Remission Through Early Monitored Insulin Therapy - Duration Month (REMIT-DM)

Sandra Sobel

Status and phase: Completed; Phase 4

Conditions: Type 2 Diabetes Mellitus

Treatments: Device: Dexcom G6; Drug: Glargine; Drug: Lispro

Study type: Interventional

Funder types: Other

Identifiers

NCT03670641

PRO17110070

Details and patient eligibility

About

REMIT-DM is a feasibility pilot study where participants will be recruited soon after their diagnosis of type 2 diabetes to be placed immediately on insulin therapy for maximum of four weeks with titrations of insulin guided by glucose levels and trends provided by a continuous glucose monitor (CGM), with the purpose of achieving diabetes remission.

Full description

REMIT-DM is a feasibility pilot study that aims to show that previously published diabetes remission through early use and titration of short-term insulin therapy is possible and safe in the ambulatory diverse American population of patients with T2D, with continuous glucose level and trend information provided by CGM. We developed the algorithm based on published diabetes remission studies and include within the algorithm the CGM trend arrows to further refine insulin doses for both safety and efficacy purposes. Data captured by the CGM transmits automatically to the cloud and is accessible at any time of day by the multidisciplinary diabetes team, which includes the certified diabetes educator (CDE) and Endocrinologist. The CGM-guided insulin titration algorithm is designed to achieve euglycemia (defined as fasting CBG < 100 mg/dL, and 2 hour post-prandial CBG < 120 mg/dL) within 2 weeks of initiating insulin therapy, then to help maintain euglycemia for 2 weeks before discontinuing insulin entirely. Ten participants will undergo a maximum of 4 weeks of insulin therapy and will be assessed for remission afterwards to confirm enough recovery of beta cell function. (Complete remission is defined as fasting glycemia <100 mg/dL without use of pharmacological therapy.) Afterwards, we will implement American Diabetes Association (ADA) guidelines for standard glycemic management, as necessary. We will use the data collected during this feasibility study to sharpen the CGM-guided insulin titration algorithm for creation of a T2DM remission mobile application that could then be tested and studied in a larger sample size.

The feasibility study will also take into account clinically meaningful data points e.g. the number of phone calls between the patient and the diabetes team, the patient experience, and patient satisfaction.

Enrollment: 10 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age ≥18
2. A1C criteria - >7.0
3. Newly diagnosed with T2D within 4 years
4. Lifestyle controlled
5. Subject may be on up to 2 medications for diabetes.
6. Smart phone or home computer compatible with DEXCOM CLARITY software
7. English speaking
8. Assessed by endocrinologist and diabetes educator to be able to perform skills necessary for CGM use and insulin delivery

Exclusion criteria

1. Autoimmune Type 1 DM, defined as positive GAD65 or islet cell antibodies
2. Pregnant
3. Chronic Kidney Disease (CKD) Stage IV or greater
4. Mental and/or cognitive disorder (based on documented disorder and/or assessment of physician or educator)
5. No access to computer for downloading CGM
6. BMI <18.0

Trial design

Primary purpose: Treatment

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

---

10 participants in 1 patient group

Insulin and CGM Intervention

Experimental group

Description:

10 individuals with newly diagnosed type 2 diabetes will be started on basal (glargine) bolus (lispro) insulin therapy for up to 4 weeks with titrations guided by continuous glucose monitor (Dexcom G6) to achieve euglycemia and then insulin stopped after 4 weeks with hopes of diabetes remission.

Treatment:

Drug: Lispro

Drug: Glargine

Device: Dexcom G6