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HyperglycemiaPhase 3HMHNCT01136746

Hospital Management of Hyperglycemia Study of Insulin Glargine Plus Insulin Lispro Versus Human Regular Insulin

A Phase 3 study testing Human regular insulin, Insulin lispro and Insulin glargine in people with Hyperglycemia, run by Eli Lilly and Company at 12 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

The purpose of this study is to compare the use of insulin glargine plus insulin lispro to human regular insulin for treatment of hyperglycemia in the hospital setting in patients without known prior history of diabetes. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Hyperglycemia
What is being tested?
Human regular insulin, Insulin lispro and Insulin glargine
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
16 participants
Where
12 sitesUnited States
Study dates
Mar 2011to Nov 2011
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Major Inclusion Criteria:

  • No known history of diabetes
  • Admission or pre-entry plasma glucose (PG) level between 140 and 400 mg/dL
  • Non-critically ill and admitted to acute care medical services
  • Have a body mass index greater than or equal to 18.5 kg/m^2 and less than or equal to 45 kilograms per square meter (kg/m^2)

Major Exclusion Criteria:

  • Received any insulin/analog therapy for longer than 108 hours prior to study entry or intermediate- or long-acting insulin/analogs (neutral protamine Hagedorn, detemir, or glargine) in the 24 hours prior to randomization or any intravenous insulin therapy prior to randomization
  • Laboratory evidence of diabetic ketoacidosis for patients with pre-randomization PG greater than 250 mg/dL
  • Have taken any oral or injectable antihyperglycemic medications other than insulin within 3 months prior to study entry
  • Have acute critical illness or are expected to require admission to an ICU or equivalent or be treated with glucocorticoid therapy during the hospital study period
  • Expected hospitalization less than 24 hours post-randomization

Trial locations and contacts

12 sites in 1 country.

12 sites in 1 country

United States12 sites
  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Atlanta, Georgia, 30312

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Bangor, Maine, 04401

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Birmingham, Alabama, 35294

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Charleston, South Carolina, 29425

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Cleveland, Ohio, 44106

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Hazard, Kentucky, 41701

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Jacksonville, Florida, 32209

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Kansas City, Missouri, 64111

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Memphis, Tennessee, 38104

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Miami, Florida, 33136

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Topeka, Kansas, 66604

  • For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician.

    Weston, Florida, 33331

Other trials in United States

About this study

Official title: Randomized Clinical Trial of Subcutaneous Analog Basal Bolus Therapy Versus Sliding Scale Human Regular Insulin in the Hospital Management of Hyperglycemia in Non-Critically Ill Patients Without Known History of Diabetes: The HMH Trial

The purpose of this study is to compare the use of insulin glargine plus insulin lispro to human regular insulin for treatment of hyperglycemia in the hospital setting in patients without known prior history of diabetes.

Read the detailed description

This study involves a comparison of 2 methods for administering subcutaneous insulin therapy to non-critically ill adult patients with hyperglycemia and without known history of diabetes who are admitted to non-intensive care unit (ICU) general medical hospital services. Basal-bolus therapy, considered the gold standard for glucose control in patients with known diabetes, will be compared with sliding scale insulin, a commonly used method of glucose control (prevailing standard practice) in hospitalized patients. In this study, basal-bolus therapy will consist of once-daily glargine plus lispro 3 to 4 times daily adjusted to achieve pre-meal capillary plasma glucose <140 milligrams per deciliter (mg/dL) and bedtime capillary plasma glucose <180 mg/dL for patients who are eating [predose plasma glucose <140 mg/dL for patients with nil per os (NPO) orders]; sliding scale insulin will be administered using human regular insulin 4 times daily as needed adjusted to achieve predose capillary plasma glucose target <140 mg/dL in patients who are eating or have NPO orders.

Conditions
Hyperglycemia
Being tested
Human regular insulin, Insulin lispro, Insulin glargine
Keywords
Hyperglycemia, Diabetes, Hospital, Diabetic
Medical subject headings
Hyperglycemia, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Human regular insulinDrug

    Also called Humulin R, LY041001

    Administered subcutaneously, four times daily, according to sliding scale insulin algorithm throughout hospital study period (1 to 10 days post-randomization)

  • Insulin lisproDrug

    Also called Humalog, LY275585

    Administered subcutaneously, 3 to 4 times daily, according to plasma glucose levels throughout hospital study period (1 to 10 days post-randomization)

  • Insulin glargineDrug

    Also called Lantus

    Administered subcutaneously, once daily, according to plasma glucose levels throughout hospital study period (1 to 10 days post-randomization)

Study groups in NCT01136746
Study groupRoleWhat they receive
Sliding scale regular insulinActive comparatorNot described
Receives: Drug: Human regular insulin
Basal-bolus therapyExperimentalNot described
Receives: Drug: Insulin lispro; Drug: Insulin glargine

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean Plasma Glucose (MPG) Throughout Hospital Study Period

    Overall MPG is derived as the mean of plasma glucose (PG) readings from Day/Visit 1 to Day/Visit 10.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  2. Percentage of Capillary Plasma Glucose Measurements Within the Range of 71 to 179 mg/dL Throughout the Hospital Study Period

    Results are reported as the percentage of total number of capillary plasma glucose measurements within the range of 71 to 179 mg/dL for each treatment arm.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

Secondary outcomes (26)
  1. Mean Plasma Glucose (MPG) by Hospital Day

    The intent was to report results up to Day 10; however, due to low enrollment, mean and standard deviations are only reported up to Day 7.

    Measured: Day 1 up to day 7 of hospital study period

  2. Percentage of Plasma Glucose Measurements Within Range 71 to 179 mg/dL by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  3. Percentage of Participants Achieving MPG Within Range 71 to 179 mg/dL and Within the Target of 100 to 179 mg/dL Throughout Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  4. Percentage of Participants Achieving MPG Within Range 71 to 179 mg/dL and Within the Target of 100 to 179 mg/dL by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  5. Mean Fasting Plasma Glucose (FPG) by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  6. Mean FPG Throughout Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  7. Percentage of Fasting Capillary PG Measurements Within the Range of 71 to 139 mg/dL and Within the Target of 100 to 139 mg/dL Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  8. Percentage of Fasting Capillary PG Measurements Within the Range of 71 to 139 mg/dL and Within the Target of 100 to 139 mg/dL by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  9. Percentage of Participants Achieving Mean FPG Range of 71 to 139 mg/dL and Target of 100 to 139 mg/dL Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  10. Percentage of Participants Achieving Mean FPG Range of 71 to 139 mg/dL and Target of 100 to 139 mg/dL by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  11. Percentage of Capillary PG Measurements >240 mg/dL Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  12. Percentage of Capillary PG Measurements >240 mg/dL by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  13. Total Daily Dose (TDD) of Insulin (Units) Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  14. TDD of Insulin (Units/kg) Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  15. TDD of Insulin (Units) by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  16. TDD of Insulin (Units/kg) by Hospital Day

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  17. Length of Hospital Stay Post-randomization Throughout the Hospital Study Period

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout the hospital study period (1 to 10 days post-randomization)

  18. Number (Incidence) of Hypoglycemia and Severe Hypoglycemia Episodes, Throughout Hospital Study Period

    Hypoglycemia was defined as any time a recorded capillary PG level is ≤70 mg/dL, even if it is not associated with signs or symptoms, or treatment consistent with current guidelines (ADA 2005; ADA 2010). Severe hypoglycemia was defined as an episode associated with a recorded capillary (or venous) PG <40 mg/dL (Umpierrez et al. 2007; Moghissi et al. 2009; Umpierrez et al. 2009), even if it is not associated with need for assistance or neuroglycopenic symptoms (ADA 2005) or prompt recovery after oral carbohydrate, glucagon, or IV glucose.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  19. Number of Hypoglycemia and Severe Hypoglycemia Episodes Adjusted for 30 Days (Rate), Throughout Hospital Study Period

    Hypoglycemia was defined as any time a recorded capillary PG level is ≤70 mg/dL, even if it is not associated with signs or symptoms, or treatment consistent with current guidelines (ADA 2005; ADA 2010). Severe hypoglycemia was defined as an episode associated with a recorded capillary (or venous) PG <40 mg/dL, even if it is not associated with need for assistance or neuroglycopenic symptoms (ADA 2005) or prompt recovery after oral carbohydrate, glucagon, or IV glucose. Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  20. Number (Incidence) of Hypoglycemia and Severe Hypoglycemia Episodes, by Hospital Day

    Hypoglycemia was defined as any time a recorded capillary PG level is ≤70 mg/dL, even if it is not associated with signs or symptoms, or treatment consistent with current guidelines (ADA 2005; ADA 2010). Severe hypoglycemia was defined as an episode associated with a recorded capillary (or venous) PG <40 mg/dL, even if it is not associated with need for assistance or neuroglycopenic symptoms (ADA 2005) or prompt recovery after oral carbohydrate, glucagon, or IV glucose. Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  21. Number of Hypoglycemia and Severe Hypoglycemia Episodes Adjusted for 30 Days (Rate), by Hospital Day

    Hypoglycemia was defined as any time a recorded capillary PG level is ≤70 mg/dL, even if it is not associated with signs or symptoms, or treatment consistent with current guidelines (ADA 2005; ADA 2010). Severe hypoglycemia was defined as an episode associated with a recorded capillary (or venous) PG <40 mg/dL, even if it is not associated with need for assistance or neuroglycopenic symptoms (ADA 2005) or prompt recovery after oral carbohydrate, glucagon, or IV glucose. Due to low enrollment, this outcome measure was not analyzed.

    Measured: Day 1 up to day 10 of hospital study period

  22. Number of Participants With Treatment-emergent Adverse Events Throughout Hospital Study Period

    Treatment-emergent adverse event - any untoward medical occurrence that either occurred or worsened at any time after treatment baseline and which did not necessarily have a causal relationship with this treatment. A summary of adverse events is located in the Reported Adverse Event Module.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  23. Percentage of Participants Requiring Intensive Care Unit Transfer

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  24. Percentage of Participants With Deterioration of Renal Function Throughout the Hospital Study Period

    Deterioration of renal function was defined by an increase in serum creatinine by >0.5 milligrams per deciliter (mg/dL). Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  25. Percentage of Participants With Documented Nosocomial Infections

    Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

  26. Number of Participants With Major Adverse Cardiovascular Events (MACE)

    MACE was defined as the composite of all-cause death, nonfatal myocardial infarction (MI), or nonfatal stroke. Due to low enrollment, this outcome measure was not analyzed.

    Measured: Throughout hospital study period (1 to 10 days post-randomization)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Jun 2010 (estimated)
  2. Study startMar 2011
  3. Primary completionNov 2011
  4. Study completionNov 2011

Why it stopped: Low enrollment

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
16 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01136746
Sponsor's protocol ID
13698
Other IDs
F3Z-US-IOPZ
Acronym
HMH
Status last verified
Nov 2012
First submitted
2 Jun 2010
Last updated
13 Nov 2012
Data monitoring committee
Yes

Publications

  • Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005 May;28(5):1245-9. doi: 10.2337/diacare.28.5.1245. No abstract available.

    PubMed 15855602
  • American Diabetes Association. Standards of medical care in diabetes--2010. Diabetes Care. 2010 Jan;33 Suppl 1(Suppl 1):S11-61. doi: 10.2337/dc10-S011. No abstract available.

    PubMed 20042772
  • Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, Inzucchi SE, Ismail-Beigi F, Kirkman MS, Umpierrez GE; American Association of Clinical Endocrinologists; American Diabetes Association. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract. 2009 May-Jun;15(4):353-69. doi: 10.4158/EP09102.RA. No abstract available.

    PubMed 19454396
  • Umpierrez GE, Smiley D, Zisman A, Prieto LM, Palacio A, Ceron M, Puig A, Mejia R. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial). Diabetes Care. 2007 Sep;30(9):2181-6. doi: 10.2337/dc07-0295. Epub 2007 May 18.

    PubMed 17513708
  • Umpierrez GE, Hor T, Smiley D, Temponi A, Umpierrez D, Ceron M, Munoz C, Newton C, Peng L, Baldwin D. Comparison of inpatient insulin regimens with detemir plus aspart versus neutral protamine hagedorn plus regular in medical patients with type 2 diabetes. J Clin Endocrinol Metab. 2009 Feb;94(2):564-9. doi: 10.1210/jc.2008-1441. Epub 2008 Nov 18.

    PubMed 19017758

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Human regular insulin, Insulin lispro and Insulin glargine in people with Hyperglycemia, run by Eli Lilly and Company at 12 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 13 Nov 2012. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 12 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 12 Oct 2012). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean Plasma Glucose (MPG) Throughout Hospital Study Period (time frame: Throughout hospital study period (1 to 10 days post-randomization)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01136746, which also lists 5 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 13 Nov 2012.

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