The REPOSE (Relative Effectiveness of Pumps Over MDI and Structured Education) Trial (REPOSE)
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ClinicalTrials.gov Identifier: NCT01616784 |
Recruitment Status
:
Completed
First Posted
: June 12, 2012
Last Update Posted
: November 23, 2015
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Type 1 Diabetes | Other: CSII (Insulin Pump) plus DAFNE Other: MDI (levemir® & quick acting insulin) plus DAFNE | Phase 3 |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 267 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Treatment |
Official Title: | The Relative Effectiveness of Pumps Over Multiple Dose Injections and Structured Education Trial |
Study Start Date : | November 2011 |
Actual Primary Completion Date : | June 2015 |
Actual Study Completion Date : | November 2015 |

Arm | Intervention/treatment |
---|---|
Active Comparator: Multiple daily injections plus DAFNE
Optimised MDI therapy using rapid and twice daily (Detemir/Levemir) long-acting insulin analogues
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Other: MDI (levemir® & quick acting insulin) plus DAFNE
Optimised MDI therapy using rapid and twice daily (Detemir/Levemir) long-acting insulin analogues
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Experimental: CSII (Insulin Pump) plus DAFNE
Medtronic MiniMed Paradigm Veo Insulin pumps (X54)
|
Other: CSII (Insulin Pump) plus DAFNE
Medtronic MiniMed Paradigm Veo Insulin pumps (X54)
Other Names:
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- The change in HbA1c after 2 years in those participants whose baseline HbA1c was at or above 7.5% (58mmol/mol). [ Time Frame: 2 years ]
The change in HbA1c after 2 years in those participants whose baseline HbA1c was at or above 7.5% (58mmol/mol).
(Change will be calculated from baseline at 24 months)
- The proportion of participants reaching the NICE target of an HbA1c level of 7.5% (58mmol/mol) or less [ Time Frame: 6, 12 and 24 months ]
HbA1c is a measurement of glycosylated haemoglobin which reflects overall blood glucose values over the previous 6-8 weeks(24). This is regarded as the gold standard measure of glycaemic control. There is a strong relationship between HbA1c and the risk of developing long term diabetic complications and it is accepted as a surrogate for long term outcomes in individuals with diabetes.
Since HbA1c can be measured by different techniques we will ensure standardisation by measuring HbA1c in blood samples at a central laboratory.
(Change will be calculated from baseline at 24 months)
- Diabetes specific quality of life [ Time Frame: 6, 12 and 24 months ]
DSQOL Diabetes-specific quality of life (QoL) will be assessed using the scale DSQOL.
(Change will be calculated from baseline at 24 months)
- Hypoglycaemia (severe & moderate) [ Time Frame: 6, 12 and 24 months ]
The investigators will record both severe and moderate episodes of hypoglycaemia in participants. This should increase power and identify the ability of CSII to reduce rates of hypoglycaemia. It will also be possible to assess the effects of both, by comparing quality of life measures in those with only moderate hypos, versus those with moderate and severe.
(Change will be calculated from baseline at 24 months)
- Insulin dose [ Time Frame: 6, 12 and 24 months ]
Some studies have indicated that CSII results in the use of less insulin. We will therefore record participants' self-reported insulin dose at each time point and calculate units/kg body weight.
(Change will be calculated from baseline at 24 months)
- Body weight [ Time Frame: 6, 12 and 24 months ]
If CSII treatment results in the use of less insulin, it may have a favourable effect on weight since with less insulin there is a propensity for the body to store fewer nutrients. We will therefore record weight at each time point of the trial.
(Change will be calculated from baseline at 24 months)
- Blood lipids & proteinuria [ Time Frame: 6, 12 and 24 months ]
Blood samples will be taken using local labs and lipids (including HDL cholesterol). Albumin- creatinine ratio (a sensitive measure of proteinuria) will be measured from urine samples.
(Change will be calculated from baseline at 24 months)
- Diabetic Ketoacidosis [ Time Frame: 6, 12 and 24 months ]
This outcome will be measured through the assessment of any SAE's and AEs.
(Change will be calculated from baseline at 24 months)
- Fear of hypoglycaemia [ Time Frame: 6, 12 and 24 months ]
The Hypoglycaemia Fear Scale (HFS) is a well validated psychometric tool assessing participants fear of hypoglycaemia both overall and in terms of behaviour and worry. It has been used to assess the impacts of different hypoglycaemic events such as severe, moderate and mild hypoglycaemic episodes on fear of hypoglycaemia (33). A specific benefit to the HFS is that it may be able to identify participants who are likely to maintain high blood glucose levels, thus aiding understanding of potential reasons for poor glycaemic control.
(Change will be calculated from baseline at 24 months)
- Diabetes Treatment Satisfaction [ Time Frame: 6, 12 and 24 months ]
The Diabetes Treatment Satisfaction Questionnaire (DTSQ measures treatment satisfaction which refers to an individual's subjective appraisal of their experience of treatment, including ease of use, side effects and efficacy. Improvements in satisfaction are not necessarily accompanied by improvements in QoL; treatment satisfaction can be high despite diabetes having a negative impact on QoL, which is why it is important to measure both separately.
(Change will be calculated from baseline at 24 months)
- Emotional Wellbeing [ Time Frame: 6, 12 and 24 months ]
The Hospital Anxiety and Depression Scale (HADS) measures anxiety on one subscale and depression on another through the use of 7 questions for each characteristic. It is important to measure emotional wellbeing in the trial as participants may find it easier to manage their condition after DAFNE education or with one of the treatments. This might have a substantial effect on their emotional wellbeing that the QoL measures are not sensitive enough to pick up.
(Change will be calculated from baseline at 24 months)
- Participant views regarding the pump/multiple injection course & treatment [ Time Frame: 6, 12 and 24 months ]
Participant post course interviews
Participants will be interviewed regarding:
- Understandings of the trial and motivation for participation.
- Views about outcome of randomisation.
- Expectations/concerns about trial participation and (if relevant) change to CSII.
- Experience of/views about the course and (if relevant) change to CSII.
- Changes they have made to diabetes management since the course and short/long terms goals set.
- Likes/dislikes of CSII or MDI treatment. (Change will be calculated from baseline at 24 months)
- Educator views regarding the pump/multiple injection course & treatment [ Time Frame: 6, 12 and 24 months ]
Educator post course interviews
Educators will be interviewed regarding:
a) Insight and experience of what took place on the course. b) Recommendations for future course development.
c) Recommendations for support that should be offered to patients who move onto pumps.
(Change will be calculated from baseline at 24 months)
- Costs and Outcomes [ Time Frame: 6, 12 and 24 months ]
Costs and quality adjusted life years will be estimated for each individual recruited to the trial. Mean values for each arm will be calculated.
(Change will be calculated from baseline at 24 months)
- Incremental cost-effectiveness ratio [ Time Frame: 6, 12 and 24 months ]
Cost-effectiveness will be described using plots of incremental costs and QALYs on the cost-effectiveness plane, together with their associated cost-effectiveness acceptability curves and frontiers. The incremental cost-effectiveness ratio and the probability that CSII will be cost-effective in the range of £20,000-£30,000 per QALY will be the main focus.
(Change will be calculated from baseline at 24 months)
- Costs [ Time Frame: 6, 12 and 24 months ]
Mean values of cost wll be estimated and the value will be calculated for each individual
(Change will be calculated from baseline at 24 months)
- General Quality of Life [ Time Frame: 6, 12 and 24 months ]
This will be measured by 3 different measures, the WHOQOL bref, SF12 and EQ5D.
(Change will be calculated from baseline at 24 months)
- Quality of adjusted life years [ Time Frame: 6, 12 and 24 months ]Mean values will be estimated and value will be calculated for each individual (Change will be calculated from baseline at 24 months)

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 and older (Adult, Senior) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Is aged 18 yrs and above.
- Have had type-1 diabetes for at least 12 months (as assessed by date clinically diagnosed).
- Is fluent in speaking, reading and understanding English.
- Has no preference to either CSII or MDI arm of the study and is happy to be randomised.
- Is currently using or willing to switch to Detemir.
- Is willing to undertake self-monitoring of blood glucose (SMBG), carbohydrate counting and insulin self-adjustment. (Enrolment staff should check that any participant with a baseline HbA1c of above 12% is willing to complete SMBG).
- Has a need for structured education to optimise diabetes control in the opinion of the investigator.
Exclusion criteria:
- Inability to give informed consent.
- Is pregnant or planning to become pregnant within the next 2 years.
- Has used CSII within the last 3 years.
- Has already completed a diabetes education course.
- Has severe needle phobia.
- Has a current history of alcohol or drug abuse.
- Has a history of heart disease within the past 3 months.
- Has hypertension that is not under control with hypertensive medication (diastolic blood pressure >100mmHg and or sustained systolic level >160).
- Has renal impairment with a chance of needing renal replacement therapy within the next 2 years (Enrolment staff should check that creatinine levels are not above 200 µmol/L).
- Has recurrent episodes of skin infections.
- Has serious or unstable medical or psychological conditions.
- Has taken part in any other investigational clinical trial during the 4 months prior to screening.
- Has any other issue that may preclude the participant from satisfactory participation in the study based on investigatory judgement.
- Has a strong need for pump therapy in the opinion of the investigator.

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): NCT01616784
United Kingdom | |
Addenbrookes Wolfson Diabetes and Endocrine Clinic, Box 281, Addenbrookes Hospital, Hills Road | |
Cambridge, Cambridgeshire, United Kingdom, CB2 0QQ | |
Harrogate District Hospital, Diabetes Centre, Lancaster Park Road, | |
Harrogate, North Yorkshire, United Kingdom, HG2 7SX | |
Dumfries and Galloway Royal Infirmary, Diabetes Centre, Cluden West, Crichton Hall, | |
Dumfries, Scotland, United Kingdom, DG1 4TG | |
Royal Infirmary of Edinburgh, Department of Diabetes, 51 Little France Crescent | |
Edinburgh, Scotland, United Kingdom, EH16 4SA | |
Stobhill ACH, Diabetes Clinic, 133 Balornock Road | |
Glasgow, Scotland, United Kingdom, G21 3UW | |
Sheffield Teaching Hospital, Diabetes Centre, Northern General Hospital, PO Box 1, Herries Road | |
Sheffield, South Yorkshire, United Kingdom, S5 7AU | |
Kings College Hospital, Diabetes Centre, Suite 3, Golden Jubilee Wing, Denmark Hill | |
London, United Kingdom, SE5 9RS | |
Nottingham University Hospitals NHS Trust, Queens Medical Centre Campus, Derby Road | |
Nottingham, United Kingdom, NG7 2UH |
Principal Investigator: | Simon Heller, Prof | University of Sheffield |
Responsible Party: | Sheffield Teaching Hospitals NHS Foundation Trust |
ClinicalTrials.gov Identifier: | NCT01616784 History of Changes |
Other Study ID Numbers: |
STH15295 08/107/01 ( Other Grant/Funding Number: HTA ) 2010-023198-21 ( EudraCT Number ) 11/H1002/10 ( Registry Identifier: REC ) 61215213 ( Registry Identifier: ISRCTN ) 10997 (DRN 628) ( Registry Identifier: UKCRN ) |
First Posted: | June 12, 2012 Key Record Dates |
Last Update Posted: | November 23, 2015 |
Last Verified: | November 2014 |
Keywords provided by Sheffield Teaching Hospitals NHS Foundation Trust:
Adult Diabetes Mellitus Type 1 Humans Hypoglycemic Agents Administration and Dosage Insulin |
Self Care Health Education Insulin Infusion Systems Randomised controlled trial Patient Education as Topic Hemoglobin A Glycosylated |
Additional relevant MeSH terms:
Diabetes Mellitus, Type 1 Diabetes Mellitus Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Autoimmune Diseases |
Immune System Diseases Insulin, Globin Zinc Insulin Insulin Detemir Hypoglycemic Agents Physiological Effects of Drugs |