized patients. The use of repeated injections of regular insulin (known as sliding scale regimen) is one of the most commonly used insulin regimen for glucose control in hospitalized patients with diabetes. Recently, the combination of basal and rapid acting insulins has been shown to improve glucose control with lower rate of hypoglycemia (low blood sugar).
详细描述
This study will compare how well regular insulin will compare to glargine (Lantus®) once daily plus glulisine (Apidra®) insulin before meals in hospitalized patients with type 2 diabetes and elevated blood glucose (sugar) levels. Lantus is a long-acting insulin which is given subcutaneously (under the skin) once daily. Apidra is a rapid-acting insulin which is given subcutaneously several times a day and frequently before meals. Regular insulin is a short-acting insulin in clinical use for more than 20 years that is also given subcutaneously several times per day. Lantus, Apidra and regular insulins are approved for use in the treatment of patients with diabetes by the FDA.
This investigator-initiated research will be conducted at Grady Memorial Hospital, Atlanta and at Jackson Memorial Hospital, Miami. Dr. Umpierrez designed the study and will serve as principal investigator. A total of 65 patients will be recruited at Grady and 65 patients at the Jackson Memorial Hospital. This study is supported by Sanofi-Aventis Pharmaceuticals.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 70 Years（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Males or females between the ages of 18 and 70 years admitted to a general medicine service.
- •A known history of type 2 diabetes mellitus > 3 months, receiving either diet alone or any combination of oral antidiabetic agents (sulfonylureas, metformin, thiazolidinediones).
- •Subjects must have an admission blood glucose > 140 mg and < 400 mg/dL without laboratory evidence of diabetic ketoacidosis (serum bicarbonate < 18 mEq/L or positive serum or urinary ketones).
排除标准
- •Subjects with increased blood glucose concentration, but without a known history of diabetes.
- •Subjects with a history of diabetic ketoacidosis and hyperosmolar hyperglycemic state, or ketonuria [57].
- •Patients with known HIV, acute critical or surgical illness and/or expected to require admission to a critical care unit (ICU, CCU), corticosteroid therapy, or to undergo surgery during the hospitalization course.
- •Patients with clinically relevant hepatic disease or impaired renal function, as shown by a serum creatinine ≥3.
- •Mental condition rendering the subject unable to understand the nature, scope, and possible consequences of the study.
- •Patients with recognized or suspected endocrine disorders associated with increased insulin resistance, acromegaly, or hyperthyroidism.
- •Female subjects are pregnant or breast feeding at time of enrollment into the study.
研究组 & 干预措施
sliding scale regular insulin
sliding scale insulin given acqhs
干预措施: sliding scale regular insulin (Drug)
glargine insulin and glulisine insulin
glargine basal insulin once a day with prandial glulisine insulin tid
干预措施: glargine basal insulin and glulisine prandial insulin (Drug)
结局指标
主要结局
blood glucose control
时间窗: During hospitalization
Differences in BG control will be assessed between the 2 arms acqhs and as needed for those patients hospitalized on the non-medical floors
次要结局
- length of hospital stay(during hospitalization)
- frequency of severe hyperglycemia (BG > 400 mg/dl),(during the hospitalization)
- frequency of hypoglycemia(during the hospitalization)
- inflammatory markers(during hospitalization)
研究者
Guillermo Umpierrez
Principal Investigator
Emory University