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Recruitment to a clinical trial improves glycemic control in patients with diabetes
Edwin A M Gale1, Scott D Beattie, Jinghui Hu
1Department of Diabetes and Metabolism, University of Bristol, Bristol, UK. edwin.gale@bristol.ac.uk
Objective:
We assessed the effect upon A1C of recruitment to a clinical trial in patients with diabetes who had been screened and interviewed to determine eligibility but whose therapy was otherwise unchanged.
Research Design And Methods:
Eligible trials were selected from the global program of an insulin manufacturer. Included were studies in which patients were seen on a single screening visit, pharmaceutical therapy was not altered before randomization, and A1C was measured in a central laboratory at both screening and randomization. Three trials involving patients with type 1 diabetes (n = 429) and three trials involving patients with type 2 diabetes (n = 611) were identified for analysis. The main outcome measure was change in A1C. Separate regression equations on the change in A1C were fitted for type 1 and type 2 diabetes and included effects of baseline A1C and the interval between the screening and randomization visits.
Results:
A1C changed by -0.13% (range +0.09 to -0.26%) in those with type 1 diabetes at a median of 28 days and by -0.16% (-0.14 to -0.27%) for those with type 2 diabetes at a median of 14 days. The mean change in A1C in those with an interval of >or=28 days was -0.24% for those with type 1 diabetes and -0.23% for those with type 2 diabetes. The reduction was proportional to initial A1C, with large decreases in those with the poorest initial control but no overall change in those at or below the 10th percentile of A1C.
Conclusions:
Recruitment to a clinical trial, independent of any therapeutic intervention, produces improvements in glucose control.
Insights
Enrollment in clinical trials improves glucose control in patients with diabetes, even without therapy changes. This effect, measured by A1C reduction, is more pronounced in individuals with initially poorer glycemic control.
Area of Science:
- Endocrinology
- Clinical Trials
- Diabetes Research
Background:
- Glycemic control is crucial for managing diabetes.
- Clinical trial participation may influence patient outcomes independently of interventions.
Purpose of the Study:
- To evaluate the impact of clinical trial recruitment on glycemic control (A1C) in patients with diabetes.
- To determine if the screening and enrollment process itself affects A1C levels.
Main Methods:
- Analysis of data from six clinical trials (3 for type 1 diabetes, 3 for type 2 diabetes) involving 1040 patients.
- A1C levels were measured at screening and randomization, with no changes in pharmaceutical therapy prior to randomization.
- Regression analysis was used to assess the change in A1C based on baseline A1C and the time between screening and randomization.
Main Results:
- A modest reduction in A1C was observed: -0.13% for type 1 diabetes and -0.16% for type 2 diabetes.
- Longer intervals between screening and randomization (≥28 days) showed greater A1C reductions (-0.24% for type 1, -0.23% for type 2).
- A1C reduction was proportional to baseline A1C, with the most significant decreases seen in patients with the highest initial A1C levels.
Conclusions:
- Clinical trial recruitment, separate from therapeutic interventions, leads to improved glycemic control.
- The process of being enrolled in a study can positively influence diabetes management outcomes.
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