The ORIGIN Trial (Outcome Reduction With Initial Glargine Intervention)

This study has been completed.
Sponsor:
Collaborator:
Population Health Research Institute
Information provided by (Responsible Party):
Sanofi
ClinicalTrials.gov Identifier:
NCT00069784
First received: October 1, 2003
Last updated: January 24, 2013
Last verified: January 2013
Results First Received: December 18, 2012  
Study Type: Interventional
Study Design: Allocation: Randomized;   Endpoint Classification: Efficacy Study;   Intervention Model: Factorial Assignment;   Masking: Open Label;   Primary Purpose: Treatment
Condition: Diabetes Mellitus, Non-Insulin-Dependent
Interventions: Drug: insulin glargine (HOE901)
Drug: omega-3 polyunsaturated fatty acids (PUFA)
Drug: placebo
Device: reusable pen device for insulin injection

  Participant Flow
  Hide Participant Flow

Recruitment Details
Key information relevant to the recruitment process for the overall study, such as dates of the recruitment period and locations
This study was conducted at 575 sites in 40 countries between August 22, 2003 and December 19, 2011. Three sites were closed and data from these sites were not analyzed following site audits and in compliance with rulings from national health authorities.

Pre-Assignment Details
Significant events and approaches for the overall study following participant enrollment, but prior to group assignment
The purpose of the factorial design was to efficiently answer two independent scientifically worthwhile questions regarding insulin glargine and omega-3 fatty acids within the context of a single clinical trial. Sample size was determined based on the insulin glargine study objective. Results reported below are those of the insulin glargine study.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids

Participant Flow:   Overall Study
    Insulin Glargine     Standard Care  
STARTED     6264 [1]   6273 [1]
Safety Population (Treated)     6231 [2]   6273 [3]
COMPLETED     5052 [4]   6273 [5]
NOT COMPLETED     1212     0  
Adverse Event                 105                 0  
Withdrawal by Subject                 1090                 0  
Unknown                 17                 0  
[1] randomized participants = intent-to-treat (ITT) population
[2] randomized patients who received at least one dose of insulin glargine
[3] patients randomized to standard care arm
[4] completed study treatment
[5] not applicable (no treatment)



  Baseline Characteristics
  Hide Baseline Characteristics

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
No text entered.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids
Total Total of all reporting groups

Baseline Measures
    Insulin Glargine     Standard Care     Total  
Number of Participants  
[units: participants]
  6264     6273     12537  
Age  
[units: years]
Mean ± Standard Deviation
  63.5  ± 7.8     63.5  ± 7.9     63.5  ± 7.8  
Gender, Customized  
[units: participants]
     
Male     4181     3969     8150  
Female     2082     2304     4386  
Missing value     1     0     1  
Baseline Weight [1]
[units: kg]
Mean ± Standard Deviation
  83.33  ± 16.77     83.13  ± 17.28     83.23  ± 17.03  
Baseline Body Mass Index [2]
[units: kg/m²]
Mean ± Standard Deviation
  29.77  ± 5.17     29.88  ± 5.33     29.82  ± 5.25  
Any previous cardiovascular event  
[units: participants]
     
No     2552     2607     5159  
Yes     3712     3666     7378  
Diabetes diagnosis at time of screening [3]
[units: participants]
     
IFG and/or IGT     735     717     1452  
Newly diagnosed diabetic     365     395     760  
Established diabetes with no OAD treatment     1414     1467     2881  
Established diabetes with one OAD treatment     3748     3692     7440  
Unclear diabetes status     2     2     4  
Duration of diabetes for established diabetes patients [4]
[units: years]
Median ( Inter-Quartile Range )
  3.50  
  ( 1.50 to 7.50 )  
  3.50  
  ( 1.50 to 7.50 )  
  3.50  
  ( 1.50 to 7.50 )  
Glycated Hemoglobin A1c (HbA1c) [5]
[units: percent]
Median ( Inter-Quartile Range )
  6.41  
  ( 5.81 to 7.18 )  
  6.40  
  ( 5.81 to 7.16 )  
  6.40  
  ( 5.81 to 7.18 )  
Fasting Plasma Glucose [6]
[units: mmol/L]
Median ( Inter-Quartile Range )
  6.94  
  ( 6.05 to 8.20 )  
  6.90  
  ( 6.00 to 8.20 )  
  6.94  
  ( 6.05 to 8.20 )  
[1] Due to missing values, N=6256 for insulin glargine and N=6271 for standard care.
[2] Due to missing values, N=6251 for insulin glargine and N=6270 for standard care.
[3]

IFG = Impaired Fasting Glucose defined as a Postprandial Plasma Glucose (PPG) value ≥140 and <200 mg/dL (ie, ≥7.8 and <11.1 mmol/L), with a Fasting Plasma Glucose (FPG) <126 mg/dL (7.0 mmol/L)

IGT = Impaired Glucose Tolerance defined as an FPG ≥110 and <126 mg/dL (≥6.1 and <7 mmol/L), without diabetes mellitus (PPG must be <200 mg/dL [11.1 mmol/L])

OAD = oral antidiabetic drug

[4] Population of patients with established diabetes. Due to missing values, N=5148 for insulin glargine and N=5141 for standard care.
[5] Due to missing values, N=6175 for insulin glargine and N=6189 for standard care.
[6] Due to missing values, N=6248 for insulin glargine and N=6266 for standard care.



  Outcome Measures
  Show All Outcome Measures

1.  Primary:   Composite of the First Occurrence of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI) or Nonfatal Stroke   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]

2.  Primary:   Composite of the First Occurrence of Cardiovascular (CV) Death, Nonfatal Myocardial Infarction (MI), Nonfatal Stroke, Revascularization Procedure or Hospitalization for Heart Failure (HF)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]

3.  Secondary:   Total Mortality (All Causes)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]

4.  Secondary:   Composite Diabetic Microvascular Outcome (Kidney or Eye Disease)   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]

5.  Secondary:   Incidence of Development of Type 2 Diabetes Mellitus in Participants With IGT and/or IFG   [ Time Frame: from randomization until the last follow-up visit or last OGTT (median duration of follow-up: 6.2 years) ]
  Hide Outcome Measure 5

Measure Type Secondary
Measure Title Incidence of Development of Type 2 Diabetes Mellitus in Participants With IGT and/or IFG
Measure Description The incidence was determined by calculating the proportion of randomized participants without diabetes at randomization who either developed diabetes during the study or who were classified as having possible diabetes based on results of two oral glucose tolerance tests (OGTT) performed after the last follow-up visit (within 21-28 days for OGTT#1 and within 10-14 weeks for OGTT#2).
Time Frame from randomization until the last follow-up visit or last OGTT (median duration of follow-up: 6.2 years)  
Safety Issue No  

Population Description
Explanation of how the number of participants for analysis was determined. Includes whether analysis was per protocol, intention to treat, or another method. Also provides relevant details such as imputation technique, as appropriate.
The analysis was based on the subgroup of the intent-to-treat (ITT) population without diabetes at randomization.

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids

Measured Values
    Insulin Glargine     Standard Care  
Number of Participants Analyzed  
[units: participants]
  737     719  
Incidence of Development of Type 2 Diabetes Mellitus in Participants With IGT and/or IFG  
[units: percentage¬†of¬†patients]
  24.7     31.2  


Statistical Analysis 1 for Incidence of Development of Type 2 Diabetes Mellitus in Participants With IGT and/or IFG
Groups [1] All groups
Odds Ratio (OR) [2] 0.72
95% Confidence Interval ( 0.58 to 0.91 )
[1] Additional details about the analysis, such as null hypothesis and power calculation:
  No text entered.
[2] Other relevant estimation information:
  Odds ratio estimated using Cochran-Mantel-Haenszel (CMH) test method stratified by double-blind treatment (omega-3 PUFA or placebo) and previous cardiovascular event (yes or no).



6.  Other Pre-specified:   Number of Patients With Various Types of Symptomatic Hypoglycemia Events   [ Time Frame: on-treatment period (median duration of follow-up: 6.2 years) ]

7.  Other Pre-specified:   Number of Patients With First Occurrence of Any Type of Cancer   [ Time Frame: from randomization until study cut-off date (median duration of follow-up: 6.2 years) ]


  Serious Adverse Events


  Other Adverse Events
  Hide Other Adverse Events

Time Frame Adverse events (AEs) were assessed through the study. The median duration of follow-up was 6.2 years.
Additional Description Aside from hypoglycemia and cancer, serious AEs were only captured if the event was considered related to a study drug. Non-serious AEs were only captured if the event resulted in some modification (suspension, alteration or cessation) in the dose of a study drug. This creates a bias for the comparison between insulin glargine and standard care.

Frequency Threshold
Threshold above which other adverse events are reported   5%  

Reporting Groups
  Description
Insulin Glargine Treatment with Insulin Glargine with or without omega-3 polyunsaturated fatty acids
Standard Care Standard care with or without omega-3 polyunsaturated fatty acids

Other Adverse Events
    Insulin Glargine     Standard Care  
Total, other (not including serious) adverse events      
# participants affected / at risk     0/6231     0/6273  



  Limitations and Caveats
  Hide Limitations and Caveats

Limitations of the study, such as early termination leading to small numbers of participants analyzed and technical problems with measurement leading to unreliable or uninterpretable data
No text entered.


  More Information