Comparison of Two Treatment Regimens in Patients With Type 2 Diabetes After Short-term Intensive Insulin Therapy (SWITCH)

Sanofi

Status and phase: Completed; Phase 4

Conditions: Type 2 Diabetes Mellitus

Treatments: Drug: Acarbose; Drug: Metformin; Drug: Repaglinide; Drug: Biphasic insulin aspart 30; Drug: INSULIN GLARGINE (HOE901); Drug: Insulin Glulisine

Study type: Interventional

Funder types: Industry

Identifiers

NCT03359837

U1111-1186-3400 (Other Identifier)

LANTUL07194

Details and patient eligibility

About

Primary Objective:

To test the hypothesis that basal insulin based treatment (G+) is noninferior to twice-daily premixed insulin (PM-2) in term of hemoglobin A1c (glycosylated hemoglobin, HbA1c) reduction from baseline to end of study. The test for superiority can be done if noninferiority is achieved.

Secondary Objectives:

• To assess efficacy in terms of percentage of patients achieving HbA1c <7% and HbA1c <7% without hypoglycemia.
• To assess efficacy in terms of percentage of patients achieving fasting plasma glucose (FPG) <7 mmol/L and FPG <7 mmol/L without hypoglycemia.
• To assess safety in term of occurrence of moderate/severe hypoglycemia.
• To assess daily blood glucose (BG) variation.
• To assess patient satisfaction.

Full description

The duration of study is approximately 21 months. Each patient will be followed for approximately 27 weeks from screening visit to end-of-study

Enrollment: 384 patients

Sex: All

Ages: 18 to 70 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion criteria :

• Patients with age between 18 and 70 years.
• Hemoglobin A1c>7.5%, and ≤11%.
• Fasting plasma glucose >7 mmol/L.
• Fasting C peptide >1 ng/mL.
• Type 2 diabetes (T2DM) patients with diabetes diagnosis between 2 and 10 years (World Health Organization 1999 T2DM diagnose criteria).
• Continuous treatment with stable doses of metformin (≥1 g/day) and 1 oral antihyperglycemic drug (at least half maximum dose) for more than 3 months prior to screening.
• Body mass index ≥21 kg/m2, and <40 kg/m2.

Exclusion criteria:

• More than 7 consecutive days of insulin treatment within the 12 months except for acute disease or surgery.
• Diabetes other than T2DM (e.g. type 1 diabetes, diabetes secondary to pancreatic disorders, drug or chemical agent intake).
• History of hypoglycemia unawareness or recurrent hypoglycemia or severe hypoglycemia within the past 12 months.
• History of sensitivity to the study drugs or to drugs with a similar chemical structure.
• Pregnancy or planned pregnancy or current lactation (women of childbearing potential must have a negative pregnancy test at study entry and a medically approved contraception method).
• Acute diabetic complications (diabetic ketoacidosis, lactic acidosis, hyperosmolar nonketotic diabetic coma) within the past 12 months.
• Significant diabetic complications and serious disease, e.g., symptomatic autonomic neuropathy, gastroparesis, unstable angina or active proliferative retinopathy.
• Acute infections which may affect BG control within the past 4 weeks.
• Active liver disease, alanine transaminase (ALT) and/or aspartate aminotransferase (AST) greater than two times the upper limit of the reference range at screening.
• Impaired renal function, defined as but not limited to, serum creatinine levels ≥1.5 mg/dL (132 μmol/L) for males and ≥1.4 mg/dL (123 μmol/L) for females or presence of macroproteinuria (>2 g/day).

The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

384 participants in 2 patient groups

Glargine based therapy

Experimental group

Description:

Once daily glargine plus prandial oral anti-hyperglycemic drugs

Treatment:

Drug: Insulin Glulisine

Drug: INSULIN GLARGINE (HOE901)

Drug: Repaglinide

Drug: Acarbose

Premixed insulin

Active Comparator group

Description:

Twice daily premixed insulin

Treatment:

Drug: Metformin

Drug: Biphasic insulin aspart 30