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Glycemic Stability of Insulin Aspart Versus Insulin Lispro in Insulin Pump Therapy

This study has been terminated.
(Treatment differences not detected with 7 point fingerstick monitoring)
Sponsor:
ClinicalTrials.gov Identifier:
NCT00428207
First Posted: January 29, 2007
Last Update Posted: May 30, 2017
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.
Collaborator:
Novo Nordisk A/S
Information provided by (Responsible Party):
Joslin Diabetes Center
  Purpose

The purpose of this study is to determine:

  1. whether there is a difference between insulin aspart and insulin lispro in continuous insulin pump therapy
  2. whether duration of the insulin infusion set placement effect blood sugar control if the infusion set is in place for longer then 72-96 hours

Condition Intervention
Type 1 Diabetes Mellitus Drug: Insulin Aspart versus Insulin Lispro Drug: Insulin Lispro versus Insulin Aspart

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Glycemic Stability of Insulin Aspart Versus Insulin Lispro in Insulin Pump Therapy

Resource links provided by NLM:


Further study details as provided by Joslin Diabetes Center:

Primary Outcome Measures:
  • Glycemic Stability [ Time Frame: 48 to 96 hours ]
    Glycemic stability will be assessed by MAGE (Mean Amplitude of Glycemic Excursion)(5), M value of Schlichtkrull, standard deviation & coefficient of variation using 7 point finger stick blood glucose measurements performed 48-96 hours after insertion of the pump infusion catheter. Data collected 48 to 72 hours post-catheter insertion will be analyzed separately from the data collected 72 to 96 hours post-catheter insertion. The mean of the measurements taken throughout the study will be used for calculation of the primary endpoint.


Secondary Outcome Measures:
  • Frequency of Catheter Change [ Time Frame: 48 to 96 hours ]
    Recorded by the subjects who will use a checklist to document the reason for the catheter change (routine, insufficient insulin in infusion system, unexplained hyperglycemia, catheter site irritation, suspected occlusion/kinking of catheter, loosening of catheter.


Enrollment: 4
Study Start Date: February 2007
Study Completion Date: August 2008
Primary Completion Date: August 2008 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Insulin Aspart Versus Insulin Lispro
Insulin aspart will be used for diabetes management, and will be delivered continuously, subcutaneously using a pump for a four week period. Insulin aspart doses will be adjusted by the principal investigator as needed to maintain glycemic control. Insulin dose adjustments will vary from patient to patient based on the carbohydrate consumption, level of physical activity, and fingerstick monitoring results SMBG (7 times per day). SMBG results collected during this four week period will be compared to the SMBG results collected while participant uses alternative treatment (insulin Lispro).
Drug: Insulin Aspart versus Insulin Lispro
Subjects will be randomly assigned to insulin aspart versus insulin lispro via random number generation. Half of the patients will begin with insulin aspart, and then will be crossed over to insulin lispro. The insulin sequence will be reversed for the other half of the patients.
Other Names:
  • NovoLog
  • NovoRapid
  • Humalog
Active Comparator: Insulin Lispro Versus Insulin Aspart
Insulin lispro will be used for diabetes management, and will be delivered continuously, subcutaneously using a pump for a four week period. Dose will be adjusted as needed to maintain glycemic control. Insulin dose adjustments will vary from patient to patient based on the carbohydrate consumption, level of physical activity, and fingerstick monitoring results SMBG (7 times per day). SMBG results collected during this four week period will be compared to the SMBG results collected while participant uses alternative treatment (insulin Aspart).
Drug: Insulin Lispro versus Insulin Aspart
Subjects will be randomly assigned to insulin lispro versus insulin aspart via random number generation. Half of the patients will begin with insulin lispro, and then will be crossed over to insulin aspart. The insulin sequence will be reversed for the other half of the patients.
Other Names:
  • Humalog
  • NovoRapid
  • Novolog

Detailed Description:

Insulin instability in pump infusion systems can result in unexplained hyperglycemia in patients on continuous subcutaneous insulin infusion (CSII) therapy. We have noted that some pump patients develop glycemic instability with use of insulin lispro, and that this resolves with change to insulin aspart. Several patients using lispro have reported noting a whitish precipitate in the infusion set, and in two cases we have examined the catheters and confirmed biochemically that this precipitate was insulin. Furthermore, in vitro studies indicate that insulin aspart is more resistant to isoelectric precipitation than insulin lispro. Although it has been rare for patients to notice a visible precipitate in the pump catheter, there is a subset of patients using lispro who have noted that their blood glucose levels will tend to rise 2 or more days after the insertion of a new pump infusion system. These findings mirror bench studies showing that the relative stability differences between aspart and lispro in pump infusion systems becomes more apparent over time.

The endpoints examined in previous randomized clinical trials comparing aspart and lispro were not directed specifically at assessing the effect of insulin type on glycemic stability. In these previous studies, pump infusion systems were changed every 48 hours whereas most pump patients routinely replace their infusion catheters only every 72-96 hours; this discrepancy may account for the failure of these trials to demonstrate the difference in the stability of insulin aspart and lispro that has been noted in clinical practice.

This investigator-initiated clinical trial is intended to assess the safety and efficacy of CSII with insulin aspart compared to insulin lispro with use of pump infusion catheters for up to 96 hours.

  Eligibility

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Type 1 diabetes treated with CSII at least 3 months.
  • Males and females, > 18 years but < 75 years old.
  • Hemoglobin A1c ≤ 8.0 % at measurement taken at week 0 (screening visit).
  • Duration of diabetes ≥ 12 months.
  • Willingness to perform self-blood glucose monitoring several times/day.

Exclusion Criteria:

  • Previous insulin precipitation in pump infusion catheters.
  • Daily insulin requirements > 25% of pump reservoir capacity. (This would preclude the subject from using the pump infusion system for more than 3 days).
  • Use of an insulin pump that does not have a downloadable record of basal and bolus doses.
  • Known or suspected allergy to trial products.
  • Pregnancy, breast-feeding, intention to become pregnant or inadequate contraception measures.
  • Known or suspected alcohol or drug abuse.
  • Impaired renal function with creatinine ≥ 1.7 mg/dl.
  • Pronounced catheter site scarring.
  • Chronic use of drugs that may influence glycemic control (e.g. steroids).
  • Any other significant concomitant disease that would interfere with participation in and completion of the trial.
  Contacts and Locations
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 ClinicalTrials.gov identifier (NCT number): NCT00428207


Locations
United States, Massachusetts
Joslin Diabetes Center
Boston, Massachusetts, United States, 02215
Sponsors and Collaborators
Joslin Diabetes Center
Novo Nordisk A/S
Investigators
Principal Investigator: Howard A Wolpert, MD Joslin Diabetes Center
  More Information

Responsible Party: Joslin Diabetes Center
ClinicalTrials.gov Identifier: NCT00428207     History of Changes
Other Study ID Numbers: 06-18
First Submitted: January 25, 2007
First Posted: January 29, 2007
Results First Submitted: April 17, 2013
Results First Posted: May 30, 2017
Last Update Posted: May 30, 2017
Last Verified: April 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Joslin Diabetes Center:
type 1 diabetes, insulin pump therapy, glycemic stability

Additional relevant MeSH terms:
Diabetes Mellitus
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases
Insulin, Globin Zinc
Insulin degludec, insulin aspart drug combination
Insulin
Insulin Aspart
Insulin, Long-Acting
Insulin Lispro
Hypoglycemic Agents
Physiological Effects of Drugs