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Published in: Trials 1/2016

Open Access 01-12-2016 | Study protocol

Assessment of three fasting plasma glucose targets for insulin glargine-based therapy in people with type 2 diabetes mellitus in China: study protocol for a randomized controlled trial

Authors: Wenying Yang, Zhaojun Yang, Jing Zhao, Hai Lu, Tianhong Luo

Published in: Trials | Issue 1/2016

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Abstract

Background

A large proportion of patients with T2DM in China do not meet accepted HbA1c targets despite the availability of guidelines that describe a treatment pathway for achieving glycemic control. The aim of this study is to identify the fasting plasma glucose (FPG) target that will provide the highest control rate of HbA1c <7 % in Chinese patients with T2DM treated with an insulin glargine-based regimen as an adjunct to an established OAD regimen. This information will support improvements in diabetes care management in China.

Methods

Approximately 934 men and women aged ≥18 to ≤65 years with poorly controlled T2DM will be enrolled and randomized to one of three FPG target groups; ≤5.6 mmol/L, ≤6.1 mmol/L, or ≤7.0 mmol/L. They will be initiated on daily insulin glargine (Lantus®) in addition to their usual OAD regimen for 24 weeks. Patients will self-monitor fasting blood glucose (SM-FBG), and the study physician will titrate the basal insulin dose according to the SM-FBG results. In addition, HbA1c and safety will be recorded. We plan to statistically derive the optimal FPG target for an HbA1c of <7 %.

Discussion

In China, treatment strategies that would achieve an optimum balance between glycemic control (as per HbA1c) and hypoglycemia are imperative to ensure improvements in the management of T2DM. Furthermore, elucidating the contribution of FPG to HbA1c in Chinese patients with T2DM and identifying a predictable relationship between FPG and HbA1c would be a valuable tool for patient self-management of diabetes.

Trial registration

NCT02545842. Registered on 8 September 2015.
Literature
1.
go back to reference Colagiuri S, Kent J, Kainu T, et al. Rising to the challenge. Preventing and managing type 2 diabetes. Report of the WISH Diabetes Forum 2015. 2015 Colagiuri S, Kent J, Kainu T, et al. Rising to the challenge. Preventing and managing type 2 diabetes. Report of the WISH Diabetes Forum 2015. 2015
3.
go back to reference International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels, Belgium: International Diabetes Federation; 2014. International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels, Belgium: International Diabetes Federation; 2014.
4.
go back to reference Aguiree F, Brown A, Cho NH, et al. IDF diabetes atlas. Brussels: International Diabetes Federation; 2013. Aguiree F, Brown A, Cho NH, et al. IDF diabetes atlas. Brussels: International Diabetes Federation; 2013.
5.
go back to reference Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101.CrossRefPubMed Yang W, Lu J, Weng J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101.CrossRefPubMed
6.
go back to reference Ji LN, Zhang PH, Weng JP, et al. Basal insulin treatment in patients with type 2 diabetes uncontrolled on oral antihyperglycemic agents: ORBIT study in China. Diabetes. 2015;64:A235–382.CrossRef Ji LN, Zhang PH, Weng JP, et al. Basal insulin treatment in patients with type 2 diabetes uncontrolled on oral antihyperglycemic agents: ORBIT study in China. Diabetes. 2015;64:A235–382.CrossRef
7.
go back to reference Chen Y, Liu L, Gu L, Babineaux S, Colclough H, Curtis B. Glycemic control in Chinese patients with type 2 diabetes mellitus receiving oral antihyperglycemic medication-only or insulin-only treatment: a cross-sectional survey. Diabetes Ther. 2015;6(2):197–211.CrossRefPubMedPubMedCentral Chen Y, Liu L, Gu L, Babineaux S, Colclough H, Curtis B. Glycemic control in Chinese patients with type 2 diabetes mellitus receiving oral antihyperglycemic medication-only or insulin-only treatment: a cross-sectional survey. Diabetes Ther. 2015;6(2):197–211.CrossRefPubMedPubMedCentral
8.
go back to reference American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38 Suppl:S8–S16.CrossRef American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2015;38 Suppl:S8–S16.CrossRef
9.
go back to reference International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104:1–52.CrossRef International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104:1–52.CrossRef
10.
go back to reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37 Suppl 1:S14–80.CrossRef American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37 Suppl 1:S14–80.CrossRef
11.
go back to reference Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21 Suppl 1:1–87.CrossRefPubMedPubMedCentral Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21 Suppl 1:1–87.CrossRefPubMedPubMedCentral
12.
go back to reference Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–89.CrossRefPubMed Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–89.CrossRefPubMed
13.
go back to reference Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol. 2014;2:474–80.CrossRefPubMed Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. Lancet Diabetes Endocrinol. 2014;2:474–80.CrossRefPubMed
14.
go back to reference Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Med Sci Monit. 2006;12:RA130–47.PubMed Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Med Sci Monit. 2006;12:RA130–47.PubMed
15.
go back to reference UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.CrossRef
16.
go back to reference Ramachandran A, Riddle MC, Kabali C, et al. Relationship between A1C and fasting plasma glucose in dysglycemia or type 2 diabetes: an analysis of baseline data from the ORIGIN trial. Diabetes Care. 2012;35:749–53.CrossRefPubMedPubMedCentral Ramachandran A, Riddle MC, Kabali C, et al. Relationship between A1C and fasting plasma glucose in dysglycemia or type 2 diabetes: an analysis of baseline data from the ORIGIN trial. Diabetes Care. 2012;35:749–53.CrossRefPubMedPubMedCentral
17.
go back to reference Tanenberg R, Stewart J, Zisman A. Glycemia optimization treatment (GOT): glycemic control and rate of severe hypoglycemia for 5 different dosing algorithms of insulin glargine (GLAR) in patients with type 2 diabetes mellitus (T2DM). Diabetologia. 2006;49:601–2. Tanenberg R, Stewart J, Zisman A. Glycemia optimization treatment (GOT): glycemic control and rate of severe hypoglycemia for 5 different dosing algorithms of insulin glargine (GLAR) in patients with type 2 diabetes mellitus (T2DM). Diabetologia. 2006;49:601–2.
18.
go back to reference Cahn A, Miccoli R, Dardano A, Del Prato S. New forms of insulin and insulin therapies for the treatment of type 2 diabetes. Lancet Diabetes Endocrinol. 2015;3(8):638–52.CrossRefPubMed Cahn A, Miccoli R, Dardano A, Del Prato S. New forms of insulin and insulin therapies for the treatment of type 2 diabetes. Lancet Diabetes Endocrinol. 2015;3(8):638–52.CrossRefPubMed
19.
go back to reference LaSall JR, Berria R. Insulin therapy in type 2 diabetes mellitus: a practical approach for primary care physicians and other health care professionals. J Am Osteopath Assoc. 2013;113:152–62. LaSall JR, Berria R. Insulin therapy in type 2 diabetes mellitus: a practical approach for primary care physicians and other health care professionals. J Am Osteopath Assoc. 2013;113:152–62.
20.
go back to reference Blonde L, Merilainen M, Karwe V, et al. Patient‐directed titration for achieving glycaemic goals using a once‐daily basal insulin analogue: an assessment of two different fasting plasma glucose targets—the TITRATE™ study. Diabetes Obes Metab. 2009;11:623–31.CrossRefPubMed Blonde L, Merilainen M, Karwe V, et al. Patient‐directed titration for achieving glycaemic goals using a once‐daily basal insulin analogue: an assessment of two different fasting plasma glucose targets—the TITRATE™ study. Diabetes Obes Metab. 2009;11:623–31.CrossRefPubMed
21.
go back to reference Ma RCW, Chan JCN. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281(1):51–63.CrossRef Ma RCW, Chan JCN. Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States. Ann N Y Acad Sci. 2013;1281(1):51–63.CrossRef
22.
go back to reference Yabe D, Seino Y, Fukushima M, Seino S. β cell dysfunction versus insulin resistance in the pathogenesis of type 2 diabetes in East Asians. Curr Diab Rep. 2015;15:36.CrossRefPubMedCentral Yabe D, Seino Y, Fukushima M, Seino S. β cell dysfunction versus insulin resistance in the pathogenesis of type 2 diabetes in East Asians. Curr Diab Rep. 2015;15:36.CrossRefPubMedCentral
23.
go back to reference Gujral UP, Pradeepa R, Weber MB, Narayan V, Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281(1):51–63.CrossRefPubMedPubMedCentral Gujral UP, Pradeepa R, Weber MB, Narayan V, Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281(1):51–63.CrossRefPubMedPubMedCentral
24.
go back to reference Chinese Diabetes Society. Chinese type 2 diabetes mellitus treatment guidelines: 2013 edition. 2014;6:447–498 Chinese Diabetes Society. Chinese type 2 diabetes mellitus treatment guidelines: 2013 edition. 2014;6:447–498
25.
go back to reference Yang W, Lv X, Li Q, et al. A prospective study to optimize insulin treatment by switching to insulin glargine in type 2 diabetic patients previously uncontrolled on premixed insulin: the optimization study. Curr Med Res Opin. 2012;28:533–41.CrossRefPubMed Yang W, Lv X, Li Q, et al. A prospective study to optimize insulin treatment by switching to insulin glargine in type 2 diabetic patients previously uncontrolled on premixed insulin: the optimization study. Curr Med Res Opin. 2012;28:533–41.CrossRefPubMed
26.
27.
go back to reference Ji LN, Lu JM, Guo XH, et al. Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables. BMC Public Health. 2013;13:602.CrossRefPubMedPubMedCentral Ji LN, Lu JM, Guo XH, et al. Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables. BMC Public Health. 2013;13:602.CrossRefPubMedPubMedCentral
28.
go back to reference Tsai ST, Pathan F, Ji L, et al. First insulinization with basal insulin in patients with type 2 diabetes in a real-world setting in Asia. J Diabetes. 2011;3:208–16.CrossRefPubMedPubMedCentral Tsai ST, Pathan F, Ji L, et al. First insulinization with basal insulin in patients with type 2 diabetes in a real-world setting in Asia. J Diabetes. 2011;3:208–16.CrossRefPubMedPubMedCentral
29.
go back to reference Handelsman Y, Mechanick J, Blonde L, et al. AACE Task Force for Developing Diabetes Comprehensive Care Plan American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17:1–53.CrossRefPubMed Handelsman Y, Mechanick J, Blonde L, et al. AACE Task Force for Developing Diabetes Comprehensive Care Plan American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract. 2011;17:1–53.CrossRefPubMed
Metadata
Title
Assessment of three fasting plasma glucose targets for insulin glargine-based therapy in people with type 2 diabetes mellitus in China: study protocol for a randomized controlled trial
Authors
Wenying Yang
Zhaojun Yang
Jing Zhao
Hai Lu
Tianhong Luo
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Trials / Issue 1/2016
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-016-1588-6

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