A Study Comparing Standard Care for Diabetes to Case-Managed Care for Diabetes in Patients With Coronary Artery Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00248352
Recruitment Status : Completed
First Posted : November 3, 2005
Last Update Posted : October 26, 2007
Information provided by:
Ottawa Heart Institute Research Corporation

Brief Summary:

The purpose of this study is to compare two ways to treat patients with Type 2 Diabetes, Standard Care or Case-Managed Care.

In-Patient Standard Care is guided by the assigned cardiologist and Out-Patient Standard Care by the existing diabetes care givers.

Case-Managed care involves a consult with an endocrinologist and counseling from a diabetic educator and a dietician.

Condition or disease Intervention/treatment Phase
Diabetes Mellitus, Type 2 Coronary Disease Behavioral: Consultation with Endocrinologist Behavioral: Counseling from Dietician Behavioral: Counseling from Diabetes Educator Not Applicable

Detailed Description:

Patients with diabetes have a higher incidence of coronary artery disease and a worsened cardiac prognosis. Death from cardiovascular disease accounts for about 70% of all diabetes-related deaths (Booth, 2003). Diabetes is also a common problem among hospitalized cardiac patients. In Ontario, from 1995 to 1997, nearly 1/3 of the 104,471 patients admitted for acute myocardial infarction had diabetes (Booth, 2003). In these patients, hyperglycemia remains a marker for poor outcome despite improvements in coronary care (Wahab, 2002; Capes, 2000).

Several important questions regarding the diabetes care of cardiac patients admitted to hospital wards are yet to be answered. First, it is not known if better glycemic control during the ward phase of hospitalization in itself improves short-term outcomes. Second, assuming that short-term glycemic control is beneficial, it is not known which interventions are effective in accomplishing this. Third, assuming that putting more resources into the management and education of patients with diabetes will translate into long term benefits, it is not known whether this should be done during the "window of opportunity" provided by a cardiac admission or whether this intervention will be more effective if it is deferred until after discharge.

These critical treatment dilemmas have prompted the proposal for the GLUCOSE Pilot Study, a randomized, controlled study to examine the effectiveness of case-managed diabetes care using a multidisciplinary team approach in patients with diabetes admitted to manage concomitant ischemic heart disease. We have designed this protocol to study the effectiveness of case-managed diabetes care by a specialized endocrinology team and compare it to usual care as delivered by the attending cardiologist. Patients will be randomized to specialized endocrinology care or usual care at the time of their admission to the ward. The short-term outcome will be glycemic control of cardiac patients with diabetes while they are admitted to a cardiology ward. In order to compare this with a more typical model of post-discharge care, patients will be re-randomized at the time of discharge into case-managed or usual care groups. The long-term (primary) outcome will be glycemic control and risk factor reduction at 6 months. This factorial design will allow us to compare several treatment models and determine which is the most efficient and effective way to achieve the best long-term diabetes control and risk factor management in our patients.

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 212 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Official Title: GLUCOSE : Glucose Lowering by Usual Care Or Specialized Endocrinology Team
Study Start Date : February 2005
Actual Study Completion Date : October 2007

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Change in HbA1C at 6 months post discharge compared to baseline measure obtained at the time of discharge
  2. Change in 10 year cardiac risk as estimated by the UKPDS risk engine at 6 months post discharge compared to baseline measures obtained at time of discharge

Secondary Outcome Measures :
  1. Percentage of patients with capillary blood glucose values within a target range of > 4.0 mmol/L to < 10.0 mmol/L during hospitalization
  2. Number of patients with one or more episodes of hypoglycemia defined as capillary blood glucose measurements < 4.0 mmol/L
  3. Number of patients with one or more episodes of persistent hyperglycemia defined as three consecutive capillary blood glucose measurements > 15.0 mmol/L
  4. Number of patients on prognosis improving medications (ACE inhibitor, ARB, Lipid Lowering Agents)
  5. Number of patients having death, MI, stroke, recurrent ischemic event or readmission to hospital
  6. Length of stay
  7. Risk factor control at 6 months post discharge:
  8. Blood pressure control, defined as percentage of patients within 2003 Canadian Diabetes Association Clinical Practice Guidelines (December 2003)
  9. Lipid levels within 2003 Canadian Diabetes Association Clinical Practice Guidelines (December 2003)
  10. Percentage of patients, who were smokers at time of index admission, who have quit
  11. Exercise history
  12. Patient satisfaction with inpatient diabetes management as measured by a standardized questionnaire administered prior to discharge
  13. Diabetes self-care as assessed by questionnaire
  14. Quality of life as assessed by questionnaire

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diabetes Mellitus, type 2, as defined by at least one of the following:

    • Previous diagnosis of diabetes
    • two glucose levels consistent with diabetes (fasting glucose >7.0 mmol/L or random glucose >11.0 mmol/L )
    • HbA1C > 6.5% using DCCT standardized methods And

Coronary Disease, as defined by at least one of the following:

  • Admitting diagnosis of acute coronary syndrome defined by 2/3 of typical history, enzyme changes, dynamic ECG changes
  • Prior history of acute coronary syndrome defined as above
  • Previously documented myocardial infarction
  • Previous coronary revascularization procedure
  • Coronary artery disease defined by coronary angiography
  • Exercise or persantine nuclear perfusion imaging positive for ischemia

Exclusion Criteria:

  • Refusal to enter the study
  • Inability to understand consent forms and provide informed consent
  • Anticipated length of non-ICU hospital stay less than 48 hours
  • Diabetes Mellitus, type 1

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00248352

Canada, Ontario
University of Ottawa Heart Institute
Ottawa, Ontario, Canada, K1Y 4W7
Sponsors and Collaborators
Ottawa Heart Institute Research Corporation
Principal Investigator: Richard F. Davies, M.D. University of Ottawa Heart Instittue
Principal Investigator: Janine Malcolm, M.D. Ottawa Hospital

Booth G, Fang J. Acute complications of Diabetes: In Hux JE, Booth GL, Slaughter PM, Laupacis A (eds.). Diabetes in Ontario: An ICES Practice Atlas. Institute for Clinical Evaluative Sciences. 2003:2.21-2.51.
Canadian Diabetes Association. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. 2003;27 (Supplement 2):S1-S152.
Hux JE, Tang M. Patterns of prevalence and incidence of diabetes: In Hux JE, Booth GL, Slaughter APM, Laupacis (eds). Diabetes in Ontario: An ICES Practice Atlas. Institute for Clinical and Evaluative Sciences. 2003:1.1-1.18.
Janes JM, Bradley C, Rees A. Preferences for, and improvements in aspects of quality of life (QoL) with, insulin lispro in a multiple injection regimen. Diabetologia. 1997;40, Suppl. 1:A353. Identifier: NCT00248352     History of Changes
Other Study ID Numbers: Glucose 101
First Posted: November 3, 2005    Key Record Dates
Last Update Posted: October 26, 2007
Last Verified: October 2007

Keywords provided by Ottawa Heart Institute Research Corporation:
Coronary Artery Disease
Diabetes Mellitus
Type 2
Chronic Disease

Additional relevant MeSH terms:
Diabetes Mellitus
Coronary Artery Disease
Myocardial Ischemia
Coronary Disease
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Heart Diseases
Cardiovascular Diseases
Arterial Occlusive Diseases
Vascular Diseases