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Information and Communication Technology Based Centralized Clinical Trial Monitoring System for Insulin Dose Adjustment (ICT)

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.
 
ClinicalTrials.gov Identifier: NCT03112343
Recruitment Status : Completed
First Posted : April 13, 2017
Last Update Posted : April 5, 2019
Sponsor:
Collaborators:
Ministry of Trade, Industry & Energy, Republic of Korea
Korea Evaluation Institute of Industrial Technology
Daegu Metropolitan City, Korea
ICT Clinical Trial Coordination Center
Information provided by (Responsible Party):
Sang-Man Jin, Samsung Medical Center

Brief Summary:

This is a 24-week, open-label, randomized, multi-center trial conducted in three tertiary hospitals. There are three follow-up measures; at baseline, post-intervention at Week 12, and Week 24. Subjects are diagnosed as type 1 DM, type 2 DM, and/or post-transplant DM, and initiate or currently use insulin therapy. After the given education on insulin dose titration and prevention for hypoglycemia and 1 week of run-in period, subjects are randomized in a 1:1 ratio to either the ICT-based intervention group or the conventional intervention group. Subjects in conventional intervention group will save and send their health information to the server via the PHR app, whereas those in ICT-based intervention group have additional algorithm-based feedback messages. The health information includes levels of blood glucose, insulin dose, details on hypoglycemia, food diary, and number of steps. The primary outcome will be the proportion of patients who reach an optimal insulin dose within 12 weeks of enrolling in the study without severe hypoglycemia or unscheduled clinic visits.

This study is based upon work supported by the Ministry of Trade, Industry & Energy (MOTIE, Korea) under Industrial Technology Innovation Program (No. 10059066, 'Establishment of ICT Clinical Trial System and Foundation for Industrialization.")


Condition or disease Intervention/treatment Phase
Diabetes Mellitus Insulin Hypoglycemia Insulin-dependent Diabetes Mellitus Device: Algorithm-based feedback messages Device: Personal Health Record Not Applicable

Detailed Description:
This is a 24-week, open, randomized, multi-center ICT-based clinical trial conducted in three different hospitals including Samsung Medical Center, Kangbuk Samsung Hospital, and Samsung Changwon Hospital. There are three follow-up measures; at baseline, post-intervention at Week 12, and Week 24. Subjects diagnosed as T1DM, T2DM, and/or post-transplant DM who initiate or currently use insulin therapy will be given education on insulin injection, dose adjustment, and prevention for hypoglycemia and provided at-home measurement device at Visit 1 for screening. Subjects will receive instructions to check daily glucose levels by home glucose meter, to record insulin regimen and dose, the hypoglycemia diary if blood glucose <70 mg/dL or a hypoglycemic event occurs in the apps, and to synchronize data for automatically transferring to system. Subjects who synchronized their information more than once during 1 week of run-in period will be selected into clinical trial and randomly assigned to either ICT-based intervention group or conventional intervention group at a ratio of 1:1. After the randomization, at Week 1, diabetes educators provide telephone counselling for re-instructing insulin dose adjustment and for re-confirming their use of at-home measurement device and PHR apps at Visit 2 (televisit). Subjects in ICT-based intervention group will have algorithm-based feedback messages when their glucose levels are out of ranges, in addition to recording, saving and sending their data to the server via the PHR app, and those in conventional intervention group will only record, save and send their data to the server via the PHR app. Investigators examine the saved health information such as levels of blood glucose, insulin dose, details on hypoglycemia recorded in hypoglycemia diary, food diary, and number of steps transferred through PHR apps. At each clinical visit, anthropometric parameters, current medication use including types of insulin, insulin dose, and other glucose-lowering agents, vital signs, body composition, and questionnaire for satisfaction investigation are examined face-to-face, and blood tests are performed. The unscheduled visit to clinic could be applied if a subject has one or more severe hypoglycemia (requiring other help for recovery) during the study period, or hypoglycemia (<70 mg/dL) twice or more times per week, or fasting blood glucose >200 mg/dL three or more times in the morning, and wants to see a doctor during Week 1-12. The unscheduled visit to clinic is also allowed to the subjects who have difficulty in insulin dose adjustment despite of two or more unscheduled tele-visit. However, even if this criterion does not apply, patients who initiate insulin or change their regimen (eg, from basal insulin once daily to premixed insulin or multiple dose insulin injections) will be allowed to have additional planned doctor visits prior to Visit 3, which is not included in the unscheduled visit, but will be evaluated as scheduled additional visit. The primary outcome will be the proportion of patients who reach an optimal insulin dose within 12 weeks of enrolling in the study without severe hypoglycemia or unscheduled clinic visits.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 112 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: randomized in a 1:1 ratio to either the information and communication technology(ICT)-based intervention group or the conventional intervention group
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: An Information and Communication Technology-based Centralized Clinical Trial to Determine the Efficacy and Safety of Insulin Dose Adjustment Education Based on a Smartphone Personal Health Record Application
Actual Study Start Date : September 26, 2017
Actual Primary Completion Date : September 30, 2018
Actual Study Completion Date : December 30, 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: ICT-based intervention
Subjects in the ICT-based intervention group have algorithm-based feedback messages in addition to conventional intervention
Device: Algorithm-based feedback messages
ICT-based intervention group have algorithm-based feedback messages in addition to conventional intervention

Device: Personal Health Record
Subjects will save and send their health information to the server via the personal health record app

Placebo Comparator: Conventional intervention group
Subjects in the conventional intervention group will only save and send their health information to the server via the personal health record app
Device: Personal Health Record
Subjects will save and send their health information to the server via the personal health record app




Primary Outcome Measures :
  1. the proportion of patients who reach his/her optimal insulin dose within 12 weeks of enrolling in the study without severe hypoglycemia or unscheduled clinic visits. [ Time Frame: Week 12 ]
    Reaching optimal insulin dose: A.For a patient who uses basal insulin only or basal insulin with pre-meal rapid-acting insulin once per day,1)3 or more fasting blood glucose(FBG) values in the morning within the target range(80-130mg/dL or 100-140 mg/dL) during Week12,2)no nocturnal(11pm-7am) or pre-breakfast hypoglycemia(<70mg/dL) during Week12,3)variation of basal insulin dose (the difference between the highest and lowest basal insulin dose) of <10% of mean total basal insulin dose during Week12. B.For a patient who uses MDI at least twice per day, the criteria A plus 4)3 or more days in which correction dose premeal insulin is required less than 3times per day during the Week12,5) no daytime(7am-11pm) hypoglycemia during Week12. C.For a patient who uses premixed insulin or NPH,1)3 or more FBG values in the morning and evening within the target range during Week 12,2) no nocturnal or pre-breakfast hypoglycemia during Week12


Secondary Outcome Measures :
  1. the proportion of patients who reach HbA1c <7% without severe hypoglycemia (unrecoverable hypoglycemia without the help of others) at Week 24 [ Time Frame: Week 24 ]
    the proportion of patients who reach HbA1c <7% without severe hypoglycemia (unrecoverable hypoglycemia without the help of others) at Week 24

  2. the proportion of patients who reach HbA1c <7% without severe hypoglycemia (unrecoverable hypoglycemia without the help of others) at Week 12 [ Time Frame: Week 12 ]
    the proportion of patients who reach HbA1c <7% without severe hypoglycemia (unrecoverable hypoglycemia without the help of others) at Week 12

  3. mean fasting blood glucose values for three consecutive days prior to Week 12 and Week 24 [ Time Frame: Week 12 and 24 ]
    mean fasting blood glucose values for three consecutive days prior to Week 12 and Week 24

  4. levels of HbA1c at Week 12 and Week 24 [ Time Frame: Week 12 and Week 24 ]
    levels of HbA1c at Week 12 and Week 24

  5. lipid profile at Week 12 and Week 24 [ Time Frame: Week 12 and 24 ]
    lipid profile at Week 12 and Week 24

  6. the proportion of patients having hypoglycemia (total, asymptomatic, daytime, nighttime, severe hypoglycemia, and coma/convulsions) at Week 12 and Week 24 [ Time Frame: Week 12 and Week 24 ]
    the proportion of patients having hypoglycemia (total, asymptomatic, daytime, nighttime, severe hypoglycemia, and coma/convulsions) at Week 12 and Week 24

  7. the number of steps during Week 1-12 and Week 13-24 [ Time Frame: Week 12 and Week 24 ]
    the number of steps during Week 1-12 and Week 13-24

  8. recorded exchange unit by food group [ Time Frame: Week 12 and 24 ]
    recorded exchange unit by food group (grains, meats and protein, fruits, vegetables, dairy, and fats and oils) in each breakfast, lunch, and dinner on 3-day food diary at Week 12 and 24

  9. daily insulin dose [ Time Frame: Week 12 and Week 24 ]
    daily insulin dose at Week 12 and Week 24

  10. blood pressure [ Time Frame: Week 12 and Week 24 ]
    blood pressure at Week 12 and Week 24

  11. body weight [ Time Frame: Week 12 and Week 24 ]
    body weight at Week 12 and Week 24

  12. lean body mass [ Time Frame: Week 12 and 24 ]
    lean body mass at Week 12 and Week 24

  13. fat mass [ Time Frame: Week 12 and 24 ]
    fat mass at Week 12 and Week 24

  14. Satisfaction evaluation by questionnaire for ICT-based centralized clinical trial monitoring [ Time Frame: Week 12 and 24 ]
    Satisfaction evaluation by questionnaire for ICT-based centralized clinical trial monitoring at Week 12 and 24

  15. Satisfaction evaluation by DTSQ [ Time Frame: Week 12 and 24 ]
    Satisfaction evaluation by DTSQ at Week 12 and 24

  16. the number of telephone counselling by diabetes educators [ Time Frame: Week 12 and 24 ]
    the number of telephone counselling by diabetes educators

  17. the number of self-monitoring blood glucose measurements [ Time Frame: Week 12 and 24 ]
    the number of self-monitoring blood glucose measurements



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 69 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria

  1. age between 18-69 years
  2. diagnosis of T1DM, T2DM, and/or post-transplant DM (Post-transplant DM includes both diagnosed T1DM or T2DM before organ transplantation and first diagnosed DM after organ transplantation)
  3. initiation or current use of insulin therapy including once-daily basal insulin (including basal insulin only or basal insulin plus rapid-acting insulin), premixed insulin, or NPH)
  4. most recent hemoglobin A1c (HbA1c) ≥7.0% based on the National Glycohemoglobin Standardization Program (NGSP) at least 3 months prior to participation (recent HbA1c values measured <3 months prior to screening are permitted.)
  5. available to use smartphone and wireless internet
  6. Voluntarily write consent to participate in the trial

Exclusion criteria

  1. on insulin pump
  2. history of alcohol or drug abuse 1 year prior to participation
  3. history of psychological disorder (e.g., schizophrenia, depression, or bipolar disorder)
  4. history of severe visual or hearing impairment
  5. pregnant
  6. any condition, in the investigator's opinion, not suitable for enrollment eligibility.

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): NCT03112343


Locations
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Korea, Republic of
Samsung Medical Center
Seoul, Korea, Republic of, 135-710
Sponsors and Collaborators
Samsung Medical Center
Ministry of Trade, Industry & Energy, Republic of Korea
Korea Evaluation Institute of Industrial Technology
Daegu Metropolitan City, Korea
ICT Clinical Trial Coordination Center
Investigators
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Study Chair: Sang-Man Jin, MD PhD Samsung Medical Center
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Sang-Man Jin, Assistant professor, Samsung Medical Center
ClinicalTrials.gov Identifier: NCT03112343    
Other Study ID Numbers: 2016-08-006-001
First Posted: April 13, 2017    Key Record Dates
Last Update Posted: April 5, 2019
Last Verified: April 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Sang-Man Jin, Samsung Medical Center:
ICT based clinical trial
Contract research organization (CRO)
eCRF
Joint Electronic-institutional review board (eIRB)
Centralized monitoring
Additional relevant MeSH terms:
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Diabetes Mellitus
Hypoglycemia
Diabetes Mellitus, Type 1
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Autoimmune Diseases
Immune System Diseases