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Published in: Trials 1/2006

Open Access 01-12-2006 | Study protocol

Will availability of inhaled human insulin (Exubera®) improve management of type 2 diabetes? The design of the Real World trial

Authors: Nick Freemantle, Thomas R Strack, the Real World Trialists

Published in: Trials | Issue 1/2006

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Abstract

Background

Common deterrents to insulin therapy for both physicians and patients are the complexity and burden of daily injections. In January 2006, the first inhaled human insulin (INH, Exubera® (insulinhuman [rDNA origin])InhalationPowder) was approved for use in adult patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) in the United States and European Union. Results from the INH clinical trial program have shown comparable efficacy of INH to subcutaneous (SC) insulin and superior efficacy versus oral antidiabetic agents; thus providing effective glycemic control in adult patients with T2DM without the requirement for preprandial injections. However, because subjects in those trials were randomized to either INH or an alternative, the studies could not estimate the effect of INH on patient acceptance of insulin therapy. Therefore, traditional study designs cannot provide answers to important and practical questions regarding real world effectiveness, which is influenced by psychological and other access barriers.

Methods

To overcome these limitations, the Real World Trial was designed to estimate the effect of the availability of INH as a treatment option for glycemic control. A total of approximately 700 patients from Canada, France, Germany, Italy, Spain, United Kingdom, and the United States with T2DM poorly controlled by oral agent therapy will be randomized to two different treatment settings. Patients and clinicians in both groups (A & B) may choose from all licensed therapies for diabetes including SC insulin delivered by pens; INH will be an additional treatment option only available in Group A. The Real World Trial (Protocol A2171018) has been registered with ClincalTrials.gov, registration id NCT00134147.

Results

The primary outcome for the trial will be the difference in mean glycosylated hemoglobin (HbA1c) at 6 months between groups. The design was based on a preceding feasibility study examining the theoretical effects of inhaled insulin availability on treatment choice in 779 patients. In that study, patients were three times more likely to choose insulin therapy when inhaled insulin was available.

Conclusion

Innovations in study designs may provide an opportunity to reveal unbiased answers to important treatment questions that are more relevant to prescribers, funding agencies, and healthcare policymakers.
Appendix
Available only for authorised users
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Metadata
Title
Will availability of inhaled human insulin (Exubera®) improve management of type 2 diabetes? The design of the Real World trial
Authors
Nick Freemantle
Thomas R Strack
the Real World Trialists
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Trials / Issue 1/2006
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-7-25

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