Comparison of Standard vs Higher Starting Dose of Insulin Glargine in Chinese Patients With Type 2 Diabetes (Glargine Starting Dose)

Study Overview
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Brief Summary
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Primary Objective: -To test the hypothesis that higher initial dose of basal insulin (0.3 U/kg) is non inferior to standard initial dose (0.2 U/kg) based on the percentage of patients with at least one episode of hypoglycemia (≤3.9 mmol/L or severe) during the 16 weeks of treatment in overweight and obese type 2 diabetic patients uncontrolled with oral anti-diabetes drugs (OADs). Secondary Objective: To evaluate the percentage of patients achieving glycated hemoglobin (HbA1c) <7%. To evaluate the percentage and accumulated percentage of patients achieving fasting plasma glucose (FPG) target (<5.6, <6.1, and <7.0 mmol/L). To assess the changes in HbA1c, FPG, and postprandial glucose (PPG). To evaluate the insulin doses change. To evaluate the weight change. To evaluate overall hypoglycemia, nocturnal hypoglycemia and severe hypoglycemia occurrence. To descriptively evaluate the safety profile. To assess patient and physician satisfaction and adherence (drop-out rate and the percentage of patients who can follow the treatment and insulin titration). Subgroup analysis on efficacy (control rate, control rate without confirmed hypoglycemia, and changes in HbA1c, FPG and PPG) and safety data according to: Age Duration of diabetes Baseline treatment (OAD) Baseline HbA1c, FPG and PP

Detailed Description
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The duration of study for each patient is approximately 20 weeks from screening visit to end-of-study follow-up phone call.

Official Title
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Comparison of Efficacy and Safety of Standard vs Higher Starting Dose of Insulin Glargine in Overweight and Obese Chinese Patients With Type 2 Diabetes

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Drug: INSULIN GLARGINE
* Drug: metformin
* Drug: acarbose


Participation Criteria
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Eligibility Criteria
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Inclusion criteria : Age ≥ 18 and ≤ 70 years. Type 2 diabetes patients with diabetes diagnosis at least 2 years. Continuous treatment with stable doses of 2-3 OADs, for more than three months prior to randomization, among which metformin ≥1.5 g/day or at maximum tolerated dose HbA1c >7.5% and ≤11%. FPG >9 mmol/L. BMI ≥25 and ≤40 kg/m^2. Ability and willingness to perform self-monitoring of blood glucose using the Sponsor-provided glucose meter and to complete the patient diary. Willingness and ability to comply with the study protocol. Signed informed consent obtained prior any study procedure. Exclusion criteria: Known hypersensitivity/intolerance to insulin glargine or any of its excipients. History of hypoglycemia unawareness. Unexplained hypoglycemia in the past 6 months. Pregnancy or planned pregnancy or current lactation (women of childbearing potential must have a negative pregnancy test at study entry and a medically approved contraception method). Acute diabetic complications (diabetic ketoacidosis, lactic acidosis, hyperosmolar nonketotic diabetic coma). History of stroke, myocardial infarction, angina pectoris, coronary artery bypass graft, or percutaneous transluminal coronary angioplasty within the previous 12 months. Active proliferative retinopathy, as defined by a photocoagulation or vitrectomy occurrence in the 6 months prior to study entry, or any other unstable (rapidly progressing) retinopathy that may require photocoagulation or surgical treatment during the study, documented by retina examination or disease history record, in the 2 years prior to study entry. Impaired renal function defined as, but not limited to, serum creatinine levels ≥1.5 mg/dL (132 μmol/L) for males and ≥1.4 mg/dL (123 μmol/L) for females or presence of macroproteinuria (>2 g/day). Active liver disease (alanine transaminase [ALT] greater than two times the upper limit of the reference range, as defined by the local laboratory). The above information is not intended to contain all considerations relevant to a patient's potential participation in a clinical trial.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard initial dose of insulin glargine<br>Dose 1 of insulin glargine will be administered subcutaneously once a day at the same time every day. Previous non-sulfonylurea OADs (eg, metformin, acarbose) are background treatment and will be continued at the same dosage and dosing frequency as before. | Drug: INSULIN GLARGINE<br>* Pharmaceutical form: solution Route of administration: subcutaneous injection<br>* Other names: HOE901;Drug: metformin<br>* Pharmaceutical form: table or capsule Route of administration: oral administration<br>Drug: acarbose<br>* Pharmaceutical form: table or capsule Route of administration: oral administration<br>|
| Experimental: Higher initial dose of insulin glargine<br>Dose 2 of insulin glargine will be administered subcutaneously once a day at the same time every day. Previous non-sulfonylurea OADs (eg, metformin, acarbose) are background treatment and will be continued at the same dosage and dosing frequency as before. | Drug: INSULIN GLARGINE<br>* Pharmaceutical form: solution Route of administration: subcutaneous injection<br>* Other names: HOE901;Drug: metformin<br>* Pharmaceutical form: table or capsule Route of administration: oral administration<br>Drug: acarbose<br>* Pharmaceutical form: table or capsule Route of administration: oral administration<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of patients with at least one episode of hypoglycemia |  | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of patients achieving HbA1c <7% |  | 16 weeks | 
| Percentage of patients achieving Fasting Plasma Glucose target (<5.6, <6.1, and <7.0 mmol/L) |  | 16 weeks | 
| Accumulated percentage of patients achieving Fasting Plasma Glucose target (<5.6, <6.1, and <7.0 mmol/L) |  | 16 weeks | 
| Change from baseline in HbA1c |  | Baseline, 16 weeks | 
| Change from baseline in Fasting Plasma Glucose |  | Baseline, 16 weeks | 
| Change from baseline in Post Prandial Glucose |  | Baseline, 16 weeks | 
| Change in body weight |  | Baseline, 16 weeks | 
| - Change in insulin dose |  | Baseline, 16 weeks | 
| Number of overall hypoglycemic events (with severe or confirmed hypoglycemia [≤3.9 mmol/L]) |  | Baseline, 16 weeks | 
| Number of nocturnal hypoglycemic events |  | Baseline, 16 weeks | 
| Number of severe hypoglycemic events |  | Baseline, 16 weeks |