430 Participants Needed

Insulin Therapy for Gestational Diabetes

(START2 Trial)

Recruiting in Rochester (>99 mi)
+1 other location
KK
RM
Overseen ByRodney McLaren Jr, MD
Age: 18+
Sex: Female
Trial Phase: Academic
Sponsor: Thomas Jefferson University
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Approved in 3 JurisdictionsThis treatment is already approved in other countries

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What data supports the effectiveness of insulin therapy for gestational diabetes?

Research shows that insulin analogs like Humalog and insulin detemir are effective in managing blood sugar levels during pregnancy, which is crucial for reducing complications in diabetic women. Studies indicate that these insulins help achieve good metabolic control without adverse effects on mothers or babies.12345

Is insulin therapy safe for use during pregnancy and in general?

Research shows that insulin analogs like lispro, aspart, glargine, and detemir are safe during pregnancy, as they do not cross the placenta or cause harm to the mother or baby. These insulins have favorable properties that help maintain stable blood sugar levels, reducing the risk of low blood sugar episodes.678910

How does insulin therapy differ from other treatments for gestational diabetes?

Insulin therapy for gestational diabetes is unique because it involves direct administration of insulin to manage blood sugar levels, which can be more effective for those who do not respond well to diet and exercise alone. Unlike metformin, which is an oral medication, insulin can be adjusted more precisely to meet individual needs, especially in cases of high insulin resistance or allergies to specific insulin types.1112131415

What is the purpose of this trial?

The aim of our study is to compare neonatal and maternal outcomes using different thresholds for the initiation and titration of pharmacotherapy for gestational diabetes (GDM). Our goal is to compare a Strict and permissive threshold. The Strict study arm target range will be 65-120 mg/dL, with time in range goal of 70%. The permissive study arm target range will be 65-140 mg/dL, with target time in range goal of 70%.

Eligibility Criteria

This trial is for pregnant individuals diagnosed with gestational diabetes. Participants should be those who are being considered for pharmacotherapy to manage their blood sugar levels. Specific eligibility criteria are not provided, but typically participants would need to meet certain health standards and not have conditions that could interfere with the study.

Inclusion Criteria

Live, non-anomalous fetus
Literacy in English, Spanish, Mandarin, or Arabic
Patients are also required to provide consent, demonstrate an understanding of the purpose of the study, and agree to the study protocol.

Exclusion Criteria

I will be younger than 18 years old at my expected due date.
I cannot undergo an oral glucose tolerance test due to health reasons.
Pre-existing diabetes or diagnosis of GDM prior to 24 weeks
See 6 more

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are assigned to either a strict or permissive threshold for pharmacotherapy initiation and titration for gestational diabetes, monitored using continuous glucose monitoring

From initiation of insulin to delivery

Follow-up

Participants are monitored for maternal and neonatal outcomes, including neonatal composite outcomes and maternal hypoglycemia

6 weeks postpartum

Treatment Details

Interventions

  • Insulin
Trial Overview The START 2 trial is testing two different blood sugar level targets for managing gestational diabetes with insulin therapy. One group will follow a 'Strict' target range of 65-120 mg/dL, while the other group will have a 'Permissive' range of 65-140 mg/dL. Both aim for a time in range goal of 70%.
Participant Groups
2Treatment groups
Active Control
Group I: Strict ArmActive Control1 Intervention
The Strict study arm target range will be 65-120 mg/dL, with time in range goal of 70%.
Group II: PermissiveActive Control1 Intervention
The permissive study arm target range will be 65-140 mg/dL, with target time in range goal of 70%.

Insulin is already approved in European Union, United States, Canada for the following indications:

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Approved in European Union as Insulin for:
  • Diabetes mellitus
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Approved in United States as Insulin for:
  • Diabetes mellitus
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Approved in Canada as Insulin for:
  • Diabetes mellitus

Find a Clinic Near You

Who Is Running the Clinical Trial?

Thomas Jefferson University

Lead Sponsor

Trials
475
Recruited
189,000+

University of Rochester

Collaborator

Trials
883
Recruited
555,000+

Findings from Research

In a study comparing 25 women treated with insulin lispro (Humalog) and 46 treated with regular human insulin, pregnancy outcomes were similar, indicating that both treatments are effective for managing diabetes during pregnancy.
There were no significant differences in key outcomes such as HbA1c levels, pregnancy duration, neonatal birth weight, or rates of complications like preterm labor and cesarean sections, suggesting that Humalog is a safe alternative to regular insulin for pregnant women with diabetes.
Pregnancy complications and perinatal outcome in diabetic women treated with Humalog (insulin lispro) or regular human insulin during pregnancy.Cypryk, K., Sobczak, M., PertyΕ„ska-Marczewska, M., et al.[2022]
Insulin detemir (IDet) is shown to be noninferior to insulin neutral protamine Hagedorn (NPH) for managing gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) in pregnant women, based on a study involving 87 participants.
The study found no significant differences in blood glucose control, maternal weight gain, or perinatal outcomes between the two insulin types, but the NPH group experienced more hypoglycemic events, suggesting IDet may be a safer option.
Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes.Herrera, KM., Rosenn, BM., Foroutan, J., et al.[2016]
In a non-inferiority trial involving 225 pregnant women with type 1 diabetes, insulin degludec was shown to be as effective as insulin detemir in controlling blood sugar levels, with similar HbA1c measurements before delivery.
Both insulins were found to have comparable safety profiles, indicating that degludec does not present additional safety concerns compared to detemir during pregnancy.
Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial.Mathiesen, ER., Alibegovic, AC., Corcoy, R., et al.[2023]

References

Pregnancy complications and perinatal outcome in diabetic women treated with Humalog (insulin lispro) or regular human insulin during pregnancy. [2022]
Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes. [2016]
Insulin degludec versus insulin detemir, both in combination with insulin aspart, in the treatment of pregnant women with type 1 diabetes (EXPECT): an open‑label, multinational, randomised, controlled, non-inferiority trial. [2023]
Insulin analogs and pregnancy: an update. [2015]
Basal insulin analogues in diabetic pregnancy: a literature review and baseline results of a randomised, controlled trial in type 1 diabetes. [2022]
Efficacy and Safety of Basal Analog Regimens in Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis of Randomized Controlled Trials. [2020]
Clinical safety of insulin detemir in patients with Type 2 diabetes in the Gulf countries: The multicenter, noninterventional, open-label LevSafe study. [2020]
Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome. [2015]
Safety of insulin analogs during pregnancy: a meta-analysis. [2022]
The care of pregestational and gestational diabetes and drug metabolism considerations. [2017]
11.United Statespubmed.ncbi.nlm.nih.gov
Use of insulin pumps in pregnancies complicated by type 2 diabetes and gestational diabetes in a multiethnic community. [2021]
[Insulin Lispro as an alternative for insulin Humulin U in the treatment of an obese gestational diabetic woman with allergy to Humulin U. Case report]. [2011]
[Outcome of non-pharmacologic treatment in a gestational diabetic woman with high insulin resistance HOMA-IR index and allergy to human insulin. Case report]. [2017]
Fasting blood glucose predicts response to extended-release metformin in gestational diabetes mellitus. [2014]
15.United Statespubmed.ncbi.nlm.nih.gov
Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes. [2023]
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