Insulin Lispro 6 Days Versus Insulin Aspart 6 Days in Pump Use

Sponsor
Eli Lilly and Company (Industry)
Overall Status
Completed
CT.gov ID
NCT01134107
Collaborator
(none)
133
15
2
13
8.9
0.7

Study Details

Study Description

Brief Summary

Patients will continue to use their current insulin pump for this study. Patients will receive insulin lispro and insulin aspart during this study. One medication will be taken for 12 weeks and then the other medication for 12 weeks. Neither the patient nor the study doctor will know which medication is being taken at any time. The order in which the two medications are taken will be determined by chance.

Condition or Disease Intervention/Treatment Phase
  • Drug: Insulin Lispro 6 Day (6D)
  • Drug: Insulin Aspart 6 Day (6D)
Phase 3

Study Design

Study Type:
Interventional
Actual Enrollment :
133 participants
Allocation:
Randomized
Intervention Model:
Crossover Assignment
Masking:
Triple (Participant, Care Provider, Investigator)
Primary Purpose:
Treatment
Official Title:
A Double-Blind, Randomized, Crossover Trial of CSII Reservoir In-use Comparing Insulin Lispro Formulation to Insulin Aspart in Patients With Type 1 Diabetes Mellitus
Study Start Date :
Nov 1, 2010
Actual Primary Completion Date :
Dec 1, 2011
Actual Study Completion Date :
Dec 1, 2011

Arms and Interventions

Arm Intervention/Treatment
Experimental: Insulin Lispro 6 Day (6D)

Drug: Insulin Lispro 6 Day (6D)
Administered by infusion pump for 12 week treatment period
Other Names:
  • Insulin Lispro Formulation
  • Humalog
  • LY275585
  • Active Comparator: Insulin Aspart 6 Day (6D)

    Drug: Insulin Aspart 6 Day (6D)
    Administered by infusion pump for 12 week treatment period

    Outcome Measures

    Primary Outcome Measures

    1. Mean of Last Six 7-point Self Monitored Blood Glucose (SMBG) Taken on Day 6 for Insulin Lispro 6D and Insulin Aspart 6D Pump Reservoir In-use [Day 6 of each reservoir cycle for the last 6 weeks of each 12-week treatment period (Week 7 through Week 12)]

    Secondary Outcome Measures

    1. Mean SMBG [Days 1-6 and Day 2 and Day 6 for each reservoir cycle throughout each 12-week treatment period]

      Mean SMBG for combined periods; all reported SMBG values on Days 1-6, Day 2, and Day 6 for Insulin Lispro 6D and Insulin Aspart 6D.

    2. Mean Daily Insulin Dose (Total, Basal, and Bolus) [Days 1-6 for each reservoir cycle throughout each 12-week treatment period]

    3. Change From Baseline to 12 Weeks for Each Treatment in Glycated Hemoglobin A1c (HbA1c) Values [Baseline, endpoint for each 12-week treatment period]

    4. Number of Participants Who Achieve or Maintain a Glycated Hemoglobin A1c (HbA1c) Less Than or Equal to 6.5% and Less Than 7% [Endpoint for each 12-week treatment period]

    Other Outcome Measures

    1. Change From Baseline to 12 Weeks for Daily Insulin Dose (Total, Basal, and Bolus) [Baseline, endpoint for each 12-week treatment period]

    2. Percentage of Participants Having a Hyperglycemic Episode [Days 1-6 for each reservoir cycle throughout each 12-week treatment period]

      A hyperglycemic episode was defined as an event with (1) a measured blood glucose concentration >250 milligrams per deciliter (mg/dL) (13.9 millimoles per liter [mmol/L]) and ≥3 hours after eating, or (2) a measured blood glucose concentration >300 mg/dL (16.7 mmol/L) and <3 hours after eating

    3. Hyperglycemic Episode Rate Per 30 Days [Days 1-6 for each reservoir cycle throughout each 12-week treatment period]

      Hyperglycemia was defined as an episode with (1) a measured blood glucose concentration >250 milligrams per deciliter [mg/dL] (13.9 millimoles per liter [mmol/L]) and ≥3 hours after eating, or (2) a measured blood glucose concentration >300 mg/dL (16.7 mmol/L) and <3 hours after eating. Rate is presented as the number of hyperglycemic episodes adjusted for 30 days.

    4. Percentage of Participants With Pump Complications [Days 1-6 for each reservoir cycle throughout each 12-week treatment period]

      Overall pump complications are defined as any combination of the following, reported by the participant: tubing clogged, tubing kinked, tubing disconnect, tubing pulled out, blood in tubing, too much heat, too much cold, empty reservoir, low battery, occlusion alarm, no delivery alarm, skin abscess at site, excessive redness at site, swelling (not nodule) at site, bleeding at site, bruising at site, reservoir change (infusion set change reason only), and other. When either a reservoir change or an infusion set change was reported, participants were questioned whether the change occurred early (prior to 6 days). If he/she responded 'yes', then the reported change was recorded as a premature change.

    5. Pump Complications Rate Per 30 Days [Days 1-6 for each reservoir cycle throughout each 12-week treatment period]

      Overall pump complications are defined as any combination of the following reported by the participant: tubing clogged, tubing kinked, tubing disconnect, tubing pulled out, blood in tubing, too much heat, too much cold, empty reservoir, low battery, occlusion alarm, no delivery alarm, skin abscess at site, excessive redness at site, swelling (not nodule) at site, bleeding at site, bruising at site, reservoir change (infusion set change reason only), and other. When either a reservoir change or an infusion set change was reported, participants were questioned whether the change occurred early (prior to 6 days). If he/she responded 'yes', then the reported change was recorded as a premature change.

    6. Percentage of Participants Having a Hypoglycemic Episode [All days for each reservoir cycle throughout each 12-week treatment period]

      A Documented Hypoglycemic Episode is defined as an event which is associated with a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L). All Reported Hypoglycemic Episodes are defined as an event which is associated with reported signs and symptoms of hypoglycemia, and/or a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L)

    7. Hypoglycemic Episode Rate Per 30 Days [All days for each reservoir cycle throughout each 12-week treatment period]

      All Reported Hypoglycemic Episodes are defined as an event which is associated with reported signs and symptoms of hypoglycemia, and/or a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L)

    8. Change From Baseline to 12 Week Endpoint for Each Treatment in Weight [Baseline, endpoint for each 12-week treatment period]

    9. Change From Baseline to 12 Weeks Endpoint for Each Treatment in Blood Pressure [Baseline, endpoint for each 12-week treatment period]

    Eligibility Criteria

    Criteria

    Ages Eligible for Study:
    13 Years and Older
    Sexes Eligible for Study:
    All
    Accepts Healthy Volunteers:
    No
    Inclusion Criteria:
    • Diagnosed with type 1 diabetes (World Health Organization criteria) for at least 24 months

    • Treated with continuous subcutaneous insulin infusion (CSII) therapy for the previous 6 months

    • Mean total daily insulin dose for 3 days prior to screening less than or equal to 46 units/day if using a 300-Unit reservoir, less than or equal to 30 units/day if using a 200 unit reservoir, or less than or equal to 26 units/day if using a 180 unit reservoir

    • Baseline body mass index (BMI) less than or equal to 35.0 kilograms per meter squared (kg/m2)

    • Baseline glycated hemoglobin A1c (HbA1c) 5% to 9%

    Exclusion Criteria:
    • Impaired renal function (serum creatinine greater than or equal to 2.0 milligrams per deciliter (mg/dL))

    • Legal blindness

    • Have had any episode in the 12 months prior to screening of hypoglycemic coma, seizures, or disorientation

    • Have had hypoglycemia unawareness (routinely asymptomatic at blood glucose less than 45 mg/dL [2.5 millimoles per liter (mmol/L)]) in the 12 months prior to screening.

    • Have had any emergency room visits or hospitalizations due to poor glucose control in the 12 months prior to screening.

    • Have had a pump-related infusion site abscess in the 12 months prior to screening.

    • Have had multiple, clinically significant occlusions as judged by the investigator.

    • Have had any infection with Staphylococcus aureus in the past 5 years

    • Have one of the following concomitant diseases: presence of clinically significant hematologic, oncologic, renal, cardiac, hepatic, or gastrointestinal disease, or any other serious disease considered by the investigator to be exclusionary.

    • Participants with malignancy other than basal cell or squamous cell skin cancer who have not yet been treated, are currently being treated, or who were diagnosed less than 5 years ago.

    • Have had a blood transfusion or severe blood loss within the 3 months prior to screening or have known hemoglobinopathy, hemolytic or sickle cell anemia, or any other traits of hemoglobin abnormalities known to interfere with HbA1c methodology.

    • Are receiving chronic systemic glucocorticoid therapy, or have received such therapy within the 4 weeks preceding screening.

    • Have an irregular sleep/wake cycle in the investigator's opinion.

    • Have a known hypersensitivity or allergy to any of the study insulins or their excipients

    • Are breastfeeding or pregnant, or intend to become pregnant during the course of the study, or are sexually active women of childbearing potential not actively practicing birth control by a method determined by the investigator to be medically acceptable.

    • Are currently enrolled in, or discontinued within the last 30 days from a clinical trial involving off-label use of an investigational drug or device, or currently enrolled in any other type of medical research not to be scientifically or medically compatible with this study.

    • Are unwilling or unable to comply with the use of a data collection device to directly record data from the participant.

    Contacts and Locations

    Locations

    Site City State Country Postal Code
    1 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Caen France 14033
    2 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Corbeil-Essonnes France 91106
    3 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. La Rochelle France 17019
    4 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Marseille France 13009
    5 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Montpellier France 34295
    6 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Narbonne France 11108
    7 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Ludwigshafen Germany 67059
    8 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Mainz Germany 55116
    9 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Münster Germany 48145
    10 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Neuwied Germany 56564
    11 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Potsdam Germany 14469
    12 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Bekescsaba Hungary 5600
    13 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Budapest Hungary 1023
    14 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Nyiregyhaza Hungary 4400
    15 For additional information regarding investigative sites for this trial, contact 1-877-CTLILLY (1-877-285-4559, 1-317-615-4559) Mon - Fri from 9 AM to 5 PM Eastern Time (UTC/GMT - 5 hours, EST), or speak with your personal physician. Zalaegerszeg Hungary 8900

    Sponsors and Collaborators

    • Eli Lilly and Company

    Investigators

    • Study Director: Call 1-877-CTLILLY (1-877-285-4559) or 1-317-615-4559 Mon - Fri 9 AM - 5 PM Eastern time (UTC/GMT - 5 hours, EST), Eli Lilly and Company

    Study Documents (Full-Text)

    None provided.

    More Information

    Publications

    None provided.
    Responsible Party:
    Eli Lilly and Company
    ClinicalTrials.gov Identifier:
    NCT01134107
    Other Study ID Numbers:
    • 12175
    • F3Z-MC-IOPW
    First Posted:
    May 31, 2010
    Last Update Posted:
    Apr 11, 2013
    Last Verified:
    Apr 1, 2013

    Study Results

    Participant Flow

    Recruitment Details
    Pre-assignment Detail
    Arm/Group Title Lispro 6D/Aspart 6D Aspart 6D/Lispro 6D
    Arm/Group Description Insulin Lispro 6 Day (6D) administered by infusion pump for 12 weeks, followed by Insulin Aspart 6D administered by infusion pump for 12 weeks. Insulin Aspart 6D administered by infusion pump for 12 weeks, followed by Insulin Lispro 6D administered by infusion pump for 12 weeks.
    Period Title: Period 1-First Treatment Intervention
    STARTED 67 66
    Received at Least One Dose of Study Drug 66 66
    COMPLETED 61 61
    NOT COMPLETED 6 5
    Period Title: Period 1-First Treatment Intervention
    STARTED 61 61
    COMPLETED 57 61
    NOT COMPLETED 4 0

    Baseline Characteristics

    Arm/Group Title Lispro 6D/Aspart 6D Aspart 6D/Lispro 6D Total
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 weeks, followed by Insulin Aspart 6D administered by infusion pump for 12 weeks. Insulin Aspart 6D administered by infusion pump for 12 weeks, followed by Insulin Lispro 6D administered by infusion pump for 12 weeks. Total of all reporting groups
    Overall Participants 67 66 133
    Age (years) [Mean (Standard Deviation) ]
    Mean (Standard Deviation) [years]
    40.71
    (11.91)
    44.73
    (12.96)
    42.70
    (12.56)
    Sex: Female, Male (Count of Participants)
    Female
    48
    71.6%
    45
    68.2%
    93
    69.9%
    Male
    19
    28.4%
    21
    31.8%
    40
    30.1%
    Race/Ethnicity, Customized (participants) [Number]
    White
    67
    100%
    66
    100%
    133
    100%
    Region of Enrollment (participants) [Number]
    France
    15
    22.4%
    14
    21.2%
    29
    21.8%
    Hungary
    33
    49.3%
    37
    56.1%
    70
    52.6%
    Germany
    19
    28.4%
    15
    22.7%
    34
    25.6%

    Outcome Measures

    1. Primary Outcome
    Title Mean of Last Six 7-point Self Monitored Blood Glucose (SMBG) Taken on Day 6 for Insulin Lispro 6D and Insulin Aspart 6D Pump Reservoir In-use
    Description
    Time Frame Day 6 of each reservoir cycle for the last 6 weeks of each 12-week treatment period (Week 7 through Week 12)

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit. Those included in the primary analysis had to have at least one reservoir in-use cycle with an SMBG measurement on Day 6 during the pre-specified collection period.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 118 118
    Mean (Standard Deviation) [millimoles per liter (mmol/L)]
    8.83
    (1.55)
    8.43
    (1.97)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments This was the primary gated analysis.
    Type of Statistical Test Non-Inferiority or Equivalence
    Comments Non-inferiority margin of 0.6 mmol/L was used.
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.36
    Confidence Interval (2-Sided) 95%
    0.06 to 0.66
    Parameter Dispersion Type:
    Value:
    Estimation Comments Least Squares Mean Difference = Insulin Lispro 6 Day minus Insulin Aspart 6 Day; adjusted for Treatment + Sequence + Period + Baseline HbA1c
    2. Secondary Outcome
    Title Mean SMBG
    Description Mean SMBG for combined periods; all reported SMBG values on Days 1-6, Day 2, and Day 6 for Insulin Lispro 6D and Insulin Aspart 6D.
    Time Frame Days 1-6 and Day 2 and Day 6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit and one SMBG measurement on a Day 6, or Day 2 depending on the analysis, for the respective treatment arm: insulin lispro 6D and insulin aspart 6D.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 126 126
    SMBG Days 1-6 (N=124, 124)
    8.70
    (2.51)
    8.47
    (2.46)
    SMBG Day 2
    8.56
    (2.51)
    8.40
    (2.47)
    SMBG Day 6 (N=124, 124)
    8.93
    (2.68)
    8.57
    (2.64)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Non-Inferiority or Equivalence
    Comments Non-inferiority margin of 0.6 mmol/L was used.
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.18
    Confidence Interval (2-Sided) 95%
    -0.10 to 0.47
    Parameter Dispersion Type:
    Value:
    Estimation Comments Least Squares Mean Difference = Insulin Lispro 6 Day (Day 1-6) minus Insulin Aspart 6 Day (Day 1-6); adjusted for Treatment + Sequence + Period + Baseline HbA1c
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D
    Comments
    Type of Statistical Test Non-Inferiority or Equivalence
    Comments Non-inferiority margin of 0.6 mmol/L was used.
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.42
    Confidence Interval (2-Sided) 95%
    0.25 to 0.58
    Parameter Dispersion Type:
    Value:
    Estimation Comments Least Squares Mean Difference = Insulin Lispro 6 Day (Day 6) minus Insulin Lispro 6 Day (Day 2); adjusted for DayGroup + Period + Baseline HbA1c
    3. Secondary Outcome
    Title Mean Daily Insulin Dose (Total, Basal, and Bolus)
    Description
    Time Frame Days 1-6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit. Participants included in insulin analyses are only those for whom data existed regarding insulin dose.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 119 119
    Daily Total Insulin
    32.90
    (8.43)
    32.48
    (8.42)
    Daily Basal Insulin
    17.83
    (5.26)
    17.71
    (5.27)
    Daily Bolus Insulin (N=116, 117)
    16.26
    (6.21)
    16.09
    (6.23)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.38
    Confidence Interval (2-Sided) 95%
    -0.13 to 0.88
    Parameter Dispersion Type:
    Value:
    Estimation Comments Daily Total Insulin: Least Squares Mean Difference = Insulin Lispro 6 Day minus Insulin Aspart 6 Day; adjusted for Treatment + Sequence + Period + Baseline Insulin Basal/Bolus/Total Dose
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.02
    Confidence Interval (2-Sided) 95%
    -0.26 to 0.31
    Parameter Dispersion Type:
    Value:
    Estimation Comments Daily Basal Insulin: Least Squares Mean Difference = Insulin Lispro 6 Day minus Insulin Aspart 6 Day; adjusted for Treatment + Sequence + Period + Baseline Insulin Basal/Bolus/Total Dose
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.23
    Confidence Interval (2-Sided) 95%
    -0.15 to 0.60
    Parameter Dispersion Type:
    Value:
    Estimation Comments Daily Bolus Insulin: Least Squares Mean Difference = Insulin Lispro 6 Day minus Insulin Aspart 6 Day; adjusted for Treatment + Sequence + Period + Baseline Insulin Basal/Bolus/Total Dose
    4. Secondary Outcome
    Title Change From Baseline to 12 Weeks for Each Treatment in Glycated Hemoglobin A1c (HbA1c) Values
    Description
    Time Frame Baseline, endpoint for each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit, and had a baseline and a post-randomization HbA1c measurement for the respective treatment period. Last Observation Carried Forward (LOCF) method was utilized in this analysis.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 126
    Mean (Standard Deviation) [percentage of HbA1c]
    -0.16
    (0.54)
    -0.31
    (0.50)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Least Squares Mean Difference
    Estimated Value 0.16
    Confidence Interval (2-Sided) 95%
    0.08 to 0.24
    Parameter Dispersion Type:
    Value:
    Estimation Comments Least Squares Mean Difference = Insulin Lispro 6 Day minus Insulin Aspart 6 Day; adjusted for Treatment + Period + Sequence + Baseline HbA1c
    5. Secondary Outcome
    Title Number of Participants Who Achieve or Maintain a Glycated Hemoglobin A1c (HbA1c) Less Than or Equal to 6.5% and Less Than 7%
    Description
    Time Frame Endpoint for each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed a post-randomization visit and had an HbA1c measurement for the respective treatment period.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 126
    HbA1c ≤6.5%
    18
    26.9%
    21
    31.8%
    HbA1c <7%
    38
    56.7%
    56
    84.8%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.80
    Confidence Interval (2-Sided) 95%
    0.39 to 1.63
    Parameter Dispersion Type:
    Value:
    Estimation Comments Odds Ratio of HbA1c ≤6.5% for Insulin Lispro 6 Day versus Insulin Aspart 6 Day.
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value
    Comments
    Method
    Comments
    Method of Estimation Estimation Parameter Odds Ratio (OR)
    Estimated Value 0.36
    Confidence Interval (2-Sided) 95%
    0.20 to 0.63
    Parameter Dispersion Type:
    Value:
    Estimation Comments Odds Ratio of HbA1c <7% for Insulin Lispro 6 Day versus Insulin Aspart 6 Day.
    6. Other Pre-specified Outcome
    Title Change From Baseline to 12 Weeks for Daily Insulin Dose (Total, Basal, and Bolus)
    Description
    Time Frame Baseline, endpoint for each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit. Participants included in insulin analyses are only those for whom data existed regarding insulin dose.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 119 115
    Total Insulin Dose
    5.21
    (8.94)
    4.97
    (7.57)
    Basal Insulin Dose
    2.34
    (3.51)
    1.91
    (3.80)
    Bolus Insulin Dose (N=112, 112)
    2.19
    (5.58)
    1.80
    (4.70)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.595
    Comments P-value for Total Insulin Dose computed using Crossover model: Variable = Treatment + Sequence + Period + Baseline Insulin Total Dose.
    Method Crossover Model
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.506
    Comments P-value for Basal Insulin Dose computed using Crossover model: Variable = Treatment + Sequence + Period + Baseline Insulin Basal Dose.
    Method Crossover Model
    Comments
    Statistical Analysis 3
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.790
    Comments P-value for Bolus Insulin Dose computed using Crossover model: Variable = Treatment + Sequence + Period + Baseline Insulin Bolus Dose.
    Method Crossover Model
    Comments
    7. Other Pre-specified Outcome
    Title Percentage of Participants Having a Hyperglycemic Episode
    Description A hyperglycemic episode was defined as an event with (1) a measured blood glucose concentration >250 milligrams per deciliter (mg/dL) (13.9 millimoles per liter [mmol/L]) and ≥3 hours after eating, or (2) a measured blood glucose concentration >300 mg/dL (16.7 mmol/L) and <3 hours after eating
    Time Frame Days 1-6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug. Participants included in hyperglycemia analyses are only those for whom data existed regarding hyperglycemia.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 124 124
    Number [percentage of participants]
    97.6
    145.7%
    98.4
    149.1%
    8. Other Pre-specified Outcome
    Title Hyperglycemic Episode Rate Per 30 Days
    Description Hyperglycemia was defined as an episode with (1) a measured blood glucose concentration >250 milligrams per deciliter [mg/dL] (13.9 millimoles per liter [mmol/L]) and ≥3 hours after eating, or (2) a measured blood glucose concentration >300 mg/dL (16.7 mmol/L) and <3 hours after eating. Rate is presented as the number of hyperglycemic episodes adjusted for 30 days.
    Time Frame Days 1-6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug. Participants included in hyperglycemia analyses are only those for whom data existed regarding hyperglycemia.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 124 124
    Mean (Standard Deviation) [hyperglycemic episodes per 30 days]
    15.47
    (9.25)
    14.23
    (10.19)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.059
    Comments
    Method negative binomial test
    Comments P-value computed using a negative binomial test including factors for treatment, period and sequence.
    9. Other Pre-specified Outcome
    Title Percentage of Participants With Pump Complications
    Description Overall pump complications are defined as any combination of the following, reported by the participant: tubing clogged, tubing kinked, tubing disconnect, tubing pulled out, blood in tubing, too much heat, too much cold, empty reservoir, low battery, occlusion alarm, no delivery alarm, skin abscess at site, excessive redness at site, swelling (not nodule) at site, bleeding at site, bruising at site, reservoir change (infusion set change reason only), and other. When either a reservoir change or an infusion set change was reported, participants were questioned whether the change occurred early (prior to 6 days). If he/she responded 'yes', then the reported change was recorded as a premature change.
    Time Frame Days 1-6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit. Participants included in pump complication analyses are only those for whom data existed regarding pump complications.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 127
    Pump Complication: Premature Reservoir Change
    42.5
    63.4%
    44.1
    66.8%
    Pump Complication: Premature Infusion Set Change
    74.8
    111.6%
    70.9
    107.4%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 1.00
    Comments P-value for overall pump complications associated with a premature reservoir change computed using Gart's Test. Participants represented in both treatment groups and with non-missing incidence value in each treatment period are used.
    Method Gart's Test
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.472
    Comments P-value for overall pump complications associated with a premature infusion set change computed using Gart's Test. Participants represented in both treatment groups and with non-missing incidence value in each treatment period are used.
    Method Gart's Test
    Comments
    10. Other Pre-specified Outcome
    Title Pump Complications Rate Per 30 Days
    Description Overall pump complications are defined as any combination of the following reported by the participant: tubing clogged, tubing kinked, tubing disconnect, tubing pulled out, blood in tubing, too much heat, too much cold, empty reservoir, low battery, occlusion alarm, no delivery alarm, skin abscess at site, excessive redness at site, swelling (not nodule) at site, bleeding at site, bruising at site, reservoir change (infusion set change reason only), and other. When either a reservoir change or an infusion set change was reported, participants were questioned whether the change occurred early (prior to 6 days). If he/she responded 'yes', then the reported change was recorded as a premature change.
    Time Frame Days 1-6 for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who completed at least one post-randomization visit. Participants included in pump complication analyses are only those for whom data existed regarding pump complications.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 127
    Pump Complication: Premature Reservoir Change
    0.42
    (0.93)
    0.45
    (1.03)
    Pump Complication: Premature Infusion Set Change
    1.01
    (1.41)
    1.10
    (1.47)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.383
    Comments P-value for Premature Reservoir Change computed using negative binomial test including factors for treatment, period and sequence.
    Method negative binomial test
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.499
    Comments P-value for Premature Infusion Set Change computed using negative binomial test including factors for treatment, period and sequence.
    Method negative binomial test
    Comments
    11. Other Pre-specified Outcome
    Title Percentage of Participants Having a Hypoglycemic Episode
    Description A Documented Hypoglycemic Episode is defined as an event which is associated with a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L). All Reported Hypoglycemic Episodes are defined as an event which is associated with reported signs and symptoms of hypoglycemia, and/or a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L)
    Time Frame All days for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug. Participants included in hypoglycemia analyses are only those for whom data existed regarding hypoglycemia.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 127
    Documented Hypoglycemic Episodes
    91.3
    136.3%
    93.7
    142%
    All Reported Hypoglycemic Episodes
    99.2
    148.1%
    99.2
    150.3%
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 1.00
    Comments The p-value is for the Documented Hypoglycemic Episodes category treatment arm comparison. The p-value for the All Reported Hypoglycemic Episodes category could not be generated using Gart's Test.
    Method Gart's Test
    Comments Participants represented in both treatment groups, and with non-missing incidence value in each treatment period, were used for p-value calculation.
    12. Other Pre-specified Outcome
    Title Hypoglycemic Episode Rate Per 30 Days
    Description All Reported Hypoglycemic Episodes are defined as an event which is associated with reported signs and symptoms of hypoglycemia, and/or a documented blood glucose (BG) concentration of <= 70 mg/dL (3.9 mmol/L)
    Time Frame All days for each reservoir cycle throughout each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug. Participants included in hypoglycemia analyses are only those for whom data existed regarding hypoglycemia.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 127 127
    Mean (Standard Deviation) [hypoglycemic episodes per 30 days]
    16.94
    (10.69)
    18.90
    (11.58)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments
    Method Negative Binomial Test
    Comments P-value computed using a negative binomial test including factors for treatment, period and sequence.
    13. Other Pre-specified Outcome
    Title Change From Baseline to 12 Week Endpoint for Each Treatment in Weight
    Description
    Time Frame Baseline, endpoint for each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug and had both baseline and post-baseline weight measurements for the respective treatment period.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 126 123
    Mean (Standard Deviation) [kilograms (kg)]
    -0.04
    (2.25)
    0.56
    (2.15)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value <0.001
    Comments
    Method Crossover Model
    Comments P-value computed using crossover model. Response = treatment + sequence + period + baseline body weight
    14. Other Pre-specified Outcome
    Title Change From Baseline to 12 Weeks Endpoint for Each Treatment in Blood Pressure
    Description
    Time Frame Baseline, endpoint for each 12-week treatment period

    Outcome Measure Data

    Analysis Population Description
    All randomized participants who received at least one dose of study drug and had both baseline and post-baseline blood pressure measurements for the respective treatment period.
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    Measure Participants 126 121
    Systolic Blood Pressure (SBP)
    -2.25
    (14.71)
    -1.36
    (12.12)
    Diastolic Blood Pressure (DBP)
    -1.61
    (10.36)
    -1.57
    (9.13)
    Statistical Analysis 1
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.147
    Comments P-value for the Systolic Blood Pressure (SBP) computed using crossover model. Response = treatment + sequence + period + baseline systolic blood pressure.
    Method Crossover Model
    Comments
    Statistical Analysis 2
    Statistical Analysis Overview Comparison Group Selection Insulin Lispro 6D, Insulin Aspart 6D
    Comments
    Type of Statistical Test Superiority or Other
    Comments
    Statistical Test of Hypothesis p-Value 0.894
    Comments P-value for Diastolic Blood Pressure (DBP) computed using crossover model. Response = treatment + sequence + period + baseline diastolic blood pressure.
    Method Crossover Model
    Comments

    Adverse Events

    Time Frame
    Adverse Event Reporting Description
    Arm/Group Title Insulin Lispro 6D Insulin Aspart 6D
    Arm/Group Description Insulin Lispro 6D administered by infusion pump for 12 week treatment period Insulin Aspart 6D administered by infusion pump for 12 week treatment period
    All Cause Mortality
    Insulin Lispro 6D Insulin Aspart 6D
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total / (NaN) / (NaN)
    Serious Adverse Events
    Insulin Lispro 6D Insulin Aspart 6D
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 3/127 (2.4%) 7/127 (5.5%)
    Metabolism and nutrition disorders
    Diabetic ketoacidosis 1/127 (0.8%) 1 0/127 (0%) 0
    Hypoglycaemia 2/127 (1.6%) 2 7/127 (5.5%) 8
    Other (Not Including Serious) Adverse Events
    Insulin Lispro 6D Insulin Aspart 6D
    Affected / at Risk (%) # Events Affected / at Risk (%) # Events
    Total 34/127 (26.8%) 31/127 (24.4%)
    Blood and lymphatic system disorders
    Haemorrhagic anaemia 1/127 (0.8%) 1 0/127 (0%) 0
    Iron deficiency anaemia 1/127 (0.8%) 1 0/127 (0%) 0
    Gastrointestinal disorders
    Abdominal pain upper 0/127 (0%) 0 1/127 (0.8%) 1
    Diarrhoea 0/127 (0%) 0 1/127 (0.8%) 1
    Dyspepsia 1/127 (0.8%) 1 0/127 (0%) 0
    Toothache 1/127 (0.8%) 1 2/127 (1.6%) 2
    General disorders
    Device occlusion 1/127 (0.8%) 2 1/127 (0.8%) 2
    Pyrexia 1/127 (0.8%) 1 1/127 (0.8%) 1
    Immune system disorders
    Hypersensitivity 2/127 (1.6%) 2 0/127 (0%) 0
    Seasonal allergy 0/127 (0%) 0 1/127 (0.8%) 1
    Infections and infestations
    Acute tonsillitis 0/127 (0%) 0 1/127 (0.8%) 2
    Bronchitis 0/127 (0%) 0 3/127 (2.4%) 3
    Cystitis 0/127 (0%) 0 1/127 (0.8%) 1
    Ear infection 1/127 (0.8%) 1 0/127 (0%) 0
    Gastroenteritis 3/127 (2.4%) 3 2/127 (1.6%) 2
    Herpes zoster 1/127 (0.8%) 1 0/127 (0%) 0
    Influenza 3/127 (2.4%) 3 3/127 (2.4%) 3
    Nasopharyngitis 10/127 (7.9%) 10 6/127 (4.7%) 6
    Pharyngitis 1/127 (0.8%) 1 0/127 (0%) 0
    Rash pustular 1/127 (0.8%) 1 1/127 (0.8%) 1
    Rhinitis 0/127 (0%) 0 1/127 (0.8%) 1
    Sinusitis 0/127 (0%) 0 1/127 (0.8%) 1
    Tracheobronchitis 0/127 (0%) 0 1/127 (0.8%) 1
    Urinary tract infection 1/127 (0.8%) 1 2/127 (1.6%) 2
    Uterine infection 1/127 (0.8%) 1 0/127 (0%) 0
    Injury, poisoning and procedural complications
    Foot fracture 1/127 (0.8%) 1 1/127 (0.8%) 1
    Joint dislocation 1/127 (0.8%) 1 0/127 (0%) 0
    Open wound 1/127 (0.8%) 1 1/127 (0.8%) 1
    Metabolism and nutrition disorders
    Iron deficiency 1/127 (0.8%) 1 0/127 (0%) 0
    Musculoskeletal and connective tissue disorders
    Arthralgia 1/127 (0.8%) 1 1/127 (0.8%) 1
    Tenosynovitis 0/127 (0%) 0 1/127 (0.8%) 1
    Nervous system disorders
    Carpal tunnel syndrome 1/127 (0.8%) 1 1/127 (0.8%) 1
    Migraine 1/127 (0.8%) 1 0/127 (0%) 0
    Paraesthesia 1/127 (0.8%) 1 0/127 (0%) 0
    Renal and urinary disorders
    Microalbuminuria 0/127 (0%) 0 1/127 (0.8%) 1
    Reproductive system and breast disorders
    Menorrhagia 1/127 (0.8%) 1 0/127 (0%) 0
    Respiratory, thoracic and mediastinal disorders
    Asthma 0/127 (0%) 0 2/127 (1.6%) 2
    Cough 1/127 (0.8%) 1 0/127 (0%) 0
    Oropharyngeal pain 1/127 (0.8%) 1 0/127 (0%) 0
    Sleep apnoea syndrome 0/127 (0%) 0 1/127 (0.8%) 1
    Skin and subcutaneous tissue disorders
    Lipohypertrophy 1/127 (0.8%) 1 0/127 (0%) 0
    Skin fissures 1/127 (0.8%) 1 1/127 (0.8%) 1
    Subcutaneous nodule 0/127 (0%) 0 2/127 (1.6%) 2
    Surgical and medical procedures
    Atherectomy 1/127 (0.8%) 1 0/127 (0%) 0
    Cataract operation 0/127 (0%) 0 1/127 (0.8%) 1
    Injection 1/127 (0.8%) 1 0/127 (0%) 0
    Vascular disorders
    Hypertension 0/127 (0%) 0 1/127 (0.8%) 1
    Phlebitis 0/127 (0%) 0 1/127 (0.8%) 1

    Limitations/Caveats

    Input to primary endpoint measurements (SMBG) contained approximately 40% missing data. Several analyses to account for missing data were conducted and results from these additional analyses were consistent with results from the original analysis.

    More Information

    Certain Agreements

    Principal Investigators are NOT employed by the organization sponsoring the study.

    The only disclosure restriction on the PI is that the sponsor can review results communications prior to public release and can embargo communications regarding trial results for a period that is more than 60 days but less than or equal to 180 days. The sponsor cannot require changes to the communication and cannot extend the embargo.

    Results Point of Contact

    Name/Title Chief Medical Officer
    Organization Eli Lilly and Company
    Phone 800-545-5979
    Email
    Responsible Party:
    Eli Lilly and Company
    ClinicalTrials.gov Identifier:
    NCT01134107
    Other Study ID Numbers:
    • 12175
    • F3Z-MC-IOPW
    First Posted:
    May 31, 2010
    Last Update Posted:
    Apr 11, 2013
    Last Verified:
    Apr 1, 2013