Trial Outcomes & Findings for Basal Bolus Versus Basal Insulin in Type 2 Diabetes Mellitus (T2DM) (NCT NCT00979628)

NCT ID: NCT00979628

Last Updated: 2018-10-10

Results Overview

The primary outcome is to determine the effective glycemic control among the subjects that received Basal Plus (glargine once daily plus corrective doses of glulisine before meals and bedtime as needed), Basal Bolus approach of glargine once daily plus corrective doses of glulisine before meals and Sliding Scale Regular Insulin (SSRI). Glycemic control is measured by mean blood glucose(BG) levels in mg/dL after first day of treatment and are compared to mean BG levels at randomization among subjects treated with Basal Plus, Basal -bolus and SSRI treatments. The optimal glycemic control is achieved when BG levels are between 70 mg/dL -140 mg/dL. The BG levels levels below 70 mg/dL are regarded as hypoglycemic events. The BG levels levels above 140 mg/dl are considered elevated and Hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions).

Recruitment status

COMPLETED

Study phase

PHASE4

Target enrollment

375 participants

Primary outcome timeframe

Randomization and 24 hrs after treatment

Results posted on

2018-10-10

Participant Flow

375 subjects were enrolled in the study from January 2010 to June 2012. The study is conducted in 3 states and patients were enrolled from 3 hospitals in state of Georgia; 1 hospitals in south Carolina and 1 hospitals in Texas.

24 subjects that were consented were withdrawn from the study and not included in analysis because they meet exclusion criteria like transferring to ICU; receiving treatment \< 24 hrs and for receiving steroids

Participant milestones

Participant milestones
Measure
Basal Bolus
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus : glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Basal Plus Regimen
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus : glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Sliding Scale Regular Insulin (SSRI)
four-time daily in patients with T2DM admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI) : four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Overall Study
STARTED
153
142
80
Overall Study
COMPLETED
144
133
74
Overall Study
NOT COMPLETED
9
9
6

Reasons for withdrawal

Reasons for withdrawal
Measure
Basal Bolus
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus : glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Basal Plus Regimen
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus : glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Sliding Scale Regular Insulin (SSRI)
four-time daily in patients with T2DM admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI) : four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Overall Study
received regimen < 24 hours
7
6
5
Overall Study
received steroids
1
1
0
Overall Study
transferred to ICU
1
2
1

Baseline Characteristics

Basal Bolus Versus Basal Insulin in Type 2 Diabetes Mellitus (T2DM)

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Basal Bolus
n=153 Participants
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus : glargine once daily plus glulisine before meals subcut at an initial dose of 0.3-0.5 units/kg/day (plus corrective doses of glulisine as needed)
Basal Plus Regimen
n=142 Participants
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus : glargine once daily subcut at an initial dose of 0.15-0.25 units/kg/day plus corrective doses of glulisine subcut before meals and bedtime as needed
Sliding Scale Regular Insulin (SSRI)
n=80 Participants
four-time daily in patients with T2DM admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI) given subcut four-times daily before meals and at bedtime
Total
n=375 Participants
Total of all reporting groups
Age, Continuous
58.7 years
STANDARD_DEVIATION 11 • n=39 Participants
58.6 years
STANDARD_DEVIATION 13 • n=41 Participants
58.7 years
STANDARD_DEVIATION 12 • n=35 Participants
58.6 years
STANDARD_DEVIATION 12 • n=31 Participants
Sex: Female, Male
Female
62 Participants
n=39 Participants
65 Participants
n=41 Participants
33 Participants
n=35 Participants
160 Participants
n=31 Participants
Sex: Female, Male
Male
91 Participants
n=39 Participants
77 Participants
n=41 Participants
47 Participants
n=35 Participants
215 Participants
n=31 Participants

PRIMARY outcome

Timeframe: Randomization and 24 hrs after treatment

The primary outcome is to determine the effective glycemic control among the subjects that received Basal Plus (glargine once daily plus corrective doses of glulisine before meals and bedtime as needed), Basal Bolus approach of glargine once daily plus corrective doses of glulisine before meals and Sliding Scale Regular Insulin (SSRI). Glycemic control is measured by mean blood glucose(BG) levels in mg/dL after first day of treatment and are compared to mean BG levels at randomization among subjects treated with Basal Plus, Basal -bolus and SSRI treatments. The optimal glycemic control is achieved when BG levels are between 70 mg/dL -140 mg/dL. The BG levels levels below 70 mg/dL are regarded as hypoglycemic events. The BG levels levels above 140 mg/dl are considered elevated and Hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions).

Outcome measures

Outcome measures
Measure
Basal Plus Regimen
n=133 Participants
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus: glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Basal Bolus
n=144 Participants
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus: glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Sliding Scale Regular Insulin (SSRI)
n=74 Participants
four-time daily in patients with type 2 diabetes mellitus (T2DM) admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI): four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Mean Blood Glucose Levels (Measured in mg/dL) at Randomization Are Compared to Mean Blood Glucose Levels After First Day of Treatment Among Subjects Treated With Basal Plus, Basal -Bolus and SSRI Treatments
Randomization
194 mg/dL
Standard Deviation 45
200 mg/dL
Standard Deviation 49
187 mg/dL
Standard Deviation 43
Mean Blood Glucose Levels (Measured in mg/dL) at Randomization Are Compared to Mean Blood Glucose Levels After First Day of Treatment Among Subjects Treated With Basal Plus, Basal -Bolus and SSRI Treatments
After first day of therapy
163 mg/dL
Standard Deviation 37
156 mg/dL
Standard Deviation 36
172 mg/dL
Standard Deviation 41

SECONDARY outcome

Timeframe: During hospital stay, up to 12 days

Effective Glycemic control is also assessed by number of hypoglycemia events among the patients treated with Basal plus, basal-bolus and SSRI treatments. Hypoglycemia event is defined as blood glucose levels \<70 mg/dL. Number of patients with hypoglycemia episodes that are treated with Basal plus, basal-bolus and SSRI treatment regimens during their hospital stay are examined and compared.

Outcome measures

Outcome measures
Measure
Basal Plus Regimen
n=144 Participants
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus: glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Basal Bolus
n=133 Participants
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus: glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Sliding Scale Regular Insulin (SSRI)
n=74 Participants
four-time daily in patients with type 2 diabetes mellitus (T2DM) admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI): four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Number of Patients With Hypoglycemia Events (Blood Glucose Levels < 70 mg/dL) During Their Hospital Stay That Are Treated With Basal Plus, Basal-bolus and SSRI Treatments
23 participants
17 participants
2 participants

Adverse Events

Basal Plus Regimen

Serious events: 18 serious events
Other events: 16 other events
Deaths: 3 deaths

Basal Bolus

Serious events: 22 serious events
Other events: 13 other events
Deaths: 0 deaths

Sliding Scale Regular Insulin (SSRI)

Serious events: 7 serious events
Other events: 3 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Basal Plus Regimen
n=133 participants at risk
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus: glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Basal Bolus
n=144 participants at risk
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus: glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Sliding Scale Regular Insulin (SSRI)
n=74 participants at risk
four-time daily in patients with T2DM admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI): four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Metabolism and nutrition disorders
Severe hypoglycemia
0.75%
1/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.69%
1/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.00%
0/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
Infections and infestations
wound infections
2.3%
3/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.69%
1/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
1.4%
1/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
Respiratory, thoracic and mediastinal disorders
pneumonia
0.00%
0/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
2.1%
3/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.00%
0/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
Respiratory, thoracic and mediastinal disorders
Acute Respiratory Failure
1.5%
2/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.69%
1/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
0.00%
0/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
Renal and urinary disorders
Acute Renal Failure
6.0%
8/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
6.2%
9/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
4.1%
3/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
Infections and infestations
Bacteremia
3.0%
4/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
4.9%
7/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
4.1%
3/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.

Other adverse events

Other adverse events
Measure
Basal Plus Regimen
n=133 participants at risk
glargine once daily plus corrective doses of glulisine before meals and bedtime as needed Basal Plus: glargine once daily plus corrective doses of glulisine before meals and bedtime as needed
Basal Bolus
n=144 participants at risk
glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed) Basal Bolus: glargine once daily plus glulisine before meals (plus corrective doses of glulisine as needed)
Sliding Scale Regular Insulin (SSRI)
n=74 participants at risk
four-time daily in patients with T2DM admitted to general medicine and surgery wards. sliding scale regular insulin (SSRI): four-time daily in patients with T2DM admitted to general medicine and surgery wards.
Metabolism and nutrition disorders
Hypoglycemia
12.0%
16/133 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
9.0%
13/144 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.
4.1%
3/74 • The time frame for the study is the duration of hospital stay of the patients. Among the study patients the mean (standard deviation) hospital stay for Basal bolus patients was 5.9 (5) days; Basal plus patients was 6(6) days; SSRI patients was 5.5(5) days.
Subjects were followed daily by the investigators for complications and mortality. But the study end points on adverse events are related to blood glucose (BG) levels. Hypoglycemia is defined as BG levels of \< 70 mg/dL. Severe hypoglycemia is defined as blood glucose levels of \< 40 mg/dL. Inpatient hyperglycemia defined as a fasting BG \>126 mg/dl or random BG \>200 mg/dl on two or more occasions.

Additional Information

Guillermo Umpierrez

EUSOM

Phone: 4047781665

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place