Status: Finalised
First registered on:
16/12/2011
Last updated on:
18/08/2016
1. Study identification
EU PAS Register NumberEUPAS2278
Official titleAssessment of association between severe hypoglycaemia and use of detemir, glargine and NPH insulins (ER11-9417/ U1111-1120-7164)
Study title acronym
Study typeOther: nation-wide register-based study
Brief description of the studyHypoglycaemia events occur among diabetes patients who use insulin for treatment of diabetes mellitus. From the oral treatments supholnylurea (SU) products can also cause hypoglycaemia. Risk of hypoglycaemia is increased with age and duration of diabetes.
Severe hypoglycemia can result in permanent neurological sequelae including neuronal cell death. Hypoglycemia also increases platelet aggregation and fibrinogen formation, which may accelerate vascular compromise in the brain. Among older patients with type 2 diabetes, a history of severe hypoglycaemic episodes severe enough to require hospitalization or an emergency department visit are associated with increased risk of dementia, particularly for patients who have a history of multiple episodes.
The development of long-acting basal insulin analogues with improved pharmacokinetics, which are able to more closely replicate endogenous insulin secretion, has been shown to have a positive effect on the balance between effective glycaemic control and hypoglycaemic risk compared to NPH insulin.
The primary aim of this retrospective follow-up study is to evaluate the differences in the incidence of the hospitalization and the secondary health care visits due to diabetes mellitus with hypoglycaemic coma between the different insulins.
Was this study requested by a regulator?No
Is the study required by a Risk Management Plan (RMP)?
Not applicable
Regulatory procedure number (RMP Category 1 and 2 studies only)
Other study registration identification numbers and URLs as applicable
2. Research centres and Investigator details
Coordinating study entity
Department/Research group
Organisation/affiliationEPID Research Oy
Details of (Primary) lead investigator
Title Dr
Last name Haukka
First name Jari
Is this study being carried out with the collaboration of a research network?
No
Other centres where this study is being conducted
Not applicable (single centre)
Countries in which this study is being conducted
National study
Finland
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed26/01/2011
Start date of data collection09/03/2011
Start date of data analysis
Date of interim report, if expected
Date of final study report14/03/201218/06/2012
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesNovo Nordisk Farma Oy100
Charities
Government body
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Haukka
First name Jari
Address line 1EPID Research Oy
Address line 2Metsänneidonkuja 12
Address line 3
CityEspoo
Postcode02130
CountryFinland
Phone number (incl. country code)358-45-6346672
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Haukka
First name Jari
Address line 1EPID Research Oy
Address line 2Metsänneidonkuja 12
Address line 3
CityEspoo
Postcode02130
CountryFinland
Phone number (incl. country code)358-45-6346672
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)A10A (INSULINS AND ANALOGUES)
Substance class (ATC Code)A10BB (Sulfonamides, urea derivatives)
7. Medical conditions to be studied
Medical condition(s)Yes
Diabetic coma
8. Population under study
Age
Children (2 - 11 years)
Adolescents (12 - 17 years)
Adults (18 - 44 years)
Adults (45 - 64 years)
Adults (65 - 74 years)
Adults (75 years and over)
Sex
Male
Female
9. Number of subjects
Estimated total number of subjects138000
10. Source of data
Is this study being carried out with an established data source?Yes
Data sources not registered with ENCePP
Finnish Prescription Register, Finland
Finnish Registry for Reimbursed Medications, Finland
Finnish National Health Care Register, Finland
Finnish Cause of Death Register, Finland
Sources of data
Disease/case registry
Administrative database, e.g. claims database
Pharmacy dispensing records
11. Scope of the study
What is the scope of the study?
Risk assessment
Drug utilisation study
Primary scope : Risk assessment
12. Main objective(s)
What is the main objective of the study?
1) to estimate the incidence of severe hypoglycaemic coma, 2) to evaluate the recurrence of severe hypoglycaemic coma, and 3) to evaluate the number of severe hypoglycaemic coma events and duration of hospitalizations and secondary health care visits due to severe hypoglycaemic coma among diabetes patients using detemir, glargine, and NPH insulins, separately in the naïve and non-naïve populations
Are there primary outcomes?Yes
Severe hypoglycaemic coma (defined as: had led to hospitalization or outpatient hospital visit due to hypoglycaemic coma) among diabetes patients using detemir, glargine and NPH insulins.
Are there secondary outcomes?Yes
Switching between different insulin among diabetic patients using detemir, glargine or NPH insulins.
13. Study design
What is the design of the study?
Nation-wide retrospective register-based linkage study
14. Follow-up of patients
Will patients be followed up?Not applicable/no follow-up
15. Data analysis plan
Please provide a brief summary of the analysis method
Crude incidence rates for detemir, glargine, and NPH-insulins, will be estimated for the first severe hypoglycaemia coma event and the recurrence of severe hypoglycaemia coma events, stratified according to the following variables: type of diabetes (T1, T2, undefined), age at start of follow-up , gender, calendar year of diagnose, time since start of insulin treatment, ever use of oral diabetes medication (A10BB) present use of other diabetes medication (A10A) and hospital district start of follow-up. The adjusted hazard ratio (HR) estimates for first occurrence and recurrence of severe hypoglycemia will be estimated using the conventional Cox’s proportional hazards model. In addition, the causal effect of the treatments will be estimated by the use of the marginal structural models (MSM).
The follow-up time in the analyses starts at the first purchase of detemir, glargine or NPH-insulin during 2000-2009 and ends at time of death or end of study period, whichever occurs first.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
Not submitted
18. Study Results
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
Haukka J, Hoti F, Erästö P, et al. Evaluation of the incidence and risk of hypoglycemic coma associated with selection of basal insulin in the treatment of diabetes: a Finnish register linkage study. Pharmacoepidemiology and Drug Safety 2013http://onlinelibrary.wiley.com/doi/10.1002/pds.3534/full
19. Other relevant documents
Conflict(s) of interest of
investigator(s)Not submitted
Composition of Steering Group and
ObserversNot submitted
Other documentsNot
submitted
Signed Code of
Conduct Checklist
Not submitted
Signed Code of Conduct Declaration
Not submitted
Signed Checklist for Study
Protocols
Not submitted
