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Glargine Dosing in Hospitalized Patients With Type 2 Diabetes and Renal Insufficiency

Information source: Loyola University
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Type 2 Diabetes; Renal Insufficiency

Intervention: Glargine & glulisine (Drug); Glargine & glulisine (Drug)

Phase: Phase 4

Status: Recruiting

Sponsored by: Loyola University

Official(s) and/or principal investigator(s):
Mary Ann Emanuele, MD, Principal Investigator, Affiliation: Loyola University

Overall contact:
Barbara Sexton, RN, Phone: 708-216-8223, Email: bsexton@lumc.edu

Summary

It is imperative to devise easy to follow, yet appropriate, guidelines for insulin use in renal-impaired patients. This will be done by comparing two regimens: 1) glargine once daily plus mealtime glulisine based on weight alone and 2) a predetermined dosing reduction algorithm with glargine/glulisine based on weight with reduction for decreased estimated GFR by MDRD as follows: < 30 ml/min/1. 73m2 or on dialysis reduce dose by 50% from weight based calculation.

Clinical Details

Official title: Glargine Dosing in Hospitalized Patients With Type 2 Diabetes and Renal Insufficiency

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: To determine if a glargine based regime with dose reduction for renal insufficiency is more efficacious than a glargine regime without such a reduction in hospitalized patients.

Secondary outcome: To determine the relative safety of each of the regimes in avoidance of hypoglycemia.

Detailed description: This study will enroll 180 hospitalized patients with Type 2 diabetes and moderate to end stage renal insufficiency (estimated glomerular filtration rate is < 30 ml/min/1. 73m2 or dialysis) in the Chicagoland area. Participants will be randomized into 1 of 2 protocols after hospital admission. Blood glucose levels will be obtained before meals, at bedtime and whenever necessary for any signs or symptoms of hypoglycemia. The primary endpoint will be the percentage of blood glucose levels reaching goal of 80-180mg/dl. A secondary endpoint will be the percentage of hypoglycemic events, defined as blood glucose values < 60 mg/dl. In addition the percentage of glucose levels within the goal range of 80-180mg. dl will be further separated into excellent control (80-140mg/dl) and acceptable control (141-180mg/dl). The 2 study groups will be: 1. Glargine & glulisine. The total daily insulin dose will be 0. 6 units/kg. Half of this will be given as glargine once daily. The other half will be given as glulisine, divided equally between breakfast, lunch, and dinner with correction factor dosing as needed for elevated premeal hyperglycemia. 2. Glargine & glulisine The calculation for the total daily insulin dose will be 0. 3 units/kg. Half of this will be given as glargine in the morning. The other half will be given as glulisine, divided equally between breakfast, lunch, and dinner, with correction factor dosing as needed for elevated premeal hyperglycemia. All oral agents will be discontinued on admission.

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Type 2 Diabetes Mellitus of mor than 1year

- GFR less than 30 ml/min/1. 73m2 or dialysis

- Age greater than 18years

- Entry blood glucose (fasting or random) greater than 180mg%

Exclusion Criteria:

- Type 1 Diabetes Mellitus

- New onset hyperglycemia

- Pregnant

- Solid organ transplant within 1 year

- Steroids prednisone greater than 7. 5mg/day or equivalent

- Hospital LOS predicted less than 2 days

- Severe liver disease

- Known hypopituitarism or adrenal insufficiency

- Patients in the ICU

- Patients with hypoglycemic unawareness

- Outpatient insulin dose less than 0. 6 units/kg

Locations and Contacts

Barbara Sexton, RN, Phone: 708-216-8223, Email: bsexton@lumc.edu

Northwestern University Medical Center, Chicago, Illinois, United States; Recruiting
Mark Molitch, MD, Phone: 312-503-4130
Mark Molitch, MD, Sub-Investigator

Rush University Medical Center, Chicago, Illinois, United States; Recruiting
David Baldwin, MD, Phone: 312-942-2813
David Baldwin, MD, Sub-Investigator

Loyola University Hospital, Maywood, Illinois 60153, United States; Recruiting
Barbara Sexton, Phone: 708-216-8223, Email: bsexton@lumc.edu
Mary Ann Emanuele, MD, Principal Investigator

Additional Information

Starting date: May 2009
Last updated: October 29, 2012

Page last updated: August 23, 2015

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