Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2
Conditions
Keywords
Diabetes, Lancets, Pain
Brief summary
The procurement of blood for SMBG, usually via a finger stick, is considered by many patients to be the most painful portion of diabetes therapy. This has led to the marketing of smaller gauge lancets, lancing devices with variable depth settings and blood glucose sensors that require less blood for measurement. In this study, two main outcomes were evaluated: The first, which was assessed at Visit 1, was whether specific combinations of lancets and lancing devices would yield sufficient blood volume to allow valid assessment of diabetic subjects' glucose levels. The other outcome, assessed at Visit 2, was the level of pain perceived by subjects during lancing with specific combinations of lancets and lancing devices. During Visit 2, pain assessment was done using a Visual Analog Scale and such that for each lancet/lancing device, the lowest lancing device setting that yielded a valid BG reading for each subject during Visit 1 was used. A third outcome measure, overall comfort with lancing, was also assessed at Visit 2. A total of 5 combinations of lancets and lancing devices were evaluated. These were as follows: * BD/33G = BD Lancet device/BD 33G lancets (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips) * OTM/33G =OneTouch® Mini Lancet device / BD 33G lancet (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips) * OTM/28G =OneTouch® Mini Lancet device / OneTouch® UltraSoft® 28G Lancet (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips) * OTU/28G = OneTouch® UltraSoft® Lancet device/OneTouch® UltraSoft® 28G Lancet (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips) * ACC/28G= Accu-Chek® Softclix Lancet device/Accu-Chek® Softclix 28G Lancet (BGM measured with Accu-Chek® Advantage BGM and Accu-Chek® Comfort Curve test strip) After enrollment and qualification, subjects were assigned to one of 4 intervention arms. The arm assignment determined which 3 of the 5 combinations of lancets and lancing devices the subjects would evaluate in Visit 1 (for volume adequacy) and of these 3, which 2 they would evaluate in Visit 2 (pain during lancing). The lancet/lancing device combinations assigned to each arm are shown in the Assigned Interventions Table below.
Interventions
BD Lancet device/BD 33G lancets (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips)
OneTouch® Mini Lancet device / BD 33G lancet (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips)
OneTouch® UltraSoft® Lancet device/OneTouch® UltraSoft® 28G Lancet (BGM measured with the OneTouch® UltraMini™ BGM) and OneTouch® Ultra® test strips)
Accu-Chek® Softclix Lancet device/Accu-Chek® Softclix 28G Lancet (BGM measured with Accu-Chek® Advantage BGM and Accu-Chek® Comfort Curve test strip)
OneTouch® Mini Lancet device / OneTouch® UltraSoft® 28G Lancet (BGM measured with the OneTouch® UltraMini™ (BGM) and OneTouch® Ultra® test strips)
Sponsors
Study design
Eligibility
Inclusion criteria
* Must currently be diagnosed with either Type I or Type II diabetes mellitus. * Must currently be performing self monitoring of blood glucose * Must be between 18-70 years of age (inclusive). * Must be able to read and follow study instructions in English.
Exclusion criteria
* Pregnant (self reported) * History of poor blood circulation. * Any skin condition on his or her fingers that prevents blood sampling. * History of a bleeding disorder. * Neuropathy or other condition affecting sensation in the hands. * Self-reported blood borne infection (e.g., HIV, hepatitis B or C \[non A, non B\], syphilis, malaria, babesiosis, brucellosis, leptospirosis, arboviral infections, relapsing fever, T lymphotropic virus Type 1, Creutzfeldt-Jakob disease). * Currently participating in another study * Employed by BD, J&J, Roche or the Clinical Site.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Study Day 1 (Visit 1) | Number of subjects in whom valid meter reading was obtained with each device configuration. The primary outcome of a successful lancing is defined as whether or not a technician is able to use the lancing system to yield a blood sample of sufficient volume to yield a valid meter reading. |
| Difference in Lancing Pain for Device Pair at Visit 2. (For Subjects Assigned to Arms A, B, C Only) | Approximately Day 3 (Visit 2) | In Visit 2 subjects kept the same group assignment they had in Visit 1. Each subject tested 2 of the 3 systems from Visit 1. Up to 6 pairs of lancings were performed in order to obtain 4 evaluable pairs. After each pair of lancing, the subject was asked to record the pain from the 2nd lancing as compared to the first using a 150mm visual analog scale(0mm = same pain, -75mm = max score for less painful than first lancing,+75mm = max score for more painful). A positive value on the scale (and in table below) indicates that the first device in the pair was more painful than the second. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference in Lancing Pain for Devices in Visit 2 Only. (For Subjects Assigned to Arm D Only) | Approximately Day 3 (Visit 2) | The subjects who participated in Study Visit 2 kept the same group assignment they had in Study Visit 1. Each subject tested 2 of the 3 systems they experienced during Visit 1. Up to 6 pairs of lancings were performed in order to obtain 4 evaluable pairs. After each pair of lancing, the subject was asked to record the difference in the pain they perceive between two lancing systems using the 150 mm visual analog scale. A positive value on the scale (and in the table below) indicates that the first device in the pair was more painful than the second. |
| Reported Device Preference Within Lancing Pair at Visit 2 | Approximately Day 3 (Visit 2) | After each pair of 4 lancings, the subject was asked: Which of the two devices did you find more comfortable, overall? The choices were: first lancing, second lancing or equivalent. The Stated Preference row indicates # of lancing pairs in which one device was preferred over the other device while the 2 rows below indicate the # of pairs in which each device was preferred. First and second device refers to the 1st and 2nd devices identified in column headers, not the device order during testing. The No Preference row includes lancing pairs with preference of equivalent or no answer. |
Countries
United States
Participant flow
Recruitment details
A total of 250 subjects were enrolled in this study between 8/4/2008 (first subject visit) and 9/5/2008 (last subject visit) at two study centers.
Pre-assignment details
After enrollment, baseline characteristics such as demography, diabetes history, and current lancets were recorded for each subject. No additional baseline measures were taken. Thereafter, subjects were assigned to one of the 4 intervention arms. Subjects were able to complete the enrollment visit and Study Visit 1 activities on the first day.
Participants by arm
| Arm | Count |
|---|---|
| Entire Study Population | 250 |
| Total | 250 |
Baseline characteristics
| Characteristic | Entire Study Population |
|---|---|
| Age Continuous | 52.1 years STANDARD_DEVIATION 12.3 |
| Blood Glucose Meter Brand Abbott | 45 participants |
| Blood Glucose Meter Brand Agamatrix | 1 participants |
| Blood Glucose Meter Brand Bayer | 20 participants |
| Blood Glucose Meter Brand BD/Novamax | 17 participants |
| Blood Glucose Meter Brand Lifescan | 106 participants |
| Blood Glucose Meter Brand Other | 16 participants |
| Blood Glucose Meter Brand Private Label Walgreens | 2 participants |
| Blood Glucose Meter Brand Reli-on | 2 participants |
| Blood Glucose Meter Brand Roche | 41 participants |
| Diabetes Type Type 1 | 95 participants |
| Diabetes Type Type 2 | 155 participants |
| Region of Enrollment United States | 250 participants |
| Sex: Female, Male Female | 151 Participants |
| Sex: Female, Male Male | 99 Participants |
| Years Since Diagnosis <1 | 12 participants |
| Years Since Diagnosis >10 | 146 participants |
| Years Since Diagnosis 1-5 | 46 participants |
| Years Since Diagnosis 6-10 | 46 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — | — / — |
| other Total, other adverse events | 5 / 62 | 6 / 63 | 11 / 62 | 6 / 63 |
| serious Total, serious adverse events | 0 / 62 | 0 / 63 | 0 / 62 | 0 / 63 |
Outcome results
Blood Sample of Sufficient Volume to Yield a Valid Meter Reading
Number of subjects in whom valid meter reading was obtained with each device configuration. The primary outcome of a successful lancing is defined as whether or not a technician is able to use the lancing system to yield a blood sample of sufficient volume to yield a valid meter reading.
Time frame: Study Day 1 (Visit 1)
Population: BD/BD33g and Mini/BD33g were included in 4 arms,the Mini/OT28g in 2 arms,and Ultra/OT28g and AC/AC28g in 1 arm. Thus the # of subj evaluated for each device was 246, 246, 124, 63, and 60, resp. Subj were analyzed for blood volume adequacy if they completed the depth setting/volume testing for at least 1 device w/o significant protocol deviation.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BD/33G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Success | 245 Participants |
| BD/33G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Unsuccessful | 1 Participants |
| OTM/33G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Success | 246 Participants |
| OTM/33G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Unsuccessful | 0 Participants |
| OTM/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Success | 124 Participants |
| OTM/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Unsuccessful | 0 Participants |
| OTU/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Unsuccessful | 0 Participants |
| OTU/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Success | 63 Participants |
| ACC/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Success | 60 Participants |
| ACC/28G | Blood Sample of Sufficient Volume to Yield a Valid Meter Reading | Sufficient Volume - Unsuccessful | 0 Participants |
Difference in Lancing Pain for Device Pair at Visit 2. (For Subjects Assigned to Arms A, B, C Only)
In Visit 2 subjects kept the same group assignment they had in Visit 1. Each subject tested 2 of the 3 systems from Visit 1. Up to 6 pairs of lancings were performed in order to obtain 4 evaluable pairs. After each pair of lancing, the subject was asked to record the pain from the 2nd lancing as compared to the first using a 150mm visual analog scale(0mm = same pain, -75mm = max score for less painful than first lancing,+75mm = max score for more painful). A positive value on the scale (and in table below) indicates that the first device in the pair was more painful than the second.
Time frame: Approximately Day 3 (Visit 2)
Population: Of the 234 subjects that completed Visit 2, 229 had evaluable pairs and were included in the analysis for Visit 2. Some of the lancing pairs from several subjects were excluded due to protocol deviations, subject discontinuation or adverse events. Of these 175 subjects were analyzed for this primary outcome.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BD/33G | Difference in Lancing Pain for Device Pair at Visit 2. (For Subjects Assigned to Arms A, B, C Only) | 10.86 mm | Standard Deviation 34.07 |
| OTM/33G | Difference in Lancing Pain for Device Pair at Visit 2. (For Subjects Assigned to Arms A, B, C Only) | 8.71 mm | Standard Deviation 36.69 |
| OTM/28G | Difference in Lancing Pain for Device Pair at Visit 2. (For Subjects Assigned to Arms A, B, C Only) | -0.03 mm | Standard Deviation 31.83 |
Difference in Lancing Pain for Devices in Visit 2 Only. (For Subjects Assigned to Arm D Only)
The subjects who participated in Study Visit 2 kept the same group assignment they had in Study Visit 1. Each subject tested 2 of the 3 systems they experienced during Visit 1. Up to 6 pairs of lancings were performed in order to obtain 4 evaluable pairs. After each pair of lancing, the subject was asked to record the difference in the pain they perceive between two lancing systems using the 150 mm visual analog scale. A positive value on the scale (and in the table below) indicates that the first device in the pair was more painful than the second.
Time frame: Approximately Day 3 (Visit 2)
Population: 61 subjects in this arm completed visit 1 and evaluable data for lancing pain. See further description above.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| BD/33G | Difference in Lancing Pain for Devices in Visit 2 Only. (For Subjects Assigned to Arm D Only) | 4.86 mm | Standard Deviation 33.75 |
Reported Device Preference Within Lancing Pair at Visit 2
After each pair of 4 lancings, the subject was asked: Which of the two devices did you find more comfortable, overall? The choices were: first lancing, second lancing or equivalent. The Stated Preference row indicates # of lancing pairs in which one device was preferred over the other device while the 2 rows below indicate the # of pairs in which each device was preferred. First and second device refers to the 1st and 2nd devices identified in column headers, not the device order during testing. The No Preference row includes lancing pairs with preference of equivalent or no answer.
Time frame: Approximately Day 3 (Visit 2)
Population: Comfort was analyzed per lancing pairs. 236 subjects performed up to 4 lancing pairs. 869 pairs were evaluated across the 4 arms. Pairs were excluded if they did not result in a valid meter reading or associated with protocol deviations or had missing comfort data.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| BD/33G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which participants stated preference | 180 lancing pairs |
| BD/33G | Reported Device Preference Within Lancing Pair at Visit 2 | First device in pair preferred | 67 lancing pairs |
| BD/33G | Reported Device Preference Within Lancing Pair at Visit 2 | Second device in pair preferred | 113 lancing pairs |
| BD/33G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which no preference was stated | 43 lancing pairs |
| OTM/33G | Reported Device Preference Within Lancing Pair at Visit 2 | First device in pair preferred | 70 lancing pairs |
| OTM/33G | Reported Device Preference Within Lancing Pair at Visit 2 | Second device in pair preferred | 113 lancing pairs |
| OTM/33G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which no preference was stated | 26 lancing pairs |
| OTM/33G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which participants stated preference | 183 lancing pairs |
| OTM/28G | Reported Device Preference Within Lancing Pair at Visit 2 | Second device in pair preferred | 89 lancing pairs |
| OTM/28G | Reported Device Preference Within Lancing Pair at Visit 2 | First device in pair preferred | 84 lancing pairs |
| OTM/28G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which no preference was stated | 32 lancing pairs |
| OTM/28G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which participants stated preference | 173 lancing pairs |
| OTU/28G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which no preference was stated | 46 lancing pairs |
| OTU/28G | Reported Device Preference Within Lancing Pair at Visit 2 | First device in pair preferred | 73 lancing pairs |
| OTU/28G | Reported Device Preference Within Lancing Pair at Visit 2 | # of pairs in which participants stated preference | 186 lancing pairs |
| OTU/28G | Reported Device Preference Within Lancing Pair at Visit 2 | Second device in pair preferred | 113 lancing pairs |