Comparison of a New Formulation of Insulin Glargine With Lantus in Patients With Type 1 Diabetes Mellitus on Basal Plus Mealtime Insulin

Study Overview
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Brief Summary
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Primary Objective: To compare the glucose control during treatment with a new formulation of insulin glargine and Lantus in adult participants with type 1 diabetes mellitus Secondary Objectives: To compare a new formulation of insulin glargine and Lantus given in the morning or in the evening To compare the incidence and frequency of hypoglycemic episodes To assess the safety and tolerability of the new formulation of insulin glargine

Detailed Description
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Up to 4-week screening period; 16-week open-label comparative efficacy and safety treatment period; 4-week post-treatment safety follow-up period.

Official Title
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A 16-week, Randomized, Open-label, Controlled Study Comparing the Efficacy and Safety of a New Formulation of Insulin Glargine Versus Lantus in Patients With Type 1 Diabetes Mellitus

Conditions
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Type 1 Diabetes Mellitus

Intervention / Treatment
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* Drug: HOE901-U300 (new formulation of insulin glargine)
* Drug: Lantus (insulin glargine)


Participation Criteria
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Eligibility Criteria
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Inclusion criteria : Participants with Type 1 diabetes mellitus Exclusion criteria: HbA1c greater than (>) 9% (at screening) Participants receiving >0.5 U/kg body weight basal insulin in the last 30 days prior to screening visit Participants not on stable insulin dose (+/- 20% total basal insulin dose) in the last 30 days prior to screening visit Less than 1 year on any basal plus mealtime insulin Participants using pre-mix insulins, human regular insulin as mealtime insulin and/or any antidiabetic drugs other than basal insulin and mealtime analogue insulin in the last 3 months before screening visit Use of an insulin pump in the last 6 months before screening visit; Any contraindication to use of insulin glargine as defined in the national product label Not willing to inject insulin glargine as assigned by the randomization process once daily in the morning or evening Hospitalization for diabetic ketoacidosis or history of severe hypoglycemia (requiring 3rd party assistance) in the last 6 months prior to randomization Initiation of any glucose-lowering agents in the last 3 months before screening visit Weight change of greater than equal to (>=) 5 kg during the last 3 months prior to screening visit Unstable proliferative diabetic retinopathy or any other rapidly progressive diabetic retinopathy or macular edema likely to require laser, surgical treatment or injectable drugs during the study period The above information is not intended to contain all considerations relevant to a participant'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 |
| --- | --- |
| Experimental: HOE901-U300 Morning Then Evening<br>HOE901-U300 (new insulin glargine 300 units per milliliter [U/mL]) subcutaneous (SC) injection once daily in morning for 8 weeks during treatment period A, followed by once daily in evening for 8 weeks during treatment period B. Dose titration seeking fasting plasma glucose 4.4-7.2 millimole per liter (mmol/L). | Drug: HOE901-U300 (new formulation of insulin glargine)<br> <br> |
| Experimental: HOE901-U300 Evening Then Morning<br>HOE901-U300 (new insulin glargine 300 U/mL) SC injection once daily in evening for 8 weeks during treatment period A, followed by once daily in morning for 8 weeks during treatment period B. Dose titration seeking fasting plasma glucose 4.4-7.2 mmol/L. | Drug: HOE901-U300 (new formulation of insulin glargine)<br> <br> |
| Active Comparator: Lantus Morning Then Evening<br>Lantus (HOE901-U100, insulin glargine 100 U/mL) SC injection once daily in morning for 8 weeks during treatment period A, followed by once daily in evening for 8 weeks during treatment period B. Dose titration seeking fasting plasma glucose 4.4-7.2 mmol/L. | Drug: Lantus (insulin glargine)<br> <br> |
| Active Comparator: Lantus Evening Then Morning<br>Lantus (HOE901-U100, insulin glargine 100 U/mL) SC injection once daily in evening for 8 weeks during treatment period A, followed by once daily in morning for 8 weeks during treatment period B. Dose titration seeking fasting plasma glucose 4.4-7.2 mmol/L. | Drug: Lantus (insulin glargine)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Time in Target Plasma Glucose Range (4.4-7.8 mmol/L [80-140 mg/dL]) | Percentage of time with glucose within glycemic range (4.4-7.8 mmol/L) was assessed by the total time within glycemic range divided by the length of the assessment interval. | Up to Week 16 (assessed at Weeks 7-8 in Period A and Weeks 15-16 in Period B) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of Time Above the Upper Limit of Glycemic Range (Greater Than [>] 7.8 mmol/L [(140 mg/dL]) | Percentage of time with glucose above the upper limit of glycemic range (>7.8 mmol/L) was assessed by the total time above the upper limit of glycemic range divided by the length of the assessment interval. | Up to Week 16 (assessed at Weeks 7-8 in Period A and Weeks 15-16 in Period B) | 
| Percentage of Time Below The Lower Limit of Glycemic Range (<4.4 mmol/L [80 mg/dL]) | Percentage of time with glucose below the lower limit of glycemic range (<4.4 mmol/L) was assessed by the total time below the lower limit of glycemic range divided by the length of the assessment interval. | Up to Week 16 (assessed at Weeks 7-8 in Period A and Weeks 15-16 in Period B) | 
| Evaluation of Diurnal Glucose Exposure, Variability, and Stability | The diurnal glucose exposure is measured as the average diurnal glucose concentration, diurnal glucose variability is measured by interquartile range (IQR), that is, average distance between the 25th and the 75th point-wise percentiles and diurnal glucose stability is assessed in terms of the mean absolute rate of change (mmol/l), that is, the area under the absolute rate of change of the median curve (based on the median point values between two adjacent hourly basket intervals), divided by the length of the assessment interval. | Up to Week 16 (assessed at Weeks 7-8 in Period A and Weeks 15-16 in Period B) | 
| Percentage of Time in Target Plasma Glucose Range (4.4-7.8 mmol/L [80-140 mg/dL]) in the Last Four Hours of Each Dosing Interval at Weeks 7 and 8 in Period A and Weeks 15 and 16 in Period B | Percentage of time with glucose within glycemic range (4.4-7.8 mmol/L) was assessed by the total time within glycemic range divided by the length of the assessment interval. | Weeks 7-8 in Period A and Weeks 15-16 in Period B | 
| Change in HbA1c From Baseline to Week 8 and 16 |  | Baseline, Week 8, 16 | 
| Change in Fasting Plasma Glucose (FPG) From Baseline to Week 8 and 16 |  | Baseline, Week 8, 16 | 
| Change in Average 7-Point Self-Monitored Plasma Glucose (SMPG) Profile From Baseline to Week 8 and 16 | Change in average of 7-point SMPG. 7-point SMPG was assessed starting with a measurement at before breakfast and 2 hours after breakfast; before and 2 hours after lunch; before and 2 hours after dinner; at bedtime. | Baseline, Week 8, 16 | 
| Change in Basal Insulin Daily Dose From Baseline to Week 8 and 16 |  | Baseline, Week 8, 16 | 
| Percentage of Participants With Hypoglycemia (All and Nocturnal) Events From Baseline Up to Week 16 | Hypoglycemia events were Severe hypoglycemia (an event that required assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions); Documented symptomatic hypoglycemia (typical symptoms of hypoglycemia with plasma glucose level of <=3.9 mmol/L [70 mg/dL]); Asymptomatic hypoglycemia (no typical symptoms of hypoglycemia but plasma glucose level <=3.9 mmol/L); Probable symptomatic hypoglycemia (an event during which symptoms of hypoglycemia were not accompanied by a plasma glucose determination, but was presumably caused by a plasma glucose level <=3.9 mmol/L, symptoms treated with oral carbohydrate without a test of plasma glucose); Relative hypoglycemia (an event during which the person with diabetes reported any of the typical symptoms of hypoglycemia, and interpreted the symptoms as indicative of hypoglycemia, but plasma glucose level >3.9 mmol/L); Severe and/or confirmed a hypoglycemia (plasma glucose <=3.9 mmol/L). | Up to Week 16 |