E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 9.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10045228 |
E.1.2 | Term | Type I diabetes mellitus |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess the superiority of insulin glulisine over insulin aspart and insulin lispro administered by external pump in term of unexplained hyperglycemia and/or infusion set occlusion. For the purpose of the study, the infusion set will always be referred to as the catheter and the cannula.
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E.2.2 | Secondary objectives of the trial |
To compare insulin glulisine, insulin aspart and insulin lispro on: • Unexplained hyperglycemia • Infusion set occlusion • HbA1c, hypoglycemic episodes, 7-point blood glucose profiles, episodes of ketosis and ketoacidosis • Insulin doses (total, basal, bolus) • Time to change the infusion set. The infusion set and the reservoir will always be replaced at the same time, either on a routine basis or when occlusion occurs or is suspected • Site infection, site inflammation / erythema, pruritis and isolated pain at injection site • Overall safety: incidence of adverse events • Change in body weight |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1. Men or women, aged from 18 to 75 years inclusive 2. Type 1 diabetic subjects 3. Treated with insulin for at least 2 years and by CSII for at least 6 months 4. Using the same insulin (insulin glulisine, insulin aspart or insulin lispro) in CSII for at least 3 months with the same external pump compatible with the 3 short acting insulin analogues used in the study 5. Using the same type of infusion set (catheter and cannula) for at least 3 months 6. Performing at least 3 blood glucose controls per day 7. HbA1c < 8.5% 8. Body mass index (BMI) < 35 kg/m2 9. Ability and willingness to perform blood glucose and ketone monitoring using the Sponsor-provided combined glucose and ketone meter and patient diary at home 10. Written informed consent obtained prior to enrolment in the study
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E.4 | Principal exclusion criteria |
1. Diabetes other than Type 1 2. Total daily dose of insulin greater than 90 U/day 3. Using an insulin pump requiring pre-filled cartridges 4. History of infection at infusion site requiring a drainage in the last 3 months 5. History of severe episodes of ketosis requiring hospitalization in the last 6 months 6. Active proliferative retinopathy, as defined by a photocoagulation or vitrectomy occurrence in the 6 months prior to visit 1, or any other unstable (rapidly progressing) retinopathy that may require photocoagulation or surgical treatment during the study. An ophtalmoscopic examination should have been performed in the 2 years prior to study entry 7. Pregnancy (women of childbearing potential must have a negative pregnancy test at study entry and a medically approved contraception method) or breastfeeding 8. Treatment with systemic corticosteroids or medication known to influence insulin sensitivity in the 3 months prior to visit 1 9. Treatment with antidiabetic drug other than insulin in the 3 months prior to visit 1 10. Likelihood of requiring treatments during the study which are not permitted 11. Treatment with an investigational product in the 30 days prior to visit 1 12. History of sensitivity to the study drugs or to drugs with a similar chemical structure 13. Presence of any condition (medical, including clinically significant abnormal laboratory test, psychological, social or geographical) actual or anticipated that the Investigator feels would compromise the patient safety or limit his/her successful participation in the study 14. Night shift workers 15. Impaired renal function as shown by serum creatinine ≥ 1.5 mg/dL (133 µmol/L) or ≥ 1.4 mg/dL (124 µmol/L) in men and women, respectively 16. Impaired hepatic function as shown by Alanine aminotransferase (ALT) and/or Aspart aminotransferase (AST) greater than three times the upper limit of normal range) 17. Alcohol or drug abuse in the last year 18. Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study 19. Patient unlikely to comply with the protocol, e.g. uncooperative attitude, inability to return for follow-up visits and unlikehood of completing the study 20. Patient is the Investigator or any sub-Investigator, research assistant, study coordinator, other staff or relative thereof directly involved in the conduct of the protocol
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E.5 End points |
E.5.1 | Primary end point(s) |
Data collected for the assessment of primary and main secondary endpoints - All across the study • Episodes of unexplained hyperglycemia, i.e. Plasma Glucose (PG) above 300 mg/dL (16.7 mmol/L) with no apparent medical or dietary reason, inappropriate insulin dose or pump failure • Episodes of infusion set occlusion. Signs of occlusion can be: Pump occlusion alarm Patient observation of occlusion • Time to change the infusion set and reservoir • Abscess (local infection requiring drainage), site infection requiring local and/or general antibiotherapy, site inflammation /erythema (no local and/or general antibiotherapy required), pruritis or isolated pain at injection site
• Episodes of ketosis and diabetes ketoacidosis (DKA), as defined by an elevated ketone value in the blood (fingertip) associated with hyperglycemia (PG above 300 mg/dL [16.7 mmol/L]) • Hypoglycemia (symptomatic diurnal and nocturnal, severe, asymptomatic). • Safety data: adverse events, vital signs
- At specific time points • Laboratory Fasting Plasma Glucose (FPG) and HbA1c at week 0, week 13, week 26 and week 39 • Self-monitored blood glucose values at 7 time points: immediately before and 2 hours after the start of breakfast, lunch and dinner, and at 3:00 AM. This will be performed at 2 consecutive days in the week before visit 2 and in the week before the end of each treatment period • Insulin doses: total daily basal dose (basal rates), bolus doses and time of the bolus will be recorded during the last 2 days of the dose adjustment phases, and at the time of the blood glucose profiles (7 points). • Body weight: at week 0, week 13, week 26 and week 39 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | No |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | Information not present in EudraCT |
E.7.1.2 | Bioequivalence study | Information not present in EudraCT |
E.7.1.3 | Other | Information not present in EudraCT |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
E.8.1.5 | Parallel group | No |
E.8.1.6 | Cross over | Yes |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | No |
E.8.2.3 | Other | No |
E.8.3 |
The trial involves single site in the Member State concerned
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 8 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 31 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 1 |
E.8.9.1 | In the Member State concerned months | 4 |
E.8.9.1 | In the Member State concerned days | |
E.8.9.2 | In all countries concerned by the trial years | 1 |
E.8.9.2 | In all countries concerned by the trial months | 4 |