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Diabetes Mellitus, Type 2NCT03455985

Effectiveness of a Diabetes Focused Discharge Order Set Among Poorly Controlled Hospitalized Patients Transitioning to Glargine U300 Insulin

A study testing Discharge Order Set (DOS) in people with Diabetes Mellitus, Type 2 and Patient Discharge, run by Ohio State University at 1 site in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Diabetes is present in 25% of hospitalized patients; yet effective hospital discharge programs for patients with diabetes are understudied. In particular, patients who are initiating or intensifying insulin therapy have the most to benefit in terms of glycemic control. Read more about this study

Who is it for?
Ages 25 to 75 years
What is being tested?
Discharge Order Set (DOS)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
158 participants
Where
1 siteUnited States
Study dates
1 May 2018to 11 Sep 2020
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 25 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of diabetes, type 2 ≥3 months duration
  • HbA1c >8.5%
  • Ages 25-75 years
  • Phone or electronic media availability
  • Receiving basal insulin >10 unit/day

Who cannot join

  • Sensitive admissions: Prisoners
  • Pregnancy
  • Unable to consent or follow study directions in English
  • Expected nursing facility stay longer than 2 weeks

Trial locations and contacts

1 site in 1 country.

United States1 site
  • The Ohio State University

    Columbus, Ohio, 43210

Other trials in United States

About this study

Diabetes is present in 25% of hospitalized patients; yet effective hospital discharge programs for patients with diabetes are understudied. In particular, patients who are initiating or intensifying insulin therapy have the most to benefit in terms of glycemic control. However, these patients are also particularly vulnerable to poor transitions of care for a variety of reasons, including the complexity of therapy, inadequate patient education, differences in patient and provider expectations, and insufficient resources. Disruption of insulin therapy following hospitalization is associated with higher HbA1c, shorter survival, and increased readmissions and medical costs. In a Society of Hospital Medicine Survey, only one fourth of hospitals were supported with written protocols to standardize medication, education, equipment, and follow-up instructions. However, discharge order sets have largely been limited to the inpatient setting and have not been utilized to guide insulin use at hospital discharge. This study will assess whether a nurse supported diabetes focused inpatient discharge order set (DOS) can improve post-discharge outcomes among hospitalized patients with poorly controlled insulin-requiring diabetes.

Read the detailed description

In this 24 week randomized controlled trial, hospitalized insulin-requiring patients with type 2 diabetes and poor glycemic control (HbA1c >8.5%) will receive standard of care insulin therapy including basal insulin glargine U300 (TOUJEO®) plus additional background therapy (non-insulin and prandial insulin therapies) with either a diabetes focused discharge order set (DOS) and follow-up communication to facilitate insulin titration and outpatient follow-up or enhanced standard care (ESC). 222 patients (type 2 diabetes) will be recruited. Hospitalized patients with type 2 diabetes (HbA1c >8.5%) who are receiving basal insulin at least 10 unit per day and are able to provide informed consent and complete study procedures will be approached. All patients will be discharged on glargine U300 with initial doses determined by the discharging team. Patients in the DOS group will receive instructions for self-titration of basal insulin as part of the discharge order. The DOS contains a comprehensive checklist for basic diet, hospital follow-up, glucose targets and instructions for monitoring, insulin pens and pen needles, glucose testing supplies, and ancillary orders. Patients will have follow-up phone calls at week 2, 6, and in-person visits at week 12 and 24. Phone calls will assess adherence with instructions for self-titration in the DOS group but are information gathering only in the ESC group, and questions related to care will be referred to the usual provider. Glucose lowering medication management following discharge will otherwise be conducted by the patient's usual or designated standard of care provider. The study and all study-related documents will be approved by the OSU IRB. All data analyses will be completed as intention to treat analyses. Longitudinal outcomes (e.g., HbA1c) will be analyzed using mixed models utilizing all available measurements from individuals randomized.

Being tested
Discharge Order Set (DOS), Enhanced Standard Care (ESC)
Medical subject headings
Diabetes Mellitus, Type 2

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Discharge Order Set (DOS)Other

    In addition to the elements in ESC, for the DOS group the primary team will be contacted to complete the Diabetes Discharge order set, which will be pre-populated into the electronic discharge navigator. Follow-up phone calls in the DOS group will also assess and reinforce insulin dose self-titration.

  • Enhanced Standard Care (ESC)Other

    Patients in the ESC group will receive hospital discharge instructions using current best practices within the overall functionality of the electronic medical record, which facilitates medication reconciliation and use of a patient care resource manager. Phone calls are information gathering only in the ESC group, and questions related to care will be referred to the usual provider.

Study groups in NCT03455985
Study groupRoleWhat they receive
Discharge Order Set (DOS)ExperimentalPatients in the DOS group will receive instructions for self-titration of basal insulin as part of the discharge order. The DOS contains a comprehensive checklist for basic diet, hospital follow-up, glucose targets and instructions for monitoring, insulin pens and pen needles, glucose testing supplies, and ancillary orders. Phone calls will assess adherence with instructions for self-titration. Glucose lowering medication management following discharge will otherwise be conducted by the patient's usual or designated standard of care provider.
Receives: Other: Discharge Order Set (DOS)
Enhanced Standard Care (ESC)OtherPatients in the ESC group will receive hospital discharge instructions using current best practices within the overall functionality of the electronic medical record, which facilitates medication reconciliation and use of a patient care resource manager. Phone calls are information gathering only in the ESC group, and questions related to care will be referred to the usual provider.
Receives: Other: Enhanced Standard Care (ESC)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in HbA1c From Baseline to 24 Weeks

    We will test for a difference in 24 week change in HbA1c between the DOS and ESC groups using a linear mixed model for the longitudinal HbA1c measurements. A Wald test of the treatment-by-time interaction will be used to test our primary hypothesis that DOS affects 24 weeks change in Hb1Ac.

    Measured: 24 weeks

Secondary outcomes (3)
  1. Change in HbA1c From Baseline to 12 Weeks

    We will test for a difference in 24 week change in HbA1c between the DOS and ESC groups using a linear mixed model for the longitudinal HbA1c measurements. A Wald test of the treatment-by-time interaction will be used to test our primary hypothesis that DOS affects 12 weeks change in Hb1Ac.

    Measured: 12 weeks

  2. Proportion Using Insulin Glargine U300 at 24 Weeks

    proportion of patients who remain on insulin glargine U300 at 24 weeks The difference in proportions of patients who remain on insulin glargine U300 at 24 weeks between treatment groups will be computed and compared using test of proportions.

    Measured: 24 weeks

  3. Fasting Glucose

    We will test for a difference in fasting glucose between the DOS and ESC groups using a linear mixed model.

    reported measure differs from original plan due to lack of fasting glucose in hospitalized patients.

    Measured: 24 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Mar 2018
  2. Study start1 May 2018
  3. Primary completion11 Sep 2020
  4. Study completion11 Sep 2020

Why it stopped: interruption of study enrollment and procedures due to COVID-19 health crisis

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
158 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03455985
Sponsor's protocol ID
2017H0354
Status last verified
Jul 2023
First submitted
28 Feb 2018
Last updated
22 Feb 2024
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cook CB, Seifert KM, Hull BP, Hovan MJ, Charles JC, Miller-Cage V, Boyle ME, Harris JK, Magallanez JM, Littman SD. Inpatient to outpatient transfer of diabetes care: planing for an effective hospital discharge. Endocr Pract. 2009 Apr;15(3):263-9. doi: 10.4158/EP.15.3.263.

    PubMed 19364697
  • Dungan K, Lyons S, Manu K, Kulkarni M, Ebrahim K, Grantier C, Harris C, Black D, Schuster D. An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocr Pract. 2014 Dec;20(12):1265-73. doi: 10.4158/EP14061.OR.

    PubMed 25100371
  • Wexler DJ, Beauharnais CC, Regan S, Nathan DM, Cagliero E, Larkin ME. Impact of inpatient diabetes management, education, and improved discharge transition on glycemic control 12 months after discharge. Diabetes Res Clin Pract. 2012 Nov;98(2):249-56. doi: 10.1016/j.diabres.2012.09.016. Epub 2012 Oct 1.

    PubMed 23036785
  • Kimmel B, Sullivan MM, Rushakoff RJ. Survey on transition from inpatient to outpatient for patients on insulin: what really goes on at home? Endocr Pract. 2010 Sep-Oct;16(5):785-91. doi: 10.4158/EP10013.OR.

    PubMed 20350914
  • Wheeler K, Crawford R, McAdams D, Robinson R, Dunbar VG, Cook CB. Inpatient to outpatient transfer of diabetes care: perceptions of barriers to postdischarge followup in urban African American patients. Ethn Dis. 2007 Spring;17(2):238-43.

    PubMed 17682352
  • Dungan KM. The effect of diabetes on hospital readmissions. J Diabetes Sci Technol. 2012 Sep 1;6(5):1045-52. doi: 10.1177/193229681200600508.

    PubMed 23063030
  • Wu EQ, Zhou S, Yu A, Lu M, Sharma H, Gill J, Graf T. Outcomes associated with insulin therapy disruption after hospital discharge among patients with type 2 diabetes mellitus who had used insulin before and during hospitalization. Endocr Pract. 2012 Sep-Oct;18(5):651-9. doi: 10.4158/EP11314.OR.

    PubMed 22440990
  • Rodriguez A, Magee M, Ramos P, Seley JJ, Nolan A, Kulasa K, Caudell KA, Lamb A, MacIndoe J, Maynard G. Best Practices for Interdisciplinary Care Management by Hospital Glycemic Teams: Results of a Society of Hospital Medicine Survey Among 19 U.S. Hospitals. Diabetes Spectr. 2014 Aug;27(3):197-206. doi: 10.2337/diaspect.27.3.197.

    PubMed 26246780
  • Wright A, Feblowitz JC, Pang JE, Carpenter JD, Krall MA, Middleton B, Sittig DF. Use of order sets in inpatient computerized provider order entry systems: a comparative analysis of usage patterns at seven sites. Int J Med Inform. 2012 Nov;81(11):733-45. doi: 10.1016/j.ijmedinf.2012.04.003. Epub 2012 Jul 18.

    PubMed 22819199
  • Neinstein A, MacMaster HW, Sullivan MM, Rushakoff R. A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system. J Diabetes Sci Technol. 2014 Jul;8(4):641-51. doi: 10.1177/1932296814536290. Epub 2014 May 25.

    PubMed 24876450
  • Yu CH, Sun XH, Nisenbaum R, Halapy H. Insulin order sets improve glycemic control and processes of care. Am J Med. 2012 Sep;125(9):922-8.e4. doi: 10.1016/j.amjmed.2012.02.018. Epub 2012 Jul 14.

    PubMed 22800878
  • Noschese M, Donihi AC, Koerbel G, Karslioglu E, Dinardo M, Curll M, Korytkowski MT. Effect of a diabetes order set on glycaemic management and control in the hospital. Qual Saf Health Care. 2008 Dec;17(6):464-8. doi: 10.1136/qshc.2006.021790.

    PubMed 19064664
  • Schnipper JL, Liang CL, Ndumele CD, Pendergrass ML. Effects of a computerized order set on the inpatient management of hyperglycemia: a cluster-randomized controlled trial. Endocr Pract. 2010 Mar-Apr;16(2):209-18. doi: 10.4158/EP09262.OR.

    PubMed 20061280
  • Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008 Oct 9;359(15):1577-89. doi: 10.1056/NEJMoa0806470. Epub 2008 Sep 10.

    PubMed 18784090
  • Barr CC. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive insulin therapy, by The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. N. Engl. J. Med 342:381-9, 2000. Surv Ophthalmol. 2001 Mar-Apr;45(5):459-60. doi: 10.1016/s0039-6257(01)00187-4. No abstract available.

    PubMed 11274700

Questions about this trial

What is this clinical trial studying?

A study testing Discharge Order Set (DOS) in people with Diabetes Mellitus, Type 2 and Patient Discharge, run by Ohio State University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: stopped early, as of the sponsor's last update on 22 Feb 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Feb 2024). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in HbA1c From Baseline to 24 Weeks (time frame: 24 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03455985, which also lists 56 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Feb 2024.

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