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Type 2 DiabetesPhase 4BEYONDNCT04196231

Durability of Combination of Insulin and GLP-1 Receptor Agonist or SGLT-2 Inhibitors Versus Basal Bolus Insulin Regimen in Type 2 Diabetes (BEYOND)

A Phase 4 study testing IDegLira, IGlarLixi and Insulin/Canaglifozin in people with Type 2 Diabetes, run by University of Campania Luigi Vanvitelli at 1 site in Italy.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

BEYOND represents an open-label, parallel, three-arm randomized controlled trial, aimed at evaluating the effects of combination therapy of fixed ratio basal insulin/GLP-1 receptor agonist (GLP-1RA) or basal insulin/SGLT-2 inhibitors (SGLT-2i) on the durability of the glycemic control, as compared with the basal bolus… Read more about this study

Who is it for?
Ages 35 to 75 years
Conditions the study is for
Type 2 Diabetes
What is being tested?
IDegLira, IGlarLixi and Insulin/Canaglifozin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
258 participants
Where
1 siteItaly
Study dates
27 Nov 2019to 20 Oct 2020
Phase
Phase 4
Are there results?
None posted in the registry

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 35 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Poor glycemic control (HbA1c ≥7.5%)
  • Stable basal bolus insulin regimen for almost a year, eventually associated with metformin.

Who cannot join

  • Type 1 diabetes or secondary diabetes;
  • Previous treatment for the last three months with GLP-1RA or DPP-4 inhibitors;
  • Hypersensitivity towards active substances or other ingredients of the drugs used in the study
  • Participation in other trial with experimental drugs within 30 days
  • Diseases that represent contraindication to GLP-1RA use (pancreatitis, gallstones)
  • Pregnancy or planned pregnancy within the time of the study
Show all 12Show fewer
  • Serum creatinine > 1,3 mg/dL in women and >1,4 mg/dL in men
  • eGFR < 30 mL/min
  • Previous cancer or antineoplastic therapy for five years before randomization
  • Current therapy with glucocorticoid (oral, topic or sistemic administration) or with antypsichotic drugs
  • Previous ketoacidosis
  • Any clinical, psychologic or psychiatric condition that is incompatible with the study according to the investigator

Trial locations and contacts

1 site in 1 country.

Italy1 site
  • Unit of Endocrinology and Metabolic Diseases

    Naples, 80138

Other trials in Italy

About this study

Official title: Durability of Combination of Insulin and GLP-1 Receptor Agonist or SGLT-2 Inhibitors Versus Basal Bolus Insulin Regimen in Type 2 Diabetes: a Randomized Controlled Trial

BEYOND represents an open-label, parallel, three-arm randomized controlled trial, aimed at evaluating the effects of combination therapy of fixed ratio basal insulin/GLP-1 receptor agonist (GLP-1RA) or basal insulin/SGLT-2 inhibitors (SGLT-2i) on the durability of the glycemic control, as compared with the basal bolus insulin regimen, in people with type 2 diabetes failing to achieve glycemic targets with injective therapy. The potential benefits for participants in the study include the possibility of improving the glyco-metabolic control with drugs that have been evaluated as safe and protective for the heart and the kidneys. The primary outcome of the study is the mean HbA1c change between groups at six months. Participants in the study will be followed for subsequent 18 months in order to evaluate the durability of glycemic control and the chenge of other secondary outcomes.

Conditions
Type 2 Diabetes
Being tested
IDegLira, IGlarLixi, Insulin/Canaglifozin, Insulin/Dapaglifozin, Insulin/Empaglifozin
Keywords
type 2 diabetes, GLP-1RA, SGLT-2i, basal insulin, basal bolus, glycemic control
Medical subject headings
Diabetes Mellitus, Type 2

What participants receive

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

  • IDegLiraDrug

    IDegLira will be started at 16 dose steps (16 U insulin degludec plus 0.58 mg liraglutide, once daily). On the basis of prebreakfast self-monitored blood glucose measurements doses of IDegLira will be titrated individually twice per week to achieve a prebreakfast plasma glucose of 80-130 mg/dL by use of an algorithm (adding 2 dose steps for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 dose steps for prebreakfast plasma glucose < 80 mg/dL). The daily dose of IDegLira could be titrated to 50 dose steps (50 U insulin degludec plus 1.8 mg liraglutide).

  • IGlarLixiDrug

    IGlarLixi will be started at 10 dose steps (10 U insulin glargine plus 5 mcg lixisenatide, once daily). On the basis of prebreakfast self-monitored blood glucose measurements, doses of IGlarLixi will be titrated individually once per week to achieve a prebreakfast plasma glucose of 80-130 mg/dL by use of an algorithm (adding 2 dose steps for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 dose steps for prebreakfast plasma glucose < 80 mg/dL). The daily dose of IGlarLixi could be titrated to 60 dose steps (60 U insulin degludec plus 20 mcg lixisenatide).

  • Insulin/CanaglifozinDrug

    Patients in this arm will continue the basal insulin used before the randomization, with dosage titration on the basis of the following algorithm: adding 2 units for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 units for prebreakfast plasma glucose < 80 mg/dL. Moreover, they will be assigned to canaglifozin, according to the current clinical practice and the drugs' data sheet. Canagliflozin will be started at 100 mg daily per oral administration, and augmented to 300 mg/per day if required (HbA1c >7.5 after 12 weeks).

  • Insulin/DapaglifozinDrug

    Patients in this arm will continue the basal insulin used before the randomization, with dosage titration on the basis of the following algorithm: adding 2 units for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 units for prebreakfast plasma glucose < 80 mg/dL. Moreover, they will be assigned to dapaglifozin, according to the current clinical practice and the drugs' data sheet. Dapagliflozin will be started at 10 mg daily per oral administration

  • Insulin/EmpaglifozinDrug

    Patients in this arm will continue the basal insulin used before the randomization, with dosage titration on the basis of the following algorithm: adding 2 units for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 units for prebreakfast plasma glucose < 80 mg/dL. Moreover, they will be assigned to empaglifozin, according to the current clinical practice and the drugs' data sheet. Empagliflozin will be started at 10 mg daily per oral administration, and augmented to 25 mg/per day if required (HbA1c >7.5 after 12 weeks).

  • Basal BolusDrug

    Patients in this arm will continue the basal insulin (glargine, degludec or glargine-300) used before the randomization. The insulin titration will be guided by the medical staff, according to the following algorithm: adding 2 units of basal insulin for prebreakfast plasma glucose >130 mg/dL; no dose change for prebreakfast plasma glucose of 80-130 mg/dL; reducing 2 units of basal insulin for prebreakfast plasma glucose < 80 mg/dL. The short acting insulin analogue (lispro, aspart or glulisine) will be started at the dosage of 4 units before meals (3 times per day) and will be titrated twice a week until achieving pre-prandial glucose values ranging from 80-130 mg/dL.

Study groups in NCT04196231
Study groupRoleWhat they receive
FR insulin/GLP-1RAActive comparatorPatients in this arm will receive one of these fixed ratio combo of insulin and GLP-1RAs, according to the current clinical practice and the drugs' data sheet: IDegLira or IGlarLixi
Receives: Drug: IDegLira; Drug: IGlarLixi
Insulin/SGLT-2iActive comparatorPatients in this arm will receive the basal insulin used before the randomization and one of these SGLT-2i according to the current clinical practice and the drugs' data sheet: canagliflozin, dapagliflozin or empagliflozin.
Receives: Drug: Insulin/Canaglifozin; Drug: Insulin/Dapaglifozin; Drug: Insulin/Empaglifozin
Basal BolusActive comparatorPatients in this arm will receive a basal insulin (glargine, glargine-300 or degludec) at bed-time plus 3 injections of a short-acting insulin analogue (aspart, lispro or glulisine) before meals
Receives: Drug: Basal Bolus

What is being measured

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

  1. Hba1c change

    HbA1c group difference at 6 months

    Measured: 6 months, 9 months, 12 months

  2. Proportions of patients with significant HbA1c change

    Proportions of patients undergoing a reduction equal or higher than 0.5% as compared with baseline levels during the follow up

    Measured: Baseline, 3 months, 6 months, 9 months, 12 months, 18 months

Secondary outcomes (11)
  1. Weight Change

    Measured: Baseline, 6 months, 18 months

  2. BMI Change

    Measured: Baseline, 6 months, 18 months

  3. Waist circumference change

    Measured: Baseline, 6 months, 18 months

  4. Blood pressure change

    Measured: Baseline, 6 months, 18 months

  5. Fasting glycemia change

    Measured: Baseline, 6 months, 18 months

  6. Post-prandial glycemia change

    Measured: Baseline, 6 months, 18 months

  7. C-peptide change

    Measured: Baseline, 6 months, 18 months

  8. Change in total daily insulin dose

    Measured: Baseline, 6 months, 18 months

  9. Change in lipide profile

    Difference between groups in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides

    Measured: Baseline, 6 months, 18 months

  10. Change in eGFR

    Measured: Baseline, 6 months, 18 months

  11. Diabetes treatment satisfaction

    In order to measure satisfaction with diabetes treatment regimens, we used the self-reported Diabetes Treatment Satisfaction Questionnaire. This instrument aims to assess levels of satisfaction in subjects using different treatment strategies. The questionnaire consists of eight questions: six questions addresses general satisfaction with a score from 0 to 6 for each question (0 = worst), that has to be computed in a total score ranging from 0 (=worst) to 36 (=best); among the remaining two questions, which has to be computed separately as two subscales, one concerns the perception of hyperglycemic events and another the perception of hypoglycemic events, both with a score from 0 (none of the time) to 6 (most of the time).

    Measured: Baseline, 6 months, 18 months

Timeline

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

  1. First posted12 Dec 2019
  2. Study start27 Nov 2019
  3. Primary completion30 Sep 2020
  4. Study completion20 Oct 2020

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
258 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04196231
Sponsor's protocol ID
BEYOND Protocol
Acronym
BEYOND
Status last verified
Oct 2020
First submitted
6 Dec 2019
Last updated
22 Oct 2020
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Giugliano D, Bellastella G, Maiorino MI, Esposito K. Beyond basal-bolus insulin regimen: Is it still the ultimate chance for therapy in diabetes? Diabetes Res Clin Pract. 2019 Nov;157:107922. doi: 10.1016/j.diabres.2019.107922. Epub 2019 Nov 9. No abstract available.

    PubMed 31715201
  • Giugliano D, Longo M, Scappaticcio L, Caruso P, Gicchino M, Petrizzo M, Bellastella G, Maiorino MI, Esposito K. BEYOND 2 years: durability of metabolic benefits by simplification of complex insulin regimens in type 2 diabetes. Endocrine. 2024 Feb;83(2):399-404. doi: 10.1007/s12020-023-03547-9. Epub 2023 Oct 3.

    PubMed 37787888
  • Giugliano D, Longo M, Caruso P, Di Fraia R, Scappaticcio L, Gicchino M, Petrizzo M, Bellastella G, Maiorino MI, Esposito K. Feasibility of Simplification From a Basal-Bolus Insulin Regimen to a Fixed-Ratio Formulation of Basal Insulin Plus a GLP-1RA or to Basal Insulin Plus an SGLT2 Inhibitor: BEYOND, a Randomized, Pragmatic Trial. Diabetes Care. 2021 Jun;44(6):1353-1360. doi: 10.2337/dc20-2623. Epub 2021 Apr 21.

    PubMed 33883195

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing IDegLira, IGlarLixi and Insulin/Canaglifozin in people with Type 2 Diabetes, run by University of Campania Luigi Vanvitelli at 1 site in Italy.

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

Who may be eligible to take part?

The sponsor lists 2 inclusion and 12 exclusion criteria. 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: finished, as of the sponsor's last update on 22 Oct 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Italy. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

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

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Hba1c change (time frame: 6 months, 9 months, 12 months). 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 NCT04196231, which also lists 3 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 22 Oct 2020.

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