Oral Anti-Diabetes Drugs vs Insulin for Diabetes

Recruiting at 2 trial locations

Overseen By Maya Fayfman, MD

Age: 18+

Sex: Any

Trial Phase: Phase 4

Sponsor: Emory University

Must be taking: Oral antidiabetics

Must not be taking: Corticosteroids

Disqualifiers: Type 1 diabetes, Renal impairment, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 6 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: Unknown

Duration: Up to 10 days

260 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if people with type 2 diabetes can safely continue using their usual oral diabetes pills in the hospital, instead of switching to insulin shots. Researchers seek to assess whether these pills control blood sugar as effectively as insulin. The trial compares two groups: one using insulin and the other continuing with oral medications. Individuals managing their type 2 diabetes with oral medication and maintaining stable blood sugar levels might be suitable for this trial. As a Phase 4 trial, this research involves an FDA-approved treatment and helps clarify its benefits for more patients.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop your current medications, but it seems to focus on continuing oral antidiabetic drugs during hospitalization. It's best to discuss your specific medications with the trial team.

What is the safety track record for these treatments?

Research has shown that oral diabetes medications, such as metformin and sulfonylureas, are generally safe for most people with type 2 diabetes. Over 75% of patients with this condition use these drugs, which have a history of being well-tolerated. However, some individuals might experience side effects, like stomach discomfort with metformin.

These medications have undergone extensive study and are approved for treating diabetes, indicating their well-established safety. Many people use them without serious problems. While all medications can have side effects, the risk of major issues with these drugs remains low for most people. Always discuss any concerns with a doctor before joining a trial. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Unlike the standard of care for diabetes, which often involves insulin injections, oral anti-diabetes drugs (OADs) offer a needle-free alternative that could make managing diabetes less invasive and more convenient for patients. Researchers are excited about these treatments because they allow patients to maintain their outpatient dosage regimen unless contraindicated, which can simplify diabetes management. Additionally, OADs can potentially provide a more consistent blood sugar control without the need for multiple daily injections, which can be a significant advantage for many individuals living with diabetes.

What evidence suggests that oral anti-diabetes drugs could be an effective treatment for diabetes?

Studies have shown that oral anti-diabetes drugs effectively lower blood sugar levels in people with type 2 diabetes. Research indicates that these medications can reduce A1C levels, a measure of average blood sugar over three months, by 0.5–1.5%. More than 75% of patients with type 2 diabetes already use these oral drugs. In this trial, one group of participants will continue using oral anti-diabetes drugs during a hospital stay. Studies suggest this approach can help maintain more stable blood sugar levels compared to stopping the drugs. Another group will receive basal bolus insulin, which involves using basal insulin with glargine or detemir and rapid-acting insulin. This evidence suggests that oral anti-diabetes drugs might be a safe and effective alternative to insulin for managing blood sugar levels in the hospital. ^{1 2 5 6 7}

Who Is on the Research Team?

Maya Fayfman, MD

Principal Investigator

Emory University

Are You a Good Fit for This Trial?

This trial is for adults aged 18-80 with type 2 diabetes, admitted to general medicine and surgery services, not critically ill or pregnant. Participants must have a blood glucose under 250 mg/dl, HbA1c below 10%, be on oral anti-diabetes drugs (OADs), and have functioning kidneys. Those with type 1 diabetes, severe COVID-19, or on steroids can't join.

Inclusion Criteria

I have type 2 diabetes and am taking oral diabetes medications.

HbA1c <10%

My blood sugar is under 250 mg/dl and I'm not on long-acting insulin.

Exclusion Criteria

I am expected not to eat or drink for more than 24-48 hours after being admitted or after surgery.

Laboratory evidence of diabetic ketoacidosis

I have never been diagnosed with diabetes.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Treatment

Participants continue their home oral antidiabetic agents or switch to basal bolus insulin therapy during hospitalization

Up to 10 days

Daily monitoring during hospital stay

Follow-up

Participants are monitored for safety and effectiveness after treatment, including hospital complications and re-admissions

30 days

What Are the Treatments Tested in This Trial?

Interventions

• Oral Anti-diabetes Drugs

Trial Overview The study tests if continuing home oral anti-diabetes drugs in the hospital is as effective as insulin therapy for managing diabetes. It compares daily blood sugar control using these drugs versus basal bolus insulin therapy in hospitalized patients.

How Is the Trial Designed?

Group I: Oral Anti-diabetes Drugs (OADs) alone Experimental Treatment 3 Interventions

OADs will be continued at same outpatient dosage unless contraindicated

Group II: Basal bolus insulin Active Control 3 Interventions

Basal insulin with glargine or detemir and rapid-acting insulin (lispro/aspart) will be used as per the hospital formulary. OADs and non-insulin injectable antidiabetic medication will be discontinued on admission.

Oral Anti-diabetes Drugs is already approved in European Union, United States, Canada, Japan, China, Switzerland for the following indications:

Approved in European Union as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Approved in United States as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Approved in Canada as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Approved in Japan as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Approved in China as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Approved in Switzerland as Oral Anti-diabetes Drugs for:

• Type 2 diabetes

Who Is Running the Clinical Trial?

Emory University

Lead Sponsor

Trials

1,735

Recruited

2,605,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Published Research Related to This Trial

Metformin is currently the recommended first-line oral antidiabetic drug for type 2 diabetes due to its effective blood glucose control and better safety profile compared to earlier drugs like sulfonylureas and phenformin.

Newer classes of oral antidiabetic drugs, such as sodium-glucose co-transporter 2 inhibitors and G-protein-coupled receptor agonists, are being developed with novel mechanisms of action, but rigorous safety evaluations are essential to ensure they do not have the adverse effects seen in previous generations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evolving therapeutic options for type 2 diabetes mellitus: an overview. Guthrie, RM.[2013]

Pharmacological treatments, including various classes of oral antidiabetic drugs, are essential for effective blood glucose control in type 2 diabetes, alongside dietary and lifestyle changes.

Different classes of oral antidiabetic drugs work through unique mechanisms, such as reducing glucose production, delaying carbohydrate absorption, and enhancing insulin sensitivity, allowing for potential synergistic effects when combined for better blood glucose management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Repaglinide in combination therapy in type 2 diabetes]. Moses, R.[2018]

A 6-month course of insulin therapy resulted in significantly better long-term glycemic control over 5 years compared to oral antidiabetic drugs (OADs), with lower A1C levels (6.49% vs 7.72%).

The insulin group also had a higher remission rate from diabetes (27.3% vs 5.9%), indicating that insulin therapy may be more effective in achieving sustained glycemic control and potential remission in newly diagnosed patients with severe hyperglycemia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term glycemic control after 6 months of basal insulin therapy. Chen, HS., Wu, TE., Kuo, CS.[2022]

In a study of 2396 patients, vildagliptin and pioglitazone/rosiglitazone showed similar overall adverse drug events, indicating that both medications are comparably safe for treating Type 2 Diabetes Mellitus (T2DM).

However, pioglitazone/rosiglitazone was associated with significantly lower dizziness compared to vildagliptin, while rosiglitazone specifically led to higher rates of weight gain and peripheral edema, suggesting the need for further investigation into these side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adverse drug effects observed with vildagliptin versus pioglitazone or rosiglitazone in the treatment of patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Bundhun, PK., Janoo, G., Teeluck, AR., et al.[2018]

In a study of 9,872 older adults with type 2 diabetes in China, insulin secretagogues, particularly sulfonylureas and glinides, were the most commonly used oral antidiabetes drugs, with dual combination therapy being the prevalent treatment approach.

Older patients (≥65 years) often struggled with glycemic control, especially those on triple or more combination treatments, indicating a need for more comprehensive treatment strategies to improve their diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Treatment Patterns and Glycemic Control in Older Adults with Type 2 Diabetes Mellitus Receiving Only Oral Antidiabetes Drugs in China. Zhang, L., Ji, L., Guo, L., et al.[2022]

In a study of type 2 diabetes patients with poor glycemic control despite insulin therapy, adding tofogliflozin significantly improved HbA1c levels, reducing them by -1.0% compared to a slight decrease in the insulin-only group.

Tofogliflozin not only helped lower HbA1c but also reduced the total daily insulin dose and weight in patients, indicating it may be a safe and effective add-on therapy for better diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of Combined Tofogliflozin and Glargine, Tofogliflozin Added to Insulin, and Insulin Dose-Increase Therapy in Uncontrolled Type 2 Diabetes. Suzuki, K., Mitsuma, Y., Sato, T., et al.[2022]

A study of 71,988 patients with Type 2 diabetes showed that those starting insulin therapy after using 1 or 2 oral antidiabetes drugs (OADs) had higher treatment discontinuation rates and less A1c reduction compared to those who had used 3 or more OADs, indicating that more OADs before insulin may lead to better outcomes.

All groups experienced significant improvements in glycemic control and reduced healthcare costs after initiating insulin therapy, highlighting the importance of timely insulin initiation for patients not achieving adequate control with OADs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Health Outcomes Associated with Initiation of Basal Insulin After 1, 2, or ≥ 3 Oral Antidiabetes Drug(s) Among Managed Care Patients with Type 2 Diabetes. Levin, PA., Zhou, S., Gill, J., et al.[2023]

Over a 10-year period from 2002 to 2011, the use of sulfonylureas (SUs) for monotherapy in type 2 diabetes treatment significantly decreased, while biguanides (BGs) saw an increase in both mono- and combination therapies.

The introduction of DPP-4 inhibitors in 2009 led to their rise as the third most commonly prescribed oral antidiabetic drug by 2011, contributing to improved glycemic control as indicated by a reduction in average glycated hemoglobin levels from 7.5% to 7.1%.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in oral antidiabetic prescriptions and improved glycemic control during the years 2002-2011 in Japan (JDDM32). Oishi, M., Yamazaki, K., Okuguchi, F., et al.[2022]

In a study of 9,872 outpatients with type 2 diabetes in China, insulin secretagogues were the most commonly used oral anti-diabetic drugs, with 70.2% of patients on these medications, indicating a preference for this class of drugs in managing diabetes.

The study found that dual-drug combination therapy was more prevalent (45.4%) than monotherapy (35.8%), and patients on sulfonylureas or glinides were more likely to frequently change their treatment due to perceived poor effectiveness, highlighting challenges in diabetes management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

China type 2 diabetes treatment status survey of treatment pattern of oral drugs users Ji, L., Lu, J., Weng, J., et al.[2016]

Pharmacogenetic factors, such as genetic variations in drug-metabolizing enzymes, can significantly influence the effectiveness and side effects of oral antidiabetic drugs (OADs) in patients with type 2 diabetes.

While some drug-drug interactions among OADs exist, they currently do not appear to have major clinical consequences, highlighting the need for more extensive studies in diverse patient populations to better understand these interactions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oral antidiabetic drug metabolism: pharmacogenomics and drug interactions. Holstein, A., Beil, W.[2019]

Biguanides and sulfonylureas, introduced in the 1950s, remain widely used for diabetes management, with well-defined safety and tolerability profiles, while newer agents like thiazolidinediones have raised concerns about potential side effects such as heart failure and hepatotoxicity.

Rapid-acting non-sulfonylurea secretagogues may offer a safer alternative for certain patients, particularly those with renal impairment, and alpha-glucosidase inhibitors like acarbose have a strong safety record, although their use is limited by tolerability issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative safety of newer oral antidiabetic drugs. Krentz, AJ.[2022]

In a study of 4627 patients with type 2 diabetes, those with moderate or poor glycemic control were significantly more likely to change their oral antidiabetic treatment patterns, such as switching or augmenting therapy, compared to those with good control.

Men generally had worse glycemic control at the start of treatment, and younger patients were more likely to modify their therapy, indicating that initial control levels and demographics play a crucial role in treatment adjustments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus. Mitchell, BD., Eby, EL., Lage, MJ.[2013]

Insulin-dependent oral antidiabetic agents like metformin, sulfonylureas, and gliptins are generally safe but have limitations in maintaining long-term blood glucose control, with no single drug providing stable control for years.

Metformin can cause gastrointestinal discomfort, while sulfonylureas carry risks of hypoglycemia and weight gain; additionally, pioglitazone is linked to serious side effects such as bladder cancer and heart failure, highlighting the need for careful patient monitoring.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Limitations of insulin-dependent drugs in the treatment of type 2 diabetes mellitus]. Valerón, PF., de Pablos-Velasco, PL.[2018]

Citations

1. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK279141/

Oral and Injectable (Non-Insulin) Pharmacological Agents ... GLP-1 RAs can be used in combination with multiple oral anti‐diabetic drugs or in combination with insulin (266). The circulating ...

2. nature.com nature.com/articles/s41598-024-66468-1

Oral antidiabetic therapy versus early insulinization on ... In the past two decades, oral antidiabetic drugs (OADs) have undergone significant advancements. DeFronzo's 'ominous octet' delineates eight ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT04416269

NCT04416269 | Oral Anti Diabetic Agents in the Hospital Over 75% of patients with T2D are treated with oral antidiabetic drugs (OADs) ... Oral Anti-diabetes Drugs (OADs) alone. OADs will be continued at same ...

4. healthcare-bulletin.co.uk healthcare-bulletin.co.uk/article/evaluation-of-oral-antidiabetic-drug-discontinuation-and-glycemic-control-in-icu-patients-a-prospective-cohort-study-3028/

Evaluation of Oral Antidiabetic Drug Discontinuation and ... This study demonstrates that discontinuation of oral antidiabetic drugs (OADs) in ICU patients with type 2 diabetes mellitus significantly impacts glycemic ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2909079/

The Effect of Oral Antidiabetic Agents on A1C Levels Summaries of previous studies of oral antidiabetic drugs (OADs) suggest that they reduce A1C levels by 0.5–1.5% (2). However, this estimated drop in A1C was ...

6. nature.com nature.com/articles/s41598-020-62646-z

Clinical outcomes of basal insulin and oral antidiabetic ... Glycosylated hemoglobin level and number of oral antidiabetic drugs predict whether or not glycemic target is achieved in insulin-requiring type ...

7. withpower.com withpower.com/trial/oral-anti-diabetes-drugs-vs-insulin-for-diabetes-28218

Oral Anti-Diabetes Drugs vs Insulin for Diabetes Oral antidiabetic drugs (OADs) like metformin and sulfonylureas have a well-established safety record, though metformin can cause stomach discomfort and ...