Purpose

Hyperglycemia affects 30-40% of hospitalized patients. Despite the fact that basal/bolus insulin therapy has been demonstrated to improve glycemic control and clinical outcomes in patients, achieving good glucose control remains a challenge. This study examines the effects of Fiasp (a faster acting insulin) on blood sugars after meals compared to another type of insulin known as Novolog. The study will be performed in patients with type 2 diabetes admitted to the hospital, who are not in the intensive care unit, and who are being seen by the inpatient diabetes consult team. Eligible participants will be treated with Fiasp or Novolog injected multiple times a day before meals and at bedtime, in addition to a once daily injection of insulin glargine as basal insulin. Which type of meal time insulin (Fiasp vs Novolog) the subject gets is decided by chance, like the flip of a coin. Insulin doses will be started and titrated based on a protocol. All the subjects will wear a blinded continuous glucose monitoring (CGM)) sensor placed in their arm which they will wear for 72 hours during the study. The glucose values from the CGM, collected during the time it is worn, will be downloaded and compared to assess the response to the two different types of insulins - Fiasp and Novolog. The goal is to determine if Fiasp works as well as or better than Novolog in controlling blood sugars, particularly after meals, in the subjects of the study.

Condition

Eligibility

Eligible Ages
Between 21 Years and 80 Years
Eligible Genders
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  1. English-speaking 2. Males and female adult subjects admitted to Boston Medical Center to a medical or surgical floor. 3. Consultation by the Inpatient Diabetes Service at Boston Medical Center is required prior to consent. 4. Age ≥ 21 and <= 80 years. 5. Diagnosed with type 2 diabetes at least 180 days prior to screening. 6. Hyperglycemia during admission, as defined by a point of care and/or venous blood glucose ≥ 140 mg/dL. 7. Prior to admission subjects must be using one of the following for outpatient diabetes management: 1. Insulin 2. ≥ 2 oral/injectable agents 3. One oral/injectable agent with a hemoglobin A1c of ≥ 8% within 3 months of enrollment. 8. Patients who are expected to remain hospitalized for a minimum of 48 hours following CGM sensor placement. 9. BMI <45 kg/m^2. 10. Subjects must have insulin glargine dosing planned at bedtime for the duration of the study period. Morning and afternoon dosing of insulin glargine are exclusionary.

Exclusion Criteria

  1. Patients with a history of type 1 diabetes or late-onset autoimmune diabetes (LADA). 2. Treatment or plan for treatment with glucocorticoids during the index hospitalization. 3. Female patients who are pregnant (tested during hospitalization or screening) or breast-feeding during the hospitalization. 4. Patients admitted with the following conditions: diabetic ketoacidosis, hyperosmolar hyperglycemic state, solid organ transplantation, or coronary artery bypass surgery. 5. Prior diagnosis of gastroparesis or cirrhosis. 6. Acute or chronic kidney disease with a serum creatinine of ≥ 2 mg/dL at the time of screening. 7. Clinically significant nausea and/or vomiting or unable to consume more than 30 grams of carbohydrate at each meal. 8. Patients expected to receive nothing by mouth (NPO) for >24 hours. 9. Use of continuous or intermittent enteral feeding or parenteral nutrition. 10. Patient receiving aspirin and/or vitamin C during the hospitalization. 11. Any mental condition rendering the subject unable to provide informed consent. 12. Patients currently incarcerated. 13. Patients using >1 unit/kg/day of insulin prior to admission. 14. Insulin pump usage within the 2 weeks prior to or during admission. 15. Patients currently using real-time continuous glucose monitoring (CGM) or personal flash glucose monitoring system (FGM). 16. Patients with a history of an allergy to any of the types of insulin or one of the excipients in the insulin used in the study.

Study Design

Phase
Phase 3
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Primary Purpose
Treatment
Masking
None (Open Label)

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Group 1 insulin glargine and Novolog
Group 1 will receive daily basal insulin glargine with a scheduled bolus of meal insulin Novolog. Meal Novolog will be dosed at the time the subject starts to eat. If the premeal BG is ≥ 150 mg/dL, additional Novolog will be administered based off the correctional scale at the same time as the prandial insulin. The dose of Novolog will be administered by the floor nurse as per usual standard of care.
  • Drug: Insulin glargine
    Insulin glargine doses will be determined by calculating the total daily dose (TDD) of insulin and providing 50% of the TDD as follows: start at 0.5 units/kg/day and subtract 0.1 unit/kg/day for 70+ yrs of age, renal insufficiency, pancreatic deficiency and add 0.1 unit/kg/day if hemoglobin A1c in >10%
    Other names:
    • Lantus®
  • Drug: NovoLog
    Novolog will be administered with each meal if premeal glucose is ≥ 150 mg/dL and at bedtime if glucose is ≥ 200 mg/dL by calculating an individualized insulin sensitivity factor for each subject per the following formula: 1500/total daily dose of insulin = sensitivity factor.
    Other names:
    • NovoLog®
  • Other: Standard carbohydrate diet
    Standard carbohydrate diet as per usual hospital care (75g with each meal)
Experimental
Group 2 insulin glargine and Fiasp
Group 2 will receive basal insulin glargine as dosed in Group 1. Meal insulin Fiasp dosing will be calculated the same way as Novolog dosing. If the premeal BG is ≥ 150 mg/dL, additional Fiasp will be administered based off the correctional scale at the same time as the prandial insulin.
  • Drug: Insulin glargine
    Insulin glargine doses will be determined by calculating the total daily dose (TDD) of insulin and providing 50% of the TDD as follows: start at 0.5 units/kg/day and subtract 0.1 unit/kg/day for 70+ yrs of age, renal insufficiency, pancreatic deficiency and add 0.1 unit/kg/day if hemoglobin A1c in >10%
    Other names:
    • Lantus®
  • Drug: Insulin Fiasp
    Fiasp will be administered with each meal if premeal glucose is ≥ 150 mg/dL and at bedtime if glucose is ≥ 200 mg/dL by calculating an individualized insulin sensitivity factor for each subject per the following formula: 1500/total daily dose of insulin = sensitivity factor.
    Other names:
    • Fiasp®
  • Other: Standard carbohydrate diet
    Standard carbohydrate diet as per usual hospital care (75g with each meal)

Recruiting Locations

Boston Medical Center
Boston, Massachusetts 02118
Contact:
Sara Alexanian, MD
617-638-8545
sara.alexanian@bmc.org

More Details

Status
Recruiting
Sponsor
Boston Medical Center

Study Contact

Sara M Alexanian, MD
617-638-8545
sara.alexanian@bmc.org

Notice

Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.