Clinical trial NCT01868646: Clinical Trial of Efficacy and Safety of Subetta in the Combined Treatment of Patients With Type II Diabetes Mellitus
Official title: Multicentre Double-blind Placebo-controlled Parallel-group Randomized Clinical Trial of Efficacy and Safety of Subetta in the Combined Treatment of Patients With Type II Diabetes Mellitus
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Type II Diabetes Mellitus
Keywords: Combined Treatment of Patients With Type II Diabetes Mellitus
Lead sponsor: Materia Medica Holding
Sponsor class: INDUSTRY
First posted: 2013-06-04
Enrollment: 190
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: The purpose of this study is:

* to assess clinical efficacy of Subetta in the combined treatment of type II diabetes mellitus;
* to assess safety of Subetta in the combined treatment of type II diabetes mellitus.

Detailed description: Patients with type II diabetes mellitus are included in the trial. It is concerned those patients, who by the time of the trial receive basal insulin with metformin or metformin and sulfonylurea derivatives and with lack of optimal glycemic control (HbA1c\>7.0%). For patients, which will be included in the trial (mainly middle aged patients without severe complications of diabetes), HbA1c\>7.0% is the marker showing that optimal individual goal of glycemic control is not achieved.

If a patient meets inclusion criteria and does not show exclusion criteria he/she is randomized in one of 2 groups: Group 1 - the group receiving standard type II diabetes mellitus therapy + Subetta at a dose of 1 tablet 4 times a day; Group 2 - the group receiving standard type II diabetes mellitus therapy + Placebo under the regimen used for Subetta. The invented names of the drugs containing basal insulin, metformin and sulfonylurea derivatives used as standard type II diabetes mellitus therapy, should be unchanged for each patient during the whole trial.

All patients will receive glucometers and the appropriate glucose test strips, so they could self monitor blood glucose and register this data in their diaries.

The trial duration is 38 weeks; the main stages of the trial are conducted during screening, then in 4 weeks (Visit 2), in 12 weeks (Visit 3), in 24 weeks (Visit 4) and in 36 weeks (Visit 5). In 1 week after randomization and the onset of the trial therapy and between the visits to the study site (on weeks 8±1, 18±1and 30±1) an investigator collects data on patient's health and complaints (phone visits) to decide whether it is necessary to arrange unplanned visit to the site.

Eligibility criteria: Inclusion Criteria:

1. Diagnosed type II diabetes mellitus (according to WHO criteria, 1999 - 2006).
2. Patient's age from 18 to 65 years inclusive.
3. Level of glycosylated hemoglobin 7.0- 10.0 %.
4. Dose of basal insulin ≥10 units/day combined with metformin or with metformin and sulfonylurea derivatives during not less than 3 months prior to inclusion in the trial.
5. Body mass index ≥25.0 and ≤40.0kg/m\^2.
6. Constant body weight (without fluctuations \> 10% during not less than 3 months prior to inclusion in the trial).
7. Glomerular filtration rate ≥ 60 ml/ min/1.73m\^2.
8. Stable dose of basal insulin for the last 3 months.(Permissible fluctuations are ±10%.)
9. Usage of contraceptive methods by both gender patients of reproductive age during the trial and within 30 days after ending the participation in the trial.
10. Availability of signed patient information sheet (Informed Consent form) for participation in the clinical trial.

Exclusion Criteria:

1. Acute diabetes mellitus complications for 3 months prior to inclusion in the trial (diabetic ketoacidosis, hyperosmolar hyperglycemic state, lacticemia, severe hypoglycemia and hypoglycemic coma).
2. Diabetic retinopathy, preproliferative, proliferative or terminal stages (based on the results of oculist examination during screening period or 6 months prior to the trial).
3. Diabetic nephropathy, proteinuria stage, chronic kidney disease on 3, 4 or 5 stage.
4. Diabetic microangiopathy:

   * ishemic heart disease (medical history of a sudden coronary death with successful reanimation, medical history of myocardial infarction, stable exertional angina III or IV FC; unstable angina; postinfarction cardiosclerosis; chronic heart failure III or IV FC);
   * cerebrovascular diseases (medical history of acute cerebrovascular accident; progressive vascular leukoencephalopathy; vascular dementia);
   * chronic obliterative peripheral vascular diseases (clinically significant);
   * diabetic neuroosteoarthropathy;
   * diabetic foot (clinically significant).
5. Heart rhythm disorder:

   * II-III atrioventricular block;
   * sick sinus syndrome;
   * long QT interval syndrome;
   * complete left bundle branch block;
   * block of 2/3 bundle branches;
   * WPW syndrome;
   * ventricular arrhythmia of III grade according Laun-Wolf;
   * paroxysmal supraventricular tachycardia;
   * paroxysmal/recurrent ventricular tachycardia;
   * atrial flutter and fibrillation;
   * ventricular flutter and fibrillation;
   * heart pacemaker implant.
6. Uncontrolled arterial hypertension characterized by the following blood tension values: systolic blood pressure over 160 mm Hg and/or diastolic blood pressure over 100 mm Hg.
7. Severe concomitant pathology including clinically significant cardio- vascular diseases of III - IV functional class (according to New York Heart Association classification, 1964), nervous and endocrine system diseases, including morbid obesity (body mass index≥40.0 kg/m\^2), renal insufficiency, liver failure.
8. Medical history of pancreatectomy or transplantation of pancreatic/islet cells.
9. Medical history of renal transplantation.
10. Malignant neoplasms/suspected malignant neoplasms.
11. Exacerbations or decompensation of chronic diseases affecting a patient's ability to participate in the clinical trial.
12. The results of analysis of liver enzymes (alanine aminotransferase, aspartate aminotransferase) more than threefold exceeding of upper limit of normal values.
13. Level of fasting triglycerides \>5.64 mmol/L.
14. Medical history of bariatric surgical operations.
15. Medical history of polyvalent allergy
16. Allergy/ intolerance to any of the components of medications used in the treatment.
17. Intake of medicines listed in the section "Prohibited concomitant treatment" for 3 months prior to the inclusion in the trial.
18. Pregnancy, breast-feeding.
19. Drug addiction, alcohol usage in the amount exceeding 2 units of alcohol per day.
20. Mental disorders of a patient.
21. Night work.
22. Participation in other clinical trials in the course of 3 months prior to the inclusion in the trial.
23. Patients, who from the investigator's point of view, will fail to comply with the observation requirements of the trial or with the intake regimen of the investigated medicines.
24. Other factors impeding patient's participation in the trial (for example, planned business trips or journeys).
25. Patient is related to the research personnel of the investigative site, who are directly involved in the trial or are the immediate relative of the researcher. The immediate relative includes husband/wife, parents, children or brothers (or sisters), regardless of whether they are natural or adopted.
26. Patient works for OOO "NPF "Materia Medica Holding" (i.e. is the company's employee, temporary contract worker or appointed official responsible for the carrying out the research) or the immediate relative.

Primary outcomes:
measure: Changes in the Mean Value of HbA1c
timeFrame: In 12, 24 and 36 weeks of the treatment as compared to the baseline
Secondary outcomes:
measure: Change in Fasting Plasma Glucose
timeFrame: In 4, 12, 24 and 36 weeks of the treatment as compared to the baseline
measure: Change in Average Daily Blood Glucose From a 7-point Patient Self-monitoring of Blood Glucose (SMBG)
timeFrame: During the whole study period (on weeks 4, 8, 12, 18, 24, 30 and 36 of the treatment) as compared to the baseline
measure: Mean Value of C-peptide
timeFrame: In 12, 24 and 36 weeks of the treatment as compared to the baseline
measure: Changes in Lipids (Concentrations of Plasma Total Cholesterol, HDL Cholesterol, LDL Cholesterol and Triglycerides)
timeFrame: In 12, 24 and 36 weeks of the treatment as compared to the baseline
measure: Changes in Dosage of Insulin (Basal Dose Insulin Measured in IU/Day)
timeFrame: In 36 weeks of the treatment as compared to the baseline
measure: Changes in Dosage of Insulin (Basal Dose Insulin Measured in IU/ kg of Body Weight)
timeFrame: In 36 weeks of the treatment as compared to the baseline
measure: Percentage of Patients With Changed Daily Dose of Per Oral Blood Sugar- Lowering Drugs
timeFrame: In 36 weeks of the treatment
measure: Changes in the Mean Absolute Value of Body Weight (kg)
timeFrame: In 36 weeks of the treatment as compared to the baseline
measure: Changes in the Mean Absolute Value of Body Mass Index (BMI) (kg/m^2)
timeFrame: baseline and 36 weeks of the treatment
measure: Satisfaction of Diabetes Treatment Based on Diabetes Treatment Satisfaction Questionnaire Data
timeFrame: In 36 weeks of the treatment
Other outcomes:
Locations:
city: Moscow region
country: Russian Federation
facility: Municipal budgetary authority "Khimki Central Clinical Hospital"
city: Moscow
country: Russian Federation
facility: State Healthcare Institution of Moscow "Central research institute of gastroenterology" of Department of health care of Moscow
city: Moscow
country: Russian Federation
facility: State Educational Institution of Higher Professional Education "Moscow State Medical Academy named after I.M. Sechenov"
city: Moscow
country: Russian Federation
facility: Nonstate Health Care Institution "Central Clinical Hospital №2 named after N.A. Semashko of Public Limited Company "Russian Railways"
city: Nizhny Novgorod Region
country: Russian Federation
facility: Nizhny Novgorod regional State Budgetary Health Institution " Nizhny Novgorod regional Clinical Hospital named after N.A. Semashko "
city: Rostov-on-Don
country: Russian Federation
facility: State Budgetary Educational Institution of High Professional Training "Rostov State Medical University" of Ministry of Health of Russian Federation, Department of Endocrinology
city: Samara
country: Russian Federation
facility: Co.Ltd " Diabet Center"
city: Smolensk
country: Russian Federation
facility: The State Budgetary Educational Institution of Higher Professional Education "Smolensk National Research Medical University" Ministry of Health of the Russian Federation
city: St. Petersburg
country: Russian Federation
facility: St. Petersburg State Budgetary Health Care Institution "City Polyclinic №6"
city: St. Petersburg
country: Russian Federation
facility: St. Petersburg State Budgetary Health Care Institution "Saint Venerable Martyr Elizaveta Municipal Hospital"
city: St. Petersburg
country: Russian Federation
facility: State Budgetary Educational Institution of High Professional Training "St. Petersburg State Medical University named after academician I.P. Pavlov" of Ministry of Health of Russian Federation, Therapy Faculty Board
city: St. Petersburg
country: Russian Federation
facility: St. Petersburg Sate Budgetary Institution "Consultative-Diagnostic Polyclinic №1 of Coastal Area"
city: St. Petersburg
country: Russian Federation
facility: St. Petersburg State Budgetary Health Care Institution "Consultative-Diagnostic Center № 85", Diabetes Center №2
city: St.Petersburg
country: Russian Federation
facility: St. Petersburg State Budgetary Health Care Institution "City Polyclinic №77 of Nevsky District", The City Diabetes Center №4
city: Vladimir
country: Russian Federation
facility: Vladimir region State budgetary institution of health care "Regional clinical hospital"
city: Voronezh
country: Russian Federation
facility: Independent Health Care Institution of Voronezh Region "Voronezh Regional Clinical Consultative-Diagnostic Center"
city: Yaroslavl
country: Russian Federation
facility: State Budgetary Health Care Institution of Yaroslavl Region "Regional Сlinical Hospital"
Study officials:
References: