Using two drugs in combination at the start of drug treatment for type 2 diabetes vs using a single drug
| ISRCTN | ISRCTN26805203 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN26805203 |
| Protocol serial number | U1111-1196-4371 |
| Sponsor | Pakistan Institute of Medical Sciences |
| Funder | Investigator initiated and funded |
- Submission date
- 10/05/2017
- Registration date
- 11/05/2017
- Last edited
- 11/05/2017
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Nutritional, Metabolic, Endocrine
Plain English summary of protocol
Background and study aims
Type 2 diabetes mellitus (T2DM) is a long term condition where a person is unable to control their blood sugar (glucose) levels as they do not produce enough insulin to function properly (insulin deficiency), or that the body’s cells don’t react to insulin as they should do (insulin resistance). According to the 2015 Internation Diabetes Federation estimates, there are 35.4 Million people with type 2 diabetes mellitus in the MENA (Middle East and North Africa) region with an estimated rise to up to 72.1 million by 2040. Diabetes-related deaths stand at a staggering 342,000 during 2015, with over half of all deaths from diabetes in the region occurring in people under 60. A major issue that is dealt with by diabetologists, especially with patients with a rural background, is poor compliance with medication and dietary advice. Furthermore, the characteristics of the diabetic Asian population are unique, in the sense that as compared to western counterparts, Asians tend to have lower BMIs, a younger onset of type 2 diabetes, a high carbohydrate diet, high blood sugar levels after meals, and a more marked problem with insulin production. Standard treatment for T2DM involves treatment with a drug called metformin. DPP4 inhibitor is another drug which helps the body to produce more insulin. The aim of this study is to assess blood sugar control in newly diabetic patients treated wit DPP4 inhibitor and metformin to treatment with metformin alone.
Who can participate?
Adults who have been newly diagnosed with T2DM.
What does the study involve?
Participants are randomly allocated to receive either a single initial drug (as current guidelines recommend), or a combination of two drugs (in a single pill). They are then monitored at intervals of three months, as is the standard procedure for people with type 2 diabetes, and blood tests are performed at the regular intervals to assess their blood sugar control. If, at any of their scheduled visits, it was found that their diabetes control was not up to standard, an additional drug is added after thorough patient education. Visits thereafter are at the scheduled three month intervals, or earlier if the patient desires. A line of communication always remains open, allowing the patients direct access to their doctors. Participants attend regular clinic appointments over a period of five years to assess how well they are managing their diabetes.
What are the possible benefits and risks of participating?
The direct benefits were availability of the drugs with no cost to the patient, scheduled visits with consultants, and direct access to a doctor if and when desired by the patient. Since no new drugs are being tested, and the treatment being used is well established, there were no unforseen risks to the participants other than those normally encountered by diabetics taking regular medication.
Where is the study run from?
Pakistan Institute of Medical Sciences (Pakistan)
When is the study starting and how long is it expected to run for?
June 2009 to July 2016
Who is funding the study?
Investigator initiated and funded (Pakistan)
Who is the main contact?
1. Dr Mohammad Ali Arif (public)
2. Professor Rauf Niazi (scientific)
Contact information
Public
Shifa International Hospital G10
SIH, 3rd Road, sector G-10/4
Islamabad
-
Pakistan
 ORCID ID |
0000-0002-6762-6687 |
|---|
Scientific
Pakistan Institute of Medical Sciences
Main Ibn-e-sina road
Sector G-8/3
Islamabad
-
Pakistan
Study information
| Primary study design | Interventional |
|---|---|
| Study design | Open labelled prospective randomised clinical trial |
| Secondary study design | Randomised controlled trial |
| Study type | Participant information sheet |
| Scientific title | Intensified treatment at the onset of diagnosis of type 2 diabetes mellitus in drug naive patients in the asian population |
| Study acronym | INTRON |
| Study objectives | The use of initial combination therapy with a DPP4 inhibitor plus metformin is superior to metformin monotherapy with sequential add on treatment in achieving and maintaining an HbA1c of <7%. |
| Ethics approval(s) | Ethics Committee of the Pakistan Institute of Medical Sciences,19/01/2010, ref: EC/PIMS-2010/0119-03-Intron |
| Health condition(s) or problem(s) studied | Type 2 diabetes mellitus |
| Intervention | Participants are randomised to one of six groups using covariate adaptive randomization. 1. MHD2 Group: Metformin 1000mg twice daily 2. MHD255 Group: Metformin 850mg thrice daily 3. SMHD Group: (Sitagliptin 50mg plus metformin 1000mg) twice daily 4. SMLD Group: (Sitagliptin 50mg plus Metformin 500mg) twice daily 5. VMHD Group: (Vildagliptin 50mg plus Metformin 1000mg) twice daily 6. VMLD Group: (Vildagliptin 50mg plus Metformin 500mg) twice daily After the first visit, patients are evaluated at week two followed by an interval thereafter of 12 weeks up to 5 years. A complete physical examination was conducted at baseline, along with anthropometric measurements (weight and height) and baseline laboratory parameters (serum creatinine, ALT and fasting lipid profile). Vital signs, fasting and random blood glucose and lab investigations are repeated at each visit along with documentation of any adverse effects (AE). Patients are instructed regarding the use of home blood glucose monitoring along with once weekly documentation of fasting plasma glucose (after a 12 hour fast) and random plasma glucose prior to the evening meal. SMBG (self-monitoring of blood glucose) could be performed at any point in time if the patient experiences symptoms of hypoglycaemia. |
| Intervention type | Drug |
| Phase | Not Applicable |
| Drug / device / biological / vaccine name(s) | |
| Primary outcome measure(s) |
Glycated Haemoglobin is measured at baseline, 3, 6, 9, and 18 months, 2, 3, and 5 years using a standardized laboratory assay for HbA1c. The reduction in HbA1c is calculated by subtracting the former measurements from the latter. |
| Key secondary outcome measure(s) |
1. Percentage of patients achieving and maintaining the target HbA1c of <7% is assessed from the documented HbA1c measured at baseline, 3, 6, 9, and 18 months, 2, 3, and 5 years |
| Completion date | 06/07/2016 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Lower age limit | 18 Years |
| Sex | All |
| Target sample size at registration | 285 |
| Key inclusion criteria | 1. Newly diagnosed patients with type 2 diabetes 2. Had not receievd any prior medication for diabetes 3. Aged 18 – 80 years 4. Asian ethnicity (Pakistani population) |
| Key exclusion criteria | 1. Previous history of ischaemic heart disease 2. Previous history of stroke or other cerebrovascular disease 3. Previous history of chronic kidney disease |
| Date of first enrolment | 19/01/2010 |
| Date of final enrolment | 19/01/2011 |
Locations
Countries of recruitment
- Pakistan
Study participating centre
Islamabad
44000
Pakistan
Results and Publications
| Individual participant data (IPD) Intention to share | Yes |
|---|---|
| IPD sharing plan summary | Available on request |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are/will be available upon request from mohammad_ali_arif@hotmail.com or ali.arif@shifa.com.pk |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Participant information sheet | Participant information sheet | 11/11/2025 | 11/11/2025 | No | Yes |
