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Diabetes Mellitus Type 2 - Insulin-TreatedNCT04678661

My Dose Coach Mobile App to Support Insulin Titration and Maintenance

A study testing Smartphone application and web portal and Standard Insulin Therapy Education in people with Diabetes Mellitus Type 2 - Insulin-Treated, run by Linda Siminerio 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

The purpose of this research study is to evaluate an electronic application (app) designed to help people with type 2 diabetes (T2DM) adjust their insulin doses. The app is called My Dose Coach. This research study is being done in 2 phases. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Smartphone application and web portal and Standard Insulin Therapy Education
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteUnited States
Study dates
15 Feb 2021to 16 Feb 2023
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 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Intervention Group
  • Patient receiving care at a UPMC Diabetes Outpatient and/or Inpatient settings
  • Adult male and female patients 18 to 75 years old
  • HbA1c > 7.5%
  • Recommended to start self titration of basal insulin
  • Access to and able to use an iOS (Apple phone operating system) or Android enabled device and have reliable internet access
Show all 13Show fewer
  • Willing and able to use the MDC app
  • Able to comprehend basic diabetes survival skills, signs and symptoms of hypoglycemia and treatment of BG
  • Usual Care Group
  • Adult male and female patients 18 to 75 years old
  • HbA1c > 7.5%
  • Started on basal insulin in a UPMC Diabetes Outpatient facility within the past three years of study start
  • Has blood glucose data available in electronic medical records (EMR) (At least two HbA1c measurements corresponding to baseline and a subsequent time point after insulin titration)

Who cannot join

  • Pregnant or breastfeeding
  • Patients unwilling to use MDC app

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Pittsburgh Medical Center

    Pittsburgh, Pennsylvania, 15213

Other trials in United States

About this study

Official title: My Dose Coach Titration and Maintenance in Patients With Type 2 Diabetes Mellitus on Basal Insulin

The purpose of this research study is to evaluate an electronic application (app) designed to help people with type 2 diabetes (T2DM) adjust their insulin doses. The app is called My Dose Coach. This research study is being done in 2 phases. Specifically in Phase 1, the study is assessing the role of the My Dose Coach app in helping participants make insulin adjustments to get their blood glucoses to the target level that is planned for with the diabetes team, called the dosing or titration phase, when first starting insulin. In Phase 2, the study is assessing the role of the My Dose Coach app in helping participants keep blood glucoses in the target range, called the maintenance phase.

Read the detailed description

Despite the increasing body of knowledge of diabetes treatment strategies, a majority of patients with T2DM are still in a persistent state of poor glycemic control and unable to meet target goals. Inertia surrounding insulin initiation and titration is a specific problem. Various approaches have been proposed to help overcome clinical inertia, including support of patient self-management, and education for both physicians and people with diabetes. Presently, paper-based guides are available in which clinicians/educators rely on to help their patients in determining and recording appropriate insulin doses. Unfortunately, this process often sets the stage for reluctance and fear of insulin initiation and delays titration with implications for long-term poor self-management and adherence. Therefore, Sanofi developed the My Dose Coach electronic app to assist with optimizing titration of basal insulins and supporting proper insulin maintenance. The primary objective of this two phase study is to demonstrate that patients who are trained on the My Dose Coach app to titrate insulin will have greater improvements in hemoglobin A1c and will be more likely to achieve glycemic control at three months as compared to usual care practice, and, for the intervention group only, those who do attain glycemic goals will be able to maintain glycemic control for an additional three months. The secondary objective of this study is to examine the feasibility of integrating digital solutions into clinical workflow and user acceptability of My Dose Coach.

Being tested
Smartphone application and web portal, Standard Insulin Therapy Education
Keywords
Mobile application, Digital titration

What participants receive

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

  • Smartphone application and web portalDevice

    Also called My Dose Coach

    My Dose Coach is indicated for single patient use outside the clinic setting by a previously diagnosed Type 2 Diabetic who has been prescribed a once-daily long-acting basal insulin. MDC is intended as an aid to the patient to provide dose suggestions based upon the HCP's independent professional judgment. Before My Dose Coach can be used, the HCP configures the dose instructions for the specific patient and activates the application using the specific patient Instructions. The application uses the dose plan instructions provided by the patient's HCP to provide dose suggestions of once-daily long-acting basal insulin (i.e. basal insulin titration) that are based on the patient's Fasting Blood Glucose (FBG) as well as hypoglycemia occurrence.

    MDC includes a Maintenance Module designed to support patients in maintaining proper insulin dosingby enabling logging of administered doses of prescribed diabetes medications and BGM and providing dosing and measurement reminders.

  • Standard Insulin Therapy EducationBehavioural

    Standard best practices for training patients to administer insulin therapy include 1) a thorough patient assessment prior to therapy initiation to address barriers, including evaluation for diminished cognitive capacity or other problem that may impair safe insulin self-administration, and assessment of health literacy and numeracy skills; 2) observation of a patient's injection practice, with re-education provided as needed; 3) use of appropriate language is necessary when teaching injection technique; 4) dose preparation, which includes inspecting the insulin dose for accuracy (following manufacturer instructions); and 5) review of signs, symptoms and treatment of hypoglycemia must be included as a critical component of the training.

Study groups in NCT04678661
Study groupRoleWhat they receive
My Dose Coach (Insulin Dosing Support App)ExperimentalPhase 1 Titration: Patients receive insulin therapy education from diabetes educator (DE). Plus, DE trains patients to use My Dose Coach (MDC) for titration guidance according to an algorithm prepared by endocrinology provider (EP). Patients are asked to return for a 3-month (mo) follow-up clinic visit. Patients who successfully reach glycemic target are invited to Phase 2. Other patients are invited to continue titrating for another 3 months. Phase 2 Maintenance: At 3-mo clinic visit, an EP or DE trains patients the MDC Maintenance Module to support proper insulin dosing. Patients are asked to return for follow-up clinic visits at mo 6. Patients are surveyed (0, 3, 6 mo) to assess changes in behavioral and psychosocial factors that influence diabetes self-management and MDC acceptability.
Receives: Device: Smartphone application and web portal; Behavioral: Standard Insulin Therapy Education
Usual Care GroupActive comparatorA retrospective comparative group will be selected from eligible patients who previously were treated at the University of Pittsburgh Medical Center (UPMC) Diabetes Outpatient Clinics following standard insulin therapy education. Patients in the usual care group will be identified using data available in the electronic medical record system. Propensity score matching will be used to pair intervention and usual care participants during phase 1 of the study (baseline to 3 months).
Receives: Behavioral: Standard Insulin Therapy Education

What is being measured

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

  1. Change From Baseline in Glycemic Control at 3 Months

    Average change in hemoglobin A1c from baseline to 3 months

    Measured: Baseline to 3 months

Secondary outcomes (14)
  1. Change From Baseline in Fasting Blood Glucose at 3 Months

    Change in fasting blood glucose from baseline to 3 months for the intervention group.

    Measured: Baseline to 3 months

  2. Change From Baseline in Fasting Blood Glucose at 6 Months

    Change in fasting blood glucose from baseline to 6 months for the intervention group.

    Measured: Baseline to 6 months

  3. Change From 3 Months in Fasting Blood Glucose at 6 Months

    Chang in fasting blood glucose from month 3 to 6 for the intervention group.

    Measured: Months 3 to 6

  4. Change From Baseline in Hemoglobin A1c at 6 Months

    Average change in hemoglobin A1c from baseline to 6 months for the intervention group.

    Measured: Baseline to 6 months

  5. Change From 3 Months in Hemoglobin A1c at 6 Months

    Average change in hemoglobin A1c from 3 months to 6 months for the intervention group.

    Measured: Months 3 to 6

  6. Proportion of Patients Who Achieve Glycemic Targets

    Achieving glycemic target defined as reduction in hemoglobin A1c <7% by 3 months after baseline

    Measured: 3 months

  7. Proportion of Patients Who Maintain Glycemic Targets

    Maintaining glycemic target defined as maintaining a hemoglobin A1c <7% at 6 months for those who achieved this target at 3 months in the intervention group.

    Measured: 6 months

  8. Change From Baseline in Diabetes Distress at 3 Months

    Diabetes distress was evaluated with the 17-item Diabetes Distress Scale, which assesses four dimensions of distress - emotional, regimen, interpersonal and physician, and has shown a consistent pattern of relationships with HbA1c, diabetes self-efficacy, diet and physical activity in multiple samples of patients with T2DM. Individual items are scored from 1 to 6; total scores are the average of all individual item scores; higher scores indicate greater distress. Possible scores range from 1 to 6.

    Measured: Baseline to 3 months

  9. Change From Baseline in Diabetes Distress at 6 Months

    Diabetes distress was evaluated with the 17-item Diabetes Distress Scale, which assesses four dimensions of distress - emotional, regimen, interpersonal and physician, and has shown a consistent pattern of relationships with HbA1c, diabetes self-efficacy, diet and physical activity in multiple samples of patients with T2DM. Individual items are scored from 1 to 6; total scores are the average of all individual item scores; higher scores indicate greater distress. Possible scores range from 1 to 6.

    Measured: Baseline to 6 months

  10. Change From 3 Months in Diabetes Distress at 6 Months

    Diabetes distress was evaluated with the 17-item Diabetes Distress Scale, which assesses four dimensions of distress - emotional, regimen, interpersonal and physician, and has shown a consistent pattern of relationships with HbA1c, diabetes self-efficacy, diet and physical activity in multiple samples of patients with T2DM. Individual items are scored from 1 to 6; total scores are the average of all individual item scores; higher scores indicate greater distress. Possible scores range from 1 to 6.

    Measured: Month 3 to month 6

  11. Participant Acceptability of Insulin Dosing Support System for Insulin Titration

    Participants rated their acceptability of My Dose Coach using a study-specific survey. Individual items are scored from 1 to 5; total scores are the average of all individual item scores; . Possible score range 1 to 5. The higher the score, the better the rating or acceptability of the insulin dosing support system.

    Measured: 3 months

  12. Participant Satisfaction With Insulin Treatment

    The Diabetes Medication Systems Rating Questionnaire-Short Form, was also be used to inform patient acceptability and satisfaction with insulin. This questionnaire includes 20 items to assess convenience, negative events, interference, self-monitoring of blood glucose burden, efficacy, social burden, psychological well-being, treatment satisfaction and treatment preference. All items are scored 0 to 100. Composite score is calculated as means of completed items. Possible score range is 0 to 100. The higher the score, the higher the level of satisfaction.

    Measured: 6 months

  13. Number of Hypoglycemic Events

    Total number of hypoglycemic events where blood glucose <70mg/dl.

    Measured: As reported across study period, up to 6 months

  14. Number of Participants Who Experienced Severe Hypoglycemic Events.

    Severe hypoglycemic events were defined a hypoglycemic events that required assistance of another person to resuscitate because blood glucoses are too low to maintain consciousness.

    Measured: As reported across study period, up to 6 months

Timeline

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

  1. First posted22 Dec 2020
  2. Study start15 Feb 2021
  3. Primary completion30 Dec 2022
  4. Study completion16 Feb 2023

Why it stopped: Technical issues with app and prolonged recruitment

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
Supportive care
Allocation
Non-randomised
Intervention model
Single group
Masking
None (open label)
Enrolment
60 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04678661
Sponsor's protocol ID
STUDY20040308
Status last verified
Jan 2024
First submitted
8 Dec 2020
Last updated
14 Feb 2024
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: A consent form used in enrolling participants will be posted.

Publications

  • Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, Jackson RA. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005 Mar;28(3):626-31. doi: 10.2337/diacare.28.3.626.

    PubMed 15735199
  • Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care. 2012 Feb;35(2):259-64. doi: 10.2337/dc11-1572. Epub 2012 Jan 6.

    PubMed 22228744
  • Peyrot M, Xu Y, Rubin RR. Development and validation of the Diabetes Medication System Rating Questionnaire-Short Form. Diabet Med. 2014 Oct;31(10):1237-44. doi: 10.1111/dme.12453. Epub 2014 Apr 18.

    PubMed 24673614

Questions about this trial

What is this clinical trial studying?

A study testing Smartphone application and web portal and Standard Insulin Therapy Education in people with Diabetes Mellitus Type 2 - Insulin-Treated, run by Linda Siminerio 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 13 inclusion and 2 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 14 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 14 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 From Baseline in Glycemic Control at 3 Months (time frame: Baseline to 3 months). 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 NCT04678661, which also lists 3 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 14 Feb 2024.

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