Status: Finalised
First registered on:
17/06/2014
Last updated on:
08/07/2014
1. Study identification
EU PAS Register NumberEUPAS6779
Official titleComparative effectiveness of insulines vs analogues to prevent complications of diabetes
Study title acronymCER insulin vs analogues
Study typeObservational study
Brief description of the studyThe major challenge concerning the treatment of diabetes is representended by the prevention of vascular and metabolic diabetic complications and the related consequences for the health status of patients.
Human insulin and/or its analogues are used to treat both type 1 diabetes mellitus, from its first onset, and type 2 diabetes, in its advanced phase. For both types of insulin, different formulations with different time to onset and duration of action, are currently available in order to provide patients with the most appropriate therapeutic option to mantain blood glucose concenration within the phisiological range throughout the day. In fact, different long-term follow-up studies of randomized clinical trials have found an association between inadequate plasma glucose control and the occurrence of diabetes complications.
Insulin analogues possess benefit relative to human insulins in terms of glycemic control however, little is known about the long-term comparative effectiveness of insulin analogue with respect to human insulins in reducing the risk of cardiovascular and metabolic complications of diabetes.
The main objective of this study was to assess the risk of diabetes complications in patients treated with insulin analogues against those using human insulin in a clinical pratice setting (i.e. Tuscany region). The secondary scope of this study was to evaluate healthcare costs respectively associated with the use of human insulins and insulin analogues (e.g. pharmacological treatment related to diabetes, hospitalizations, diagnostic procedures).
Was this study requested by a regulator?No
Is the study required by a Risk Management Plan (RMP)?
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
Centre to which the investigator belongsARS
Department/Research groupOsservatorio di Epidemiologia
Organisation/affiliationAgenzia regionale di sanità della Toscana (ARS)
Details of (Primary) lead investigator
Title Dr
Last name Gini
First name Rosa
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
Italy
3. Study timelines: initial administrative steps, progress reports and final report
PlannedActual
Date when funding contract was signed09/09/201309/09/2013
Start date of data collection30/09/201318/11/2013
Start date of data analysis
Date of interim report, if expected
Date of final study report02/04/201409/06/2014
4. Sources of funding
Please provide estimates of the percentage of funding by source for this study
Names(s)Approximate % funding
Pharmaceutical companiesEli Lilly Italia50
Charities
Government bodyARS50
Research councils
EU funding scheme
5. Contact details for enquiries
Scientific Enquiries
Title Dr
Last name Gini
First name Rosa
Address line 1Via Pietro Dazzi 1
Address line 250141
Address line 3
CityFlorence
Postcode50141
CountryItaly
Phone number (incl. country code)39-0554624341
Alternative phone number
Fax number (incl. country code)
Public Enquiries
Title Dr
Last name Gini
First name Rosa
Address line 1Via Pietro Dazzi 1
Address line 250141
Address line 3
CityFlorence
Postcode50141
CountryItaly
Phone number (incl. country code)39-0554624341
Alternative phone number
Fax number (incl. country code)
6. Study drug(s) information
Substance class (ATC Code)A10A (INSULINS AND ANALOGUES)
7. Medical conditions to be studied
Medical condition(s)Yes
Diabetic hyperosmolar coma
Diabetic eye disease
Diabetic neuropathy
Diabetic nephropathy
Diabetic vascular disorder
Diabetic ketoacidosis
Diabetic retinopathy
Diabetic complication
8. Population under study
Age
Infants and toddlers (28 days - 23 months)
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
Other population
Renal impaired
Hepatic impaired
Immunocompromised
Pregnant women
9. Number of subjects
Estimated total number of subjects6339
10. Source of data
Is this study being carried out with an established data source?No
Sources of data
Administrative database, e.g. claims database
Pharmacy dispensing records
11. Scope of the study
What is the scope of the study?
Effectiveness evaluation
Secondary scope: Evaluation of healthcare costs associated with the use of human insulins and insulin analogues respectively.
Primary scope : Effectiveness evaluation
12. Main objective(s)
What is the main objective of the study?
To assess the effectectiveness of Analogue Insulin vs Human Insulin in reducing the risk of long-term microvascular, macrovascular and metabolic complications of diabetes.
Are there primary outcomes?Yes
Overall vascular and metabolic complications of diabetes mellitus.
Are there secondary outcomes?Yes
1) Microvascular complications
2) Macrovascular complications
3) Metabolic complications
13. Study design
What is the design of the study?
Case-control study
14. Follow-up of patients
Will patients be followed up?Yes
Please describe duration of follow up
Patients with an incident insulin prescription (ATC code A10*) between January 2005 and December 2011, and receiving the 4th insulin prescription within 1 year, were followed-up until the occurrence of the outcome of interest (index date), a cancer diagnosis, death,
unsubscription from the Regional Healthcare Service or the end of data availability (December 2012).
15. Data analysis plan
Please provide a brief summary of the analysis method
This was a nested case-control in which cases were subjects with an incident inpatient diagnosis of vascular/metabolic diabetic complications. For each case, up to 3 sex, age and index date matched controls were randomly selected from the cohort.
Incidence rate of diabetic complications was calculated by dividing the number of events by the sum of the person-time of the at risk population.
Using a time-dependent exposure definition, Odds Ratio and 95% confidence interval of diabetic complications associated with current use of insulin analogue vs human insulin(≤1 year prior to the outcome) were estimated by conditional logistic regression and adjusted for selected comorbidities.
As for the economic analysis, patients were allocated to specific insulin treatment considering the exposure observed during the 1st year of enrollment while costs where evaluated considering the 2nd year. A multiple linear regression analysis model was applied and adjusted for selected confounder.
16. ENCePP seal
Are you requesting the ENCePP seal for this study?
No
17. Full protocol
18. Study Results
Please list the 5 most relevant publications using data from your study
ReferenceLink to web-publication
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
