Effect of Glycemic Variability on Autonomic Tone in Hospitalized Patients With Type 2 Diabetes

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: NCT01409239
Recruitment Status : Completed
First Posted : August 4, 2011
Results First Posted : December 4, 2013
Last Update Posted : December 4, 2013
Information provided by (Responsible Party):
Kathleen Dungan, Ohio State University

Brief Summary:

Glycemic variability has been associated with mortality in hospitalized patients with hyperglycemia. However, it is unknown how modulation of glycemic variability would impact outcomes. One possibility is that glycemic variability could impact autonomic tone. In particular, heart rate variability (HRV) measurement is a sensitive marker for measuring autonomic tone, and aberrations in HRV have been associated with mortality. The current randomized pilot study will compare the effects of continuous intravenous (IV) insulin and subcutaneous basal bolus insulin on glycemic variability and autonomic tone in hospitalized non-critically ill patients with diabetes. Non-critically ill patients who are hyperglycemic or are requiring at least 20 units of insulin per day will be included. Patients with conditions that preclude accurate HRV readings (such as atrial fibrillation or paced rhythms) will be excluded. Patients randomized to intravenous insulin will receive the therapy for 24 hours according to our standard hospital guideline. Patients randomized to subcutaneous (SQ) insulin will receive basal bolus therapy using insulin analogues. All therapies will begin between 8 and 10 AM. Patients will undergo repeated heart rate variability recordings during the 24 hour period. Blood draws will be collected at baseline and at 24 hours for measurement of catecholamines, insulin, and c-peptide. Glycemic variability will be measured using a continuous subcutaneous glucose monitor and reported as coefficient of variation. The primary outcome measure is low frequency-to-high frequency power spectrum ratio of heart rate variability.

  1. Glycemic variability is associated with unfavorable changes in autonomic tone, as assessed by low frequency (LF)/high frequency (HF) HRV ratio, independent of changes in overall glycemia.
  2. Short-term increases in glycemic variability, followed by more prolonged glycemic stability are observed in generalized hospitalized patients treated with intravenous insulin compared to standardized basal bolus therapy. LF/HF HRV differs among subjects receiving intravenous compared to subcutaneous insulin.
  3. Glycemic variability differs among subjects receiving intravenous compared to subcutaneous insulin

Condition or disease Intervention/treatment Phase
Type 2 Diabetes Inpatient Drug: Intravenous insulin Drug: Subcutaneous Insulin Phase 4

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 42 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Study Start Date : July 2011
Actual Primary Completion Date : June 2012
Actual Study Completion Date : December 2012

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: Subcutaneous Insulin Drug: Subcutaneous Insulin
basal bolus insulin using carb counting technique and insulin analogues
Experimental: Intravenous insulin Drug: Intravenous insulin
24 hr IV insulin administered according to hospital guideline

Primary Outcome Measures :
  1. Difference Between Heart Rate Variability Between Intravenous and Subcutaneous Group [ Time Frame: 6 hour ]
    difference in mean low frequency/high frequency heart rate variability (LF/HF HRV)at 6 hour. 2 patients were excluded who did not have usable LF/HF HRV data at 6 hours. These patients remained in the study as they did have other measures.

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Age 18 and above
  • Admitted to a general medicine or medicine subspecialty service
  • Insulin use (>20 units/day) or hyperglycemia. Hyperglycemia is defined as glucose greater than 180 mg/dL on at least 2 occasions separated by at least 4 hours apart.

Exclusion Criteria:

  • Type 1 diabetes
  • Hospital stay expected less than 48 hours
  • Inability to consent
  • Pregnancy
  • Prisoners
  • Previous participation
  • Autonomic neuropathy
  • Conditions that preclude accurate heart rate variability monitoring: atrial fibrillation, frequent ectopy, congestive heart failure, paced heart rhythms
  • Conditions which require lower dose insulin algorithms: end stage renal or liver disease

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): NCT01409239

United States, Ohio
The Ohio State University
Columbus, Ohio, United States, 43210
Sponsors and Collaborators
Kathleen Dungan
Principal Investigator: Kathleen M Dungan, MD Ohio State University

Responsible Party: Kathleen Dungan, Assistant Professor, Ohio State University Identifier: NCT01409239     History of Changes
Other Study ID Numbers: CCTS869
First Posted: August 4, 2011    Key Record Dates
Results First Posted: December 4, 2013
Last Update Posted: December 4, 2013
Last Verified: November 2013

Keywords provided by Kathleen Dungan, Ohio State University:
glycemic variability
autonomic tone

Additional relevant MeSH terms:
Diabetes Mellitus, Type 2
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Insulin, Globin Zinc
Hypoglycemic Agents
Physiological Effects of Drugs