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NCT Number: NCT07652528

CGM-guided Patch Pump vs Basal-Bolus Injection for Steroid-Induced Hyperglycemia in Sudden Sensorineural Hearing Loss: SHIP Trial

This exploratory randomized controlled trial evaluates whether a CGM-guided temporary patch pump (CareLevo CSII) reduces glucocorticoid-induced hyperglycemia (GIH) compared to a Lantus-based basal-bolus injection (MDI) regimen in patients with sudden sensorineural hearing loss (SSNHL) and type 2 diabetes or prediabetes receiving high-dose systemic corticosteroids (methylprednisolone 48 mg/day).

Patients with SSNHL are treated with high-dose oral corticosteroids as standard of care, which often causes significant postprandial hyperglycemia - particularly in patients with pre-existing diabetes or prediabetes. No randomized trial has investigated the optimal insulin delivery strategy for this specific clinical scenario.

All enrolled participants undergo a 2-night inpatient admission (Day 1-3) for safe insulin initiation and device education, followed by outpatient management (Day 4-14). All participants wear a CareSens Air continuous glucose monitor (CGM, 15-day sensor) throughout Day 1-14.

Participants meeting insulin activation criteria are randomized 1:1 to:

* Arm A (CSII): CareLevo patch pump using a steroid-wave basal profile and carbohydrate-band meal bolus via the app's bolus calculator (CGM-integrated, IOB-adjusted) * Arm B (MDI): Insulin glargine U-100 (Lantus) qAM plus Fiasp prandial bolus via pen using a pre-printed dose table with identical carbohydrate-band algorithm

Both arms use identical glycemic targets, carbohydrate-band bolus algorithm (ICR/ISF identical), and correction rules. The primary difference is insulin delivery (patch pump vs. pen injection) and basal profile (steroid-wave CSII vs. flat glargine). The primary outcome is 24-hour CGM Time Above Range (TAR) >180 mg/dL averaged over the 9-day high-dose steroid period (Day 1-9).

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Key information

Conditions

Sudden Sensorineural Hearing Loss (SSNHL) Diabetes Mellitus Diabetes Mellitus, Type 2 Ear Diseases Endocrine System Diseases Glucose Metabolism Disorders Hearing Disorders Hearing Loss Hearing Loss, Sudden Metabolic Diseases Nervous System Diseases Neurologic Manifestations Nutritional and Metabolic Diseases Otorhinolaryngologic Diseases Pathological Conditions, Signs and Symptoms Prediabetes / Type 2 Diabetes Prediabetic State Sensation Disorders Signs and Symptoms

Age range

19 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

BACKGROUND SSNHL is treated with high-dose systemic corticosteroids (methylprednisolone 48 mg/day, prednisolone-equivalent 60 mg/day). In patients with diabetes or prediabetes, GIH is characterized by afternoon-to-evening postprandial predominance. Despite guideline recommendations for insulin-based management, no randomized evidence exists to guide optimal insulin delivery for this short-term, high-dose steroid course. ADA Standards of Care 2026 acknowledges glargine- or NPH-based basal-bolus insulin as established approaches for GIH; however, neither addresses the potential advantage of steroid-wave basal profiling achievable with CSII.

STUDY DESIGN Single-center, open-label, exploratory RCT. Day 1-3: 2-night inpatient admission. Day 4-14: outpatient management with fixed discharge dosing plan provided at Day 3.

STEROID PROTOCOL (standard of care):

Day 1-9: Methylprednisolone 48 mg/day | Day 10-11: 32 mg/day | Day 12-13: 16 mg/day | Day 14: 8 mg/day | Day 15~: discontinuation

CGM:

All participants: CareSens Air CGM (i-SENS, South Korea), 15-day sensor, attached on Day 0 (study-funded). CGM data collected Day 1-14. Primary endpoint computed from Day 1-9 24-hour data. Steroid-wave window (10:00-22:00) TAR is a pre-specified key secondary endpoint.

INSULIN PROTOCOLS - COMMON ELEMENTS:

Initial study TDD: 0.35-0.40 U/kg/day (T2DM insulin-naïve, PE ≥60 mg/day); 0.20-0.25 U/kg/day (prediabetes). Upper limit: 0.50 U/kg/day or 60 U/day.

Basal budget: 35-45% of study TDD for both arms (delivery method differs). Carbohydrate-band meal bolus: Patients select from 6 meal-size categories (0/30/45/60/75/90g). ICR: breakfast ~45g/(0.15×TDD); lunch/dinner ~60g/(0.20×TDD). Identical algorithm for both arms.

Correction: ISF = 1500/TDD (daytime); 2×ISF (nighttime). Fixed correction table provided at discharge (calculated once; not recalculated during outpatient period). No routine post-meal correction. Rescue correction only: ≥3h after last bolus, sustained POC/CGM ≥300 mg/dL.

Arm A (CSII): CareLevo patch pump with fast-acting insulin aspart (Fiasp). Steroid-wave basal profile: 00:00-04:00 8%, 04:00-07:00 12%, 07:00-10:00 15%, 10:00-16:00 35%, 16:00-22:00 25%, 22:00-24:00 5% of basal budget. Bolus calculator integrated with CGM; patient selects carbohydrate band. IOB reflected in all bolus calculations. Patch replaced Day 8.

Arm B (MDI): Insulin glargine U-100 (Lantus) qAM = 45% of TDD, administered with morning steroid. Fiasp prandial bolus via insulin pen using pre-printed dose table (same carbohydrate-band algorithm as Arm A). Fixed correction table provided at discharge.

SAMPLE SIZE:

44 participants (22 per arm). Two-sided α=0.05, 80% power, assumed Δ=15%p (MDI TAR=55%, CSII TAR=40%), SD=16%, 20% dropout (Cohen's d=0.94). ANCOVA covariates: baseline POC glucose, HbA1c, diabetes category, BMI.

Who can participate

Healthy volunteers accepted: No

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

Inclusion criteria

  • Age ≥19 years
  • Idiopathic SSNHL: ≥30 dB sensorineural hearing loss across ≥3 consecutive frequencies within 72 hours
  • Affected ear PTA4 (mean of 0.5/1/2/4 kHz) ≥40 dB HL (moderate or greater)
  • Planned methylprednisolone 48 mg/day orally once in the morning
  • At least one of: known T2DM; HbA1c 5.7-10.0% within 3 months; POC glucose ≥140 mg/dL ×2 (≥2h apart, ≥1 postprandial) within 24h of steroid
  • If on prior insulin: outpatient TDD ≤30 U/day
  • Able to eat ≥2 meals/day, wear CGM and patch pump, use smartphone
  • Willing to undergo 2-night inpatient admission (Day 1-3)
  • Written informed consent

Exclusion criteria

  • Type 1 DM, LADA, pancreatogenic DM, DKA/HHS within 12 months, ketonuria at enrollment
  • Enrollment POC ≥350 mg/dL or immediate IV insulin requirement
  • HbA1c ≥10.0%
  • eGFR <30 mL/min/1.73m² or dialysis
  • Pregnancy/breastfeeding; women of childbearing potential: positive urine hCG
  • ICU, sepsis, NPO, TPN/enteral nutrition
  • Severe hepatic failure (Child-Pugh C)
  • Dexamethasone, divided-dose, or pulse steroids planned
  • Prior CSII or AID device user
  • Skin adhesive allergy precluding CGM or patch pump use
  • Insufficient cognitive function for device or dosing table use
  • Planned MRI requiring repeated CGM/pump removal
  • PTA >70 dB (profound hearing loss requiring combined intratympanic steroid)

Treatment and study plan

CareLevo Patch-type Insulin Pump

Device

CareLevo (CareMedi Inc., South Korea): tubeless patch pump, 300U reservoir, max 7-day wear, basal 0.05-15 U/hr, bolus 0.05-25 U, CareSens Air CGM integration via smartphone app. Steroid-wave basal profile (highest during 10:00-16:00, 35% of basal budget). App bolus calculator accepts CGM glucose + patient-selected carbohydrate band (0/30/45/60/75/90g) and computes dose based on ICR, ISF, and IOB. Provided free by manufacturer (CareMedi); manufacturer has no role in study design, data analysis, or publication.

Insulin Glargine U-100 (Lantus)

Drug

Lantus administered subcutaneously once daily in the morning with steroid intake. Dose = 45% of study TDD. De-escalated proportionally: Day 10-11 ×0.67, Day 12-13 ×0.33, Day 14 ×0.17 or discontinuation. Selected over NPH for practical utility and supply stability; evidence supports comparable efficacy to NPH for GIH in BBI framework (Ruiz de Adana et al. 2018). Toujeo/Tresiba excluded due to prolonged time to steady-state (≥5 days) incompatible with 14-day protocol.

Fast-acting Insulin Aspart (Fiasp)

Drug

Fiasp used as prandial and correction insulin in both arms. Meal bolus via carbohydrate-band selection (0/30/45/60/75/90g). ICR: breakfast 45g/(0.15×TDD); lunch/dinner 60g/(0.20×TDD). ISF = 1500/TDD (daytime), 2×ISF (night). Arm A: app auto-calculation with IOB. Arm B: pre-printed dose table (same algorithm). No routine postprandial correction. Rescue correction: ≥3h post-bolus + POC/CGM ≥300 mg/dL sustained.

CareSens Air Continuous Glucose Monitor

Device

CareSens Air (i-SENS, South Korea), 15-day sensor attached Day 0. 5-minute interval glucose transmitted to smartphone and Sens365 platform for research team monitoring. Arm A: real-time CGM integrated into CareLevo bolus calculator. Primary endpoint (24h TAR) and key secondary endpoint (window TAR 10:00-22:00) computed from Sens365 raw export. 15-day sensor covers entire study period (Day 1-14) without sensor change. Provided free by manufacturer (i-SENS); manufacturer has no role in study design, analysis, or publication.

Primary outcomes

  1. 24-hour CGM Time Above Range (TAR) >180 mg/dL (%) - averaged over Day 1-9

    Time frame: Day 1 through Day 9 (24 hours per day)

    Percentage of CGM readings exceeding 180 mg/dL over 24 hours, averaged across the 9-day high-dose corticosteroid period (Day 1-9). Calculated from 5-minute interval CareSens Air CGM raw data exported from Sens365 platform. 24-hour TAR is the standard CGM metric per international consensus guidelines and AGP reporting framework, enabling direct comparison with published literature on glucocorticoid-induced hyperglycemia. Minimum 70% CGM data completeness per day required for inclusion in primary analysis; days with <70% completeness handled by multiple imputation in primary analysis and complete-case analysis as sensitivity analysis.

Secondary outcomes

  1. CGM TAR >180 mg/dL (%) during steroid pharmacodynamic window (10:00-22:00) - pre-specified exploratory analysis of the steroid-specific time period corresponding to peak methylprednisolone effect

    Time frame: Day 1-9, 10:00-22:00 window

  2. Time In Range (TIR) 70-180 mg/dL (%, 24-hour)

    Time frame: Day 1-9

  3. Time Above Range >250 mg/dL (%, 24-hour)

    Time frame: Day 1-9

  4. Postprandial incremental AUC >180 mg/dL (breakfast, lunch, dinner - 2-4h post-meal)

    Time frame: Day 1-9

  5. Time Below Range (TBR) <70 mg/dL (%, 24-hour) - key safety outcome to verify TAR reduction is not accompanied by increased hypoglycemia

    Time frame: Day 1-9

  6. Nocturnal Time Below Range <70 mg/dL (00:00-06:00)

    Time frame: Day 1-9

  7. Severe hypoglycemia rate (requiring third-party assistance)

    Time frame: Day 1-14

  8. Glycemic variability: Coefficient of Variation (CV%), SD, MAGE

    Time frame: Day 1-9

  9. Number of daily needle punctures (bolus + correction injections/activations) - key treatment burden metric

    Time frame: Day 1-14

  10. Total daily insulin dose and correction insulin proportion

    Time frame: Day 1-9

  11. Rate of rescue therapy (protocol stop criteria reached)

    Time frame: Day 1-14

  12. CGM TAR >180 mg/dL and TBR <70 mg/dL during steroid taper period (Day 10-14) - exploratory safety

    Time frame: Day 10-14

  13. Hearing recovery: PTA change (4-frequency average 0.5/1/2/4 kHz)

    Time frame: Baseline and Day 60 (±14 days)

  14. Hearing recovery: Siegel criteria classification (Complete/Partial/Minimal/No Recovery)

    Time frame: Day 60 (±14 days)

  15. Salvage intratympanic steroid injection rate

    Time frame: Day 60 (±14 days)

  16. Treatment satisfaction and device burden: ITSQ Inconvenience of Regimen subscale (Q1-Q5) and Insulin Delivery Device Satisfaction subscale (Q17-Q22); Anderson et al. Clin Ther 2004. Permission obtained.

    Time frame: Day 10-15 (outpatient visit)

  17. CGM data completeness and device-related events (patch premature removal, occlusion - Arm A)

    Time frame: Day 1-14

  18. Treatment-related cost (CGM, insulin, device consumables)

    Time frame: Day 1-15

Study contacts

Contact information is provided by the study sponsor or research team.

Hun Jee Choe MD, PhD

CONTACT

[email protected]

+82-10-9493-5703

Sponsors and collaborators

Lead sponsor

Hallym University

Other

Registry information

Official study title

Steroid-induced Hyperglycemia Management With Insulin Patch Pump in Sudden Sensorineural Hearing Loss: a CGM-guided Exploratory Randomized Controlled Trial (SHIP Trial)

Acronym: SHIP

Important dates

Study start
2026
Primary completion
2028
Study completion
2028
First posted
Jun 17, 2026
Registry last updated
Jul 22, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

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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