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Completed

NCT Number: NCT03175120

A Trial Comparing Insulin Degludec/Liraglutide and Insulin Degludec in Combination With Metformin in Chinese Subjects With Type 2 Diabetes Mellitus Inadequately Controlled With Basal Insulin Therapy and Metformin With or Without One Other Oral Antidiabetic Drug (OAD)

This trial is conducted in Asia. The aim of this trial is to confirm the superiority of insulin degludec/liraglutide versus insulin degludec in controlling glycaemia in Chinese subjects with type 2 diabetes mellitus after 26 weeks of treatment

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Key information

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 3

Primary location

Novo Nordisk Investigational Site, Hefei, Anhui, China

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Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Informed consent obtained before any trial-related activities. Trial-related activities are any procedures that are carried out as part of the trial, including procedures to determine suitability for the trial - Male or female, age at least 18 years at the time of signing inform consent - Type 2 diabetes mellitus (clinically diagnosed) - HbA1c (glycosylated haemoglobin) above or equal to 7.5% by central laboratory analysis, with the aim of a median of 8.5%. When approximately 50% of the randomised subjects have an HbA1c above 8.5%, the remaining subjects randomised must have an HbA1c below or equal to 8.5% or when approximately 50% of the subjects randomised have an HbA1c below or equal to 8.5%, the remaining subjects randomised must have an HbA1c above 8.5% - Current treatment for at least 90 calendar days prior to screening with basal insulin plus metformin plus/minus α-glucosidase inhibitors, sulphonylureas, glinides or thiazolidinediones. Subjects should be on a stable dose for at least 60 calendar days prior to screening of: Basal insulin 20-50 units (U)/day (both inclusive) ( Individual fluctuations of plus/minus 5U during the 60 day period prior to the day of screening are acceptable.) on the day of screening in combination with: - Metformin (above or equal to 1500 mg or max tolerated dose) or - Metformin (above or equal to 1500 mg or max tolerated dose) and sulphonylureas (above or equal to half of the max approved dose according to local label) or - Metformin (above or equal to 1500 mg or max tolerated dose) and glinide (at least half of the max approved dose according to local label) or - Metformin (above or equal to 1500 mg or max tolerated dose) and α-glucosidase inhibitors (AGI) (at least half of the max approved dose according to local label) or - Metformin (above or equal to 1500 mg or max tolerated dose) and thiazolidinediones (at least half of the max approved dose according to local label) - Body mass index (BMI) above or equal to 24 kg/m^2 Exclusion Criteria: Current use of any antidiabetic drug (except for basal insulin, metformin, α-glucosidase inhibitors, sulphonylureas, glinides or thiazolidinediones) or anticipated change in concomitant medication, that in the investigator´s opinion could interfere with glucose level (e.g. systemic corticosteroids) - Treatment with glucagon like peptide -1 receptor agonists, or dipeptidyl-peptidase-4 inhibitors or insulin (except for basal insulin) within 90 days prior to Visit 1 - Impaired liver function defined as alanine aminotransferase above or equal to 2.5 times upper normal range - Impaired renal function defined as serum-creatinine above or equal to 133 μmol/L for males and above or equal to 125 μmol/L for females, or as defined according to local contraindications for metformin Screening calcitonin above or equal to 50 ng/L - Personal or family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia type 2 (MEN2) - Cardiac disorder defined as: congestive heart failure (NYHA class III-IV), diagnosis of unstable angina pectoris, cerebral stroke and/or myocardial infarction within the last 12 months prior to screening and/or planned coronary, carotid or peripheral artery revascularisation procedures - Severe uncontrolled treated or untreated hypertension (systolic blood pressure above or equal to 180 mm Hg or diastolic blood pressure above or equal to 100 mm Hg) - Proliferative retinopathy or maculopathy (macular oedema) requiring acute treatment - History of pancreatitis (acute or chronic)

Treatment and study plan

insulin degludec/liraglutide

Drug

Administered subcutaneously (s.c., under the skin) once daily in combination with metformin for the treatment duration of 26 weeks.

insulin degludec

Drug

Administered subcutaneously (s.c., under the skin) once daily in combination with metformin for the treatment duration of 26 weeks.

Primary outcomes

  1. Change in HbA1c

    Time frame: Week 0, week 26

    Change in glycosylated haemoglobin (HbA1c) from baseline (week 0) to week 26 is presented.

Secondary outcomes

  1. Change in Body Weight

    Time frame: Week 0, week 26

    Change in body weight from baseline (week 0) to week 26 is presented.

  2. Number of Treatment-emergent Severe or Blood Glucose (BG) Confirmed Hypoglycaemic Episodes

    Time frame: Up to 26 weeks

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the American Diabetes Association (ADA) classification (requiring assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 millimoles per liter (mmol/L) with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Number of treatment-emergent severe or BG confirmed hypoglycaemic episodes during 26 weeks of treatment is presented.

  3. Change in Fasting Plasma Glucose (FPG)

    Time frame: Week 0, week 26

    Change in FPG from baseline (week 0) to week 26 is presented.

  4. Change in Waist Circumference

    Time frame: Week 0, week 26

    Change in waist circumference from baseline (week 0) to week 26 is presented.

  5. Change in Mean of the 9-point Self-measured Plasma Glucose (SMPG) Profile

    Time frame: Week 0, week 26

    Participants measured plasma glucose values using the blood glucose meter at 9 time points: before breakfast, 90 min after start of breakfast, before lunch, 90 minutes after start of lunch, before dinner, 90 min after start of dinner, bedtime, at 4:00 am and before breakfast the following day. The mean of profile is defined as the area under the profile divided by measurement time and is calculated using the trapezoidal method. Change in mean of the 9-point SMPG profile from baseline (week 0) to week 26 is presented.

  6. Change in SMPG-mean Post Prandial Increments

    Time frame: Week 0, week 26

    Participants measured plasma glucose values using the blood glucose meter at 9 time points: before breakfast, 90 min after start of breakfast, before lunch, 90 minutes after start of lunch, before dinner, 90 min after start of dinner, bedtime, at 4:00 am and before breakfast the following day. Change in SMPG-mean postprandial increment over all meals from baseline (week 0) to week 26 is presented.

  7. Insulin Dose

    Time frame: Week 26

    The mean of actual daily total insulin dose after 26 weeks of treatment is presented.

  8. SMPG-9-point Profile (Individual Points in the Profile)

    Time frame: Week 26

    Participants measured plasma glucose values using the blood glucose meter at 9 time points: before breakfast, 90 min after start of breakfast, before lunch, 90 minutes after start of lunch, before dinner, 90 min after start of dinner, bedtime, at 4:00 am and before breakfast the following day. SMPG-9-point profile (individual points in the profile) at week 26 is presented.

  9. Change in Fasting High-density Lipoprotein (HDL) Cholesterol- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting HDL cholesterol (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  10. Change in Fasting Low-density Lipoprotein (LDL) Cholesterol- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting LDL cholesterol (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  11. Change in Fasting Very Low-density Lipoprotein (VLDL) Cholesterol- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting VLDL cholesterol (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  12. Change in Fasting Total Cholesterol- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting total cholesterol (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  13. Change in Fasting Triglycerides- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting triglycerides (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  14. Change in Fasting Free Fatty Acids- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting free fatty acids (measured in mmol/L) from baseline (week 0) to week 26 is presented as ratio to baseline.

  15. Change in Fasting C-peptide- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting C-peptide (measured in nanomoles per liter (nmol/L)) from baseline (week 0) to week 26 is presented as ratio to baseline.

  16. Change in Fasting Insulin- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting insulin (measured in picomoles per liter (pmol/L)) from baseline (week 0) to week 26 is presented as ratio to baseline.

  17. Change in Fasting Glucagon- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in fasting glucagon (measured in picograms per milliliter (pg/mL)) from baseline (week 0) to week 26 is presented as ratio to baseline.

  18. Change in HOMA-B (Beta-cell Function)- Ratio to Baseline

    Time frame: Week 0, week 26

    Change in HOMA-B from baseline (week 0) to week 26 is presented as ratio to baseline.

  19. Participants Who Achieved HbA1c < 7.0%, ADA Target (Yes/no)

    Time frame: Week 26

    Participants who achieved HbA1c < 7.0%, ADA target (yes/no) is presented.

  20. Participants Who Achieved HbA1c ≤ 6.5%, American Association of Clinical Endocrinologists (AACE) Target (Yes/no)

    Time frame: Week 26

    Participants who achieved HbA1c ≤ 6.5%, AACE target (yes/no) is presented.

  21. Participants Who Achieved HbA1c < 7.0% and Change From Baseline in Body Weight Below or Equal to Zero

    Time frame: Week 26

    Participants who achieved HbA1c < 7.0% and change from baseline in body weight below or equal to zero is presented.

  22. Participants Who Achieved HbA1c ≤ 6.5% and Change From Baseline in Body Weight Below or Equal to Zero

    Time frame: Week 26

    Participants who achieved HbA1c ≤ 6.5% and change from baseline in body weight below or equal to zero is presented.

  23. Participants Who Achieved HbA1c < 7.0% Without Treatment-emergent Severe or BG Confirmed Hypoglycaemic Episodes

    Time frame: Week 26

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Participants who achieved HbA1c < 7.0% at week 26 without treatment-emergent severe or BG confirmed hypoglycaemic episodes during the last 12 weeks of treatment is presented.

  24. Participants Who Achieved HbA1c ≤ 6.5% Without Treatment-emergent Severe or BG Confirmed Hypoglycaemic Episodes

    Time frame: Week 26

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Participants who achieved HbA1c ≤ 6.5% at week 26 without treatment-emergent severe or BG confirmed hypoglycaemic episodes during the last 12 weeks of treatment is presented.

  25. Participants Who Achieved HbA1c < 7.0% and Change From Baseline in Body Weight Below or Equal to Zero and Without Treatment-emergent Severe or BG Confirmed Hypoglycaemic Episodes

    Time frame: Week 26

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Participants who achieved HbA1c < 7.0% and change from baseline in body weight below or equal to zero and without treatment-emergent severe or BG confirmed hypoglycaemic episodes during the last 12 weeks of treatment is presented.

  26. Participants Who Achieved HbA1c ≤ 6.5% and Change From Baseline in Body Weight Below or Equal to Zero and Without Treatment-emergent Severe or BG Confirmed Hypoglycaemic Episodes

    Time frame: Week 26

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Participants who achieved HbA1c ≤ 6.5% and change from baseline in body weight below or equal to zero and without treatment-emergent severe or BG confirmed hypoglycaemic episodes during the last 12 weeks of treatment is presented.

  27. Number of Treatment-emergent Adverse Events (TEAEs)

    Time frame: Weeks 0-27

    A TEAE was defined as an adverse event with onset date on or after the first day of exposure to randomised treatment and no later than seven days after the last day of randomised treatment. If the event had onset date before the first day of exposure on randomised treatment and increased in severity during the treatment period and until 7 days after the last drug date, then this event was considered as a TEAE.

  28. Number of Treatment-emergent Nocturnal Severe or BG Confirmed Hypoglycaemic Episodes

    Time frame: Weeks 0-27

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with or without symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Nocturnal hypoglycaemic episodes were episodes occurring between 00:01 and 05.59 a.m. both inclusive. Number of treatment-emergent nocturnal severe or BG confirmed hypoglycaemic episodes is presented.

  29. Number of Treatment-emergent Severe or BG Confirmed Symptomatic Hypoglycaemic Episodes

    Time frame: Weeks 0-27

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Number of treatment-emergent severe or BG confirmed symptomatic hypoglycaemic episodes is presented.

  30. Number of Treatment-emergent Nocturnal Severe or BG Confirmed Symptomatic Hypoglycaemic Episodes

    Time frame: Weeks 0-27

    Severe or BG confirmed hypoglycaemic episodes were defined as episodes that were severe according to the ADA classification (required assistance of another person to actively administer carbohydrate, glucagon, or take other corrective actions) or BG confirmed by a plasma glucose value < 3.1 mmol/L with symptoms consistent with hypoglycaemia. Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Nocturnal hypoglycaemic episodes were episodes occurring between 00:01 and 05.59 a.m. both inclusive. Number of treatment-emergent nocturnal severe or BG confirmed symptomatic hypoglycaemic episodes is presented.

  31. Number of Treatment-emergent Hypoglycaemic Episodes According to ADA Definition

    Time frame: Weeks 0-27

    Hypoglycaemic episodes were defined as treatment-emergent if the onset of the episode occurred on or after the first day of trial product administration, and no later than 7 calendar days after the last day on trial product. Number of treatment-emergent hypoglycaemic episodes according to ADA definition is presented.

  32. Change in Physical Examination

    Time frame: Week -2, week 26

    Physical examination parameters are categorised as cardiovascular system; central and peripheral nervous system; gastrointestinal system including mouth; general appearance; head, ears, eyes, nose, throat, neck; lymph node palpation; musculoskeletal system; respiratory system; skin and thyroid gland. The number of participants assessed as normal, abnormal not clinically significant (NCS) and abnormal clinically significant (CS) at week -2 and week 26 is presented.

  33. Eye Examination

    Time frame: Week -2, week 26

    Dilated fundoscopy or fundus photography was performed by the investigator at week -2 and week 26. The results of the examination were interpreted for each eye (left/right) are categorised as normal, abnormal NCS or abnormal CS. Number of participants in each category at week -2 and week 26 were presented.

  34. Change in Electrocardiogram (ECG)

    Time frame: Week -2, week 26

    The ECG was assessed by the investigator at baseline (week -2) and week 26 and categorised as normal, abnormal NCS or abnormal CS. Number of participants in each ECG category at baseline and week 26 were presented.

  35. Change in Pulse

    Time frame: Week 0, week 26

    Change in pulse from baseline (week 0) to week 26 is presented.

  36. Change in Blood Pressure (Systolic and Diastolic Blood Pressure)

    Time frame: Week 0, week 26

    Change in blood pressure (systolic and diastolic blood pressure) from baseline (week 0) to week 26 is presented.

  37. Change in Biochemical Parameter- Amylase, Lipase, Creatinine Kinase, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP)

    Time frame: Week 0, week 26

    Change in amylase, lipase, creatinine kinase, ALT, AST, ALP from baseline (week 0) to week 26 is presented.

  38. Change in Biochemical Parameter-calcium (Total), Albumin Corrected Calcium, Potassium, Sodium, Urea

    Time frame: Week 0, week 26

    Change in calcium (total), albumin corrected calcium, potassium, sodium, urea from baseline (week 0) to week 26 is presented.

  39. Change in Albumin

    Time frame: Week 0, week 26

    Change in albumin from baseline (week 0) to week 26 is presented.

  40. Change in Total Bilirubin

    Time frame: Week 0, week 26

    Change in total bilirubin from baseline (week 0) to week 26 is presented.

  41. Change in Creatinine

    Time frame: Week 0, week 26

    Change in creatinine from baseline (week 0) to week 26 is presented.

  42. Change in Total Protein

    Time frame: Week 0, week 26

    Change in total protein from baseline (week 0) to week 26 is presented.

  43. Change in Haematological Parameter- Haematocrit

    Time frame: Week 0, week 26

    Change in haematocrit from baseline (week 0) to week 26 is presented.

  44. Change in Haematological Parameter- Haemoglobin

    Time frame: Week 0, week 26

    Change in haemoglobin from baseline (week 0) to week 26 is presented.

  45. Change in Haematological Parameter- Leukocytes and Thrombocytes

    Time frame: Week 0, week 26

    Change in leukocytes and thrombocytes from baseline (week 0) to week 26 is presented.

  46. Change in Haematological Parameter- Erythrocytes

    Time frame: Week 0, week 26

    Change in erythrocytes from baseline (week 0) to week 26 is presented.

  47. Change in Haematological Parameter- Basophils

    Time frame: Week 0, week 26

    Change in basophils from baseline (week 0) to week 26 is presented.

  48. Change in Haematological Parameter- Eosinophils

    Time frame: Week 0, week 26

    Change in eosinophils from baseline (week 0) to week 26 is presented.

  49. Change in Haematological Parameter- Lymphocytes

    Time frame: Week 0, week 26

    Change in lymphocytes from baseline (week 0) to week 26 is presented.

  50. Change in Haematological Parameter- Monocytes

    Time frame: Week 0, week 26

    Change in monocytes from baseline (week 0) to week 26 is presented.

  51. Change in Haematological Parameter- Neutrophils

    Time frame: Week 0, week 26

    Change in neutrophils from baseline (week 0) to week 26 is presented.

  52. Change in Calcitonin

    Time frame: Week 0, week 26

    Calcitonin levels were measured and were categorised as low, normal or high. Number of participants in each category at week 0 and week 26 were presented.

  53. Urinalysis (Erythrocytes, Protein, Glucose and Ketones)

    Time frame: Week 0, week 26

    The urinalysis was the measurements of protein, glucose, erythrocytes and ketones at week 0 and week 26 and categorised as negative, trace, 1+, 2+ and 3+. Number of participants in each category at week 0 and week 26 are presented.

  54. Anti-insulin Degludec Specific Antibodies

    Time frame: Week 27

    Serum samples were analysed for the presence of anti-insulin degludec specific antibodies. Results are presented as percentage of bound radioactivity-labelled insulin/total added radioactivity-labelled insulin (%B/T).

  55. Antibodies Cross-reacting to Human Insulin

    Time frame: Week 27

    Serum samples were analysed for the presence of antibodies cross-reacting to human insulin. Results are presented as percentage of bound radioactivity-labelled insulin/total added radioactivity-labelled insulin (%B/T).

  56. Total Insulin Antibodies

    Time frame: Week 27

    Serum samples were analysed for the presence of total insulin antibodies. Results are presented as percentage of bound radioactivity-labelled insulin/total added radioactivity-labelled insulin (%B/T).

  57. Occurrence of Anti-liraglutide Antibodies (Yes/no)

    Time frame: Week 27

    This outcome measure is only applicable for the Insulin degludec/liraglutide treatment arm. Number of participants who measured with anti-liraglutide antibodies at week 27 are presented.

  58. Occurrence of Anti-liraglutide Antibodies Cross Reacting Native Glucagon-like Peptide-1 (GLP-1)

    Time frame: Week 27

    This outcome measure is only applicable for the Insulin degludec/liraglutide treatment arm. Number of participants who measured with anti-liraglutide antibodies cross reacting native GLP-1 at week 27 are presented.

  59. Occurrence of Neutralising Liraglutide Antibodies

    Time frame: Week 27

    This outcome measure is only applicable for the Insulin degludec/liraglutide treatment arm. Number of participants who measured with neutralising liraglutide antibodies at week 27 are presented.

  60. Occurrence of Neutralising Liraglutide Antibodies Cross Reacting Native GLP-1

    Time frame: Week 27

    This outcome measure is only applicable for the Insulin degludec/liraglutide treatment arm. Number of participants who measured with neutralising liraglutide antibodies cross reacting native GLP-1 at week 27 are presented.

Sponsors and collaborators

Lead sponsor

Novo Nordisk A/S

Industry

Registry information

Official study title

A Trial Comparing the Efficacy and Safety of Insulin Degludec/Liraglutide and Insulin Degludec in Combination With Metformin in Chinese Subjects With Type 2 Diabetes Mellitus Inadequately Controlled With Basal Insulin Therapy and Metformin With or Without One Other OAD

Acronym: DUAL™ II China

Important dates

Study start
2017
Primary completion
2019
Study completion
2019
First posted
Jun 5, 2017
Registry last updated
Mar 19, 2020

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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