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Diabetes Mellitus, Type 1Phase 4HumAn-1NCT05614089

Human Versus Analogue Insulin for Youth With Type 1 Diabetes in Low-Resource Settings

A Phase 4 study testing Insulin Glargine and NPH or premixed 70/30 (human insulin) in people with Diabetes Mellitus, Type 1 and Type 1 Diabetes, run by Jing Luo at 3 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The primary objective of this trial is to determine whether insulin glargine reduces the risk of serious hypoglycemia or improves Time in Range at 6 months when compared against standard of care human insulin (e.g. NPH or premixed 70/30) among youth living with type 1 diabetes (T1D) in low resource settings. Read more about this study

Who is it for?
Ages 7 to 25 years
Conditions the study is for
Diabetes Mellitus, Type 1, Type 1 Diabetes
What is being tested?
Insulin Glargine and NPH or premixed 70/30 (human insulin)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
400 participants
Where
3 sitesin 2 countries
Study dates
15 Mar 2023to 19 Mar 2025
Phase
Phase 4
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 7 to 25 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Children and young adults (age 7-25)
  • Have a clinical diagnosis of type 1 diabetes (T1D)

Who cannot join

  • Prior use of any insulin analogue
  • Patients (or parents for children <18 years old) who refuse to or cannot provide informed consent
  • Who are currently pregnant or plan to become pregnant over the next year
  • Who have previously used a continuous glucose monitor (CGM) for glucose monitoring
  • Who were first diagnosed with T1D less than 12 months ago
  • Who is diagnosed with severe malnutrition

Trial locations and contacts

3 sites in 2 countries.

3 sites in 2 countries

Tanzania2 sites
  • Bugando Medical Center

    Mwanza

  • Sekou-Toure Hospital

    Mwanza

Other trials in Tanzania

Bangladesh1 site
  • BIRDEM Hospital

    Dhaka

Other trials in Bangladesh

About this study

Official title: Human Versus Analogue Insulin for Youth With Type 1 Diabetes in Low-Resource Settings: A Randomized Controlled Trial

The primary objective of this trial is to determine whether insulin glargine reduces the risk of serious hypoglycemia or improves Time in Range at 6 months when compared against standard of care human insulin (e.g. NPH or premixed 70/30) among youth living with type 1 diabetes (T1D) in low resource settings.

Read the detailed description

Long-acting insulin analogues have become a de-facto standard of care for patients with T1D living in high-income countries. Unfortunately, insulin analogues remain unavailable or unaffordable for much of the global population. In both 2017 and 2019, applications to add long-acting insulin analogues to the WHO's Model List of Essential Medicines (EML) were rejected due to insufficient evidence of superiority and an unfavorable cost-effectiveness profile when compared against older, less expensive, human insulins (e.g., NPH insulin and premixed 70/30 insulin). In 2021, long-acting insulin analogues were added to the EML but the decision remains controversial since the WHO concluded that "magnitude of clinical benefit of long-acting insulin analogues over human insulin for most clinical outcomes was small." Moreover, studies that compare long-acting insulin analogues versus human insulins conducted in high-income settings may not generalize to children and young adults living with T1D in very low-resource settings.

To address this unmet need, Pitt has partnered with Brigham and Women's Hospital, The London School of Hygiene and Tropical Medicine, the Clinton Health Access Initiative and Life For a Child to conduct a randomized controlled trial comparing insulin glargine, a long-acting analogue insulin, against intermediate human insulin among 400 children and young adults living with T1D in a lower resource setting.

Note: In preparation for results submission, we made minor changes to the outcomes sections to reflect what is listed in the protocol.

For Primary Outcomes #1 and #2, and Secondary Outcomes #3,#4, #5, #7, #8: we added 12 months measurements (in addition to the 6 months measurement). We updated Secondary Outcome #9 to specify the PedsQL Diabetes Symptoms Score. We added Secondary Outcome #10 to include the PedsQL Diabetes Management Score. We added Secondary Outcome #11 for ITSQ scores.

Being tested
Insulin Glargine, NPH or premixed 70/30 (human insulin)
Keywords
Type 1 Diabetes, Insulin Glargine, Human Insulin, Insulin Analogue, Bangladesh, Tanzania
Medical subject headings
Diabetes Mellitus, Type 1, Insulin Resistance

What participants receive

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

  • Insulin GlargineDrug

    Formulation: Available as a clear liquid in a glass cartridge (1 cartridge =3ml=300 units).

    Route: Reusable pen

    Amount of each dose: varies depending on baseline basal insulin needs

    Dose escalation scheme: Participants randomly assigned to glargine will start with a dose that is generally equal to 80% of their total basal human insulin dose prior to the switch (per ISPAD guidelines and the switching guide developed by Life for a Child with the guidance of Dr. Ragnar Hanas and two other ISPAD members familiar with less-resourced settings).

    Frequency of dose: once per day (usually administered before bedtime)

    Duration of therapy: 12 months

  • NPH or premixed 70/30 (human insulin)Drug

    Formulation: Available as a liquid in a glass cartridge (3ml=300IU) or as liquid in a prefilled, disposable pen (3ml=300IU).

    Route: Bangladesh = reusable pens; Tanzania = disposable pens

    Amount of each dose: varies depending on baseline basal insulin needs (per usual care or treating clinician)

    Frequency of dose: once or twice per day (per usual care or treating clinician)

    Duration of therapy: 12 months

Study groups in NCT05614089
Study groupRoleWhat they receive
GlargineExperimentalInsulin glargine (long-acting insulin analogue)
Receives: Drug: Insulin Glargine
NPH or premixed 70/30 (human insulin)Active comparatorNPH or premixed 70/30 (human insulin)
Receives: Drug: NPH or premixed 70/30 (human insulin)

What is being measured

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

  1. Time-in-serious Hypoglycemia

    % time spent less than 54 mg/dl averaged across all daily measures. For 6-month outcome, these data were averaged across two CGM sensors (placed at 6 and 6.5 months). For 12-month outcome, these data were from one CGM sensor placed at 11.5 months.

    Measured: 6 and 12 months after randomization

  2. Time-in-range (TIR)

    % time spent between 70 and 180mg/dl inclusive averaged across all daily measures. For 6-month outcome, these data were averaged across two CGM sensors (placed at 6 and 6.5 months). For 12-month outcome, these data were from one CGM sensor placed at 11.5 months.

    Measured: 6 and 12 months after randomization

Secondary outcomes (9)
  1. Time-in-hypoglycemia

    % time spent less than 70mg/dl averaged across all daily measures. For 6-month outcome, these data were averaged across two CGM sensors (placed at 6 and 6.5 months). For 12-month outcome, these data were from one CGM sensor placed at 11.5 months.

    Measured: 6 and 12 months after randomization

  2. Time-above-range

    % time spent greater than 180mg/dl averaged across all daily measures. For 6-month outcome, these data were averaged across two CGM sensors (placed at 6 and 6.5 months). For 12-month outcome, these data were from one CGM sensor placed at 11.5 months.

    Measured: 6 and 12 months after randomization

  3. Nocturnal Hypoglycemic Events

    Number of events defined as ≥15 minutes in duration <70 mg/dL between midnight and 6:00 am; specifically, at least 2 sensor values <70 mg/dL that are ≥15 minutes apart plus no intervening values ≥70 mg/dL For 6-month outcome, these data were averaged across two CGM sensors (placed at 6 and 6.5 months). For 12-month outcome, these data were from one CGM sensor placed at 11.5 months.

    Measured: 6 and 12 months after randomization

  4. Glycemic Control (HbA1c)

    Mean HbA1c lab result reported as percent, which is typically how it is reported.

    Measured: baseline, 3, 6, 9 and 12 months after randomization

  5. Rate of Severe Hypoglycemic Events

    Severe hypoglycemic events (requiring assistance of another person to correct) reported by participant per 1000 person-years

    Measured: 6 and 12 months after randomization

  6. Rate of Diabetic Ketoacidosis (DKA)

    Hospitalization or Emergency Room Visit (serious adverse event) with primary diagnosis of Diabetic Ketoacidosis. This was measured by self-report and confirmed through review of hospital records

    Measured: 6 and 12 months after randomization

  7. Pediatric Quality of Life Inventory 3.2 Diabetes Module (PedsQL 3.2 DM) Diabetes Symptoms Score

    Mean PedsQL 3.2 DM Diabetes Symptoms score. PedsQL 3.2 DM Diabetes Symptoms scale is composed of 15 items. All items use the same 5-point Likert response scale, with responses ranging from "never" (0) to "almost always" (4). Items are reverse scored and transformed on a scale ranging from 0 to 100. The score is the sum of all the items over the number of items answered. Higher scores indicate fewer diabetes symptoms and therefore improved diabetes-specific health-related quality of life (D-HRQoL).

    Measured: Baseline and at 6 and 12 months after randomization

  8. Pediatric Quality of Life Inventory 3.2 Diabetes Module (PedsQL 3.2 DM) Diabetes Management Score

    Mean PedsQL 3.2 DM Diabetes Management score. PedsQL 3.2 DM Diabetes Management scale is composed of 18 items. All items use the same 5-point Likert response scale, with responses ranging from "never" (0) to "almost always" (4). Items are reverse scored and transformed on a scale ranging from 0 to 100. Higher scores indicate fewer diabetes management problems and therefore improved D-HRQoL.

    Measured: Baseline and at 6 and 12 months after randomization

  9. Insulin Treatment Satisfaction Questionnaire (ITSQ) Scores

    The ITSQ is composed of 22 items. A total 22-item score is reported, and the items are also divided into five subscales: Regimen Inconvenience (5 items), Lifestyle Flexibility (3 items), Glycemic Control (3 items), Hypoglycemic Control (5 items), and Insulin Delivery Device Satisfaction (6 items). Items use 7-point Likert scale responses, ranging from 1 (positive, e.g. "No bother at all") to 7 (negative, e.g. "A tremendous bother"), though the specific response labels vary by question. Items were reverse scored and transformed to range from 0 to 100. Higher scores indicate higher treatment satisfaction.

    Measured: Baseline and at 6 and 12 months after randomization

Timeline

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

  1. First posted14 Nov 2022
  2. Study start15 Mar 2023
  3. Primary completion13 Aug 2024
  4. Study completion19 Mar 2025

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 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
400 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05614089
Sponsor's protocol ID
STUDY21110122
Acronym
HumAn-1
Status last verified
Sep 2025
First submitted
28 Oct 2022
Last updated
10 Sep 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
Yes: De-identified, summary level data will be shared with other researchers, upon request.

Publications

  • Luo J, Kehlenbrink S, Chang CH, Lalama CM, Kirsch J, Ansbro E, Prust ML, Garvin A, Zabeen B, Majaliwa E, Ramaiya K, Kayange N, Foulds A, Flabe AH, Nyarubamba RF, Rollman BL, Ogle GD. Human versus analogue insulin for children and young adults with type 1 diabetes in low-resource settings (HumAn-1): a multicentre, open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jul 6:S2213-8587(26)00097-5. doi: 10.1016/S2213-8587(26)00097-5. Online ahead of print.

    PubMed 42409045
  • Foulds A, Josey C, Kehlenbrink S, Rollman BL, Chang CH, Lalama C, Ansbro E, Prust ML, Zabeen B, Ramaiya K, Ogle G, Chae SR, Luo J. Human versus Analogue Insulin for Youth with Type 1 Diabetes in Low-Resource Settings (HumAn-1): protocol for a randomised controlled trial. BMJ Open. 2025 Jan 30;15(1):e092432. doi: 10.1136/bmjopen-2024-092432.

    PubMed 39890140

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Insulin Glargine and NPH or premixed 70/30 (human insulin) in people with Diabetes Mellitus, Type 1 and Type 1 Diabetes, run by Jing Luo at 3 sites in 2 countries.

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 2 inclusion and 6 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: finished, as of the sponsor's last update on 10 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Tanzania, Bangladesh. 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.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 10 Sep 2025). 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?

Time-in-serious Hypoglycemia (time frame: 6 and 12 months after randomization). The study lists 2 primary outcomes in all. 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 NCT05614089, which also lists 2 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 10 Sep 2025.

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