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A Study of Insulin Efsitora Alfa (LY3209590) Compared to Degludec in Adults With Type 2 Diabetes Who Are Starting Basal Insulin for the First Time (QWINT-2) Phase 3 928

Abgeschlossen
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Die klinische Studie NCT05362058 (QWINT-2) untersuchte Behandlung im Zusammenhang mit Diabetes, Typ-2-Diabetes. Diese interventionsstudie der Phase 3 hat den Status abgeschlossen. Die Studie begann am 3. Juni 2022 mit 928 Teilnehmern. Sie wurde durchgeführt von Eli Lilly und am 10. April 2024 abgeschlossen. Die Daten von ClinicalTrials.gov wurden zuletzt am 16. Mai 2025 aktualisiert.
Kurzbeschreibung
The purpose of this study is to determine the effect and safety of insulin efsitora alfa (LY3209590) compared to degludec in adult participants with type 2 diabetes who are starting basal insulin for the first time. The study consists of a 1-week screening period, a 2-week lead-in period, a 52-week treatment period, and a 5-week safety follow-up period. The study will last up to 60 weeks.
Offizieller Titel

A Phase 3, Parallel-Design, Open-Label, Randomized Control Study to Evaluate the Efficacy and Safety of LY3209590 as a Weekly Basal Insulin Compared to Insulin Degludec in Insulin Naïve Adults With Type 2 Diabetes

Erkrankungen
DiabetesTyp-2-Diabetes
Publikationen
Wissenschaftliche Artikel und Forschungspapiere zu dieser klinischen Studie:
Weitere Studien-IDs
  • QWINT-2
  • 18262
  • I8H-MC-BDCX (Andere Kennung) (Eli Lilly and Company)
  • 2021-005891-21 (EudraCT-Nummer)
NCT-Nummer
NCT05362058
Studienbeginn (tatsächlich)
2022-06-03
Zuletzt aktualisiert
2025-05-16
Studienende (vorauss.)
2024-04-10
Geplante Rekrutierung
928
Studientyp
Interventionsstudie
PHASE
Phase 3
Status
Abgeschlossen
Primäres Ziel
Behandlung
Zuteilungsmethode
Randomisiert
Interventionsmodell
Parallel
Verblindung
Keine (offene Studie)
Studienarme/Interventionen
Teilnehmergruppe/StudienarmIntervention/Behandlung
Experimentell500 U/mL - Insulin Efsitora Alfa
* Participants received 500 units per milliliter (U/mL) of insulin efsitora alfa administered subcutaneously (SC) once weekly (QW) over a 52-week treatment period, followed by a 5-week safety follow-up period. * Participants continued their protocol-specified stable therapy with non-insulin antihyperglycemic medications throughout the study, at the discretion of the investigator.
Insulin Efsitora Alfa
Administered SC
Aktives Vergleichspräparat100 U/mL - Insulin Degludec
* Participants received 100 U/mL insulin degludec administered SC once daily (QD) over a 52-week treatment period, followed by a 5-week safety follow-up period. * Participants continued their protocol-specified stable therapy with non-insulin antihyperglycemic medications throughout the study, at the discretion of the investigator.
Insulin Degludec
Administered SC
Hauptergebnismessungen
ErgebnismessungBeschreibung der MessungZeitrahmen
Change From Baseline in HbA1c at Week 52 [Noninferiority Analysis]
* HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time. * Least Squares (LS) mean was determined using Analysis of Covariance (ANCOVA) model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.
Baseline, Week 52
Nebenergebnismessungen
ErgebnismessungBeschreibung der MessungZeitrahmen
Change From Baseline in HbA1c at Week 52 in Participants Using GLP-1 Receptor Agonists [Noninferiority Analysis]
* HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time. * LS mean was determined using ANCOVA model with Baseline + Country + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.
Baseline, Week 52
Change From Baseline in HbA1c at Week 52 in Participants Not Using GLP-1 Receptor Agonists [Noninferiority Analysis]
* HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time. * LS mean was determined using ANCOVA model with Baseline + Country + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.
Baseline, Week 52
Change From Baseline in HbA1c at Week 52 [Superiority Analysis]
* HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time. * LS mean was determined using ANCOVA model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 52 were imputed by return-to-baseline multiple imputations approach.
Baseline, Week 52
Percentage of Time in the Blood Glucose Range Between 70 and 180 mg/dL [3.9 and 10.0 mmol/L] - Week 48 to Week 52
* Percentage of time spent within the blood glucose range of 70 to 180 milligrams per deciliter (mg/dL) \[3.9 to 10.0 millimoles per liter (mmol/L)\], as measured during the continuous glucose monitoring (CGM) session over a 24-hour period, from Week 48 to Week 52. * LS mean was determined using ANCOVA model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization + SU Use at Randomization + Treatment (Type III sum of squares) as variables. Missing data at baseline were imputed using multiple imputation under the assumption of missing at random, while missing data at Week 48-52 were imputed using a return-to-baseline multiple imputation approach.
Week 48 to Week 52
Change From Baseline in HbA1c at Week 26 [Superiority Analysis]
* HbA1c is the glycosylated fraction of hemoglobin A. It is measured to identify average plasma glucose concentration over prolonged periods of time. * LS mean was determined using ANCOVA model with Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment (Type III sum of squares) as variables. Missing data at Week 26 were imputed by return-to-baseline multiple imputations approach.
Baseline, Week 26
Percentage of Time in the Blood Glucose Range Between 70 and 180 mg/dL [3.9 and 10.0 mmol/L] - Week 22 to Week 26
* Percentage of time spent within the blood glucose range of 70 to 180 mg/dL (3.9 to 10.0 mmol/L), as measured during the CGM session over a 24-hour period, from Week 22 to Week 26. * LS mean was determined using ANCOVA model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization + SU Use at Randomization + Treatment (Type III sum of squares) as variables. Missing data at baseline were imputed using multiple imputation under the assumption of missing at random, while missing data at Week 22-26 were imputed using a return-to-baseline multiple imputation approach.
Week 22 to Week 26
Change From Baseline in Fasting Blood Glucose (FBG)
Change from baseline in fasting blood glucose measured by self-monitoring blood glucose (SMBG).
Baseline, Week 26, Week 52
Glucose Variability
* Glucose variability measured as coefficient of variation (CV) for blood glucose during the CGM session over a 24-hour period, between Week 22 to Week 26 and Week 48 to Week 52 was reported. * LS mean was determined using Mixed Model Repeated Measures (MMRM) model with Baseline + Country +HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Week 22 to Week 26 and Week 48 to Week 52
Basal Insulin Dose
* The insulin dose was calculated based on the participant's entry of daily or weekly insulin doses in an electronic diary. The average weekly basal insulin dose at Week 26 and Week 52 was reported. * LS mean was determined using MMRM model with Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Week 26 and Week 52
Hypoglycemia Event Rate
* A hypoglycemic event with blood glucose (BG) levels of less than (\<) 54 mg/dL (3.0 mmol/L) \[Level 2\] or Severe Hypoglycemia \[Level 3\] was reported. A severe hypoglycemic event was characterized by altered mental or physical status, requiring the assistance of another person to actively administer carbohydrate, glucagon, or other resuscitative actions for the treatment of hypoglycemia. * Group mean was reported and determined by Negative binomial model using Number of episodes = HbA1c at Baseline (%) + Treatment, with log (exposure in days/365.25) as an offset variable.
Baseline up to Week 52
Nocturnal Hypoglycemia Event Rate
* The event rate of participant-reported clinically significant nocturnal hypoglycemia (defined as blood glucose level \<54 mg/dL (3.0 mmol/L) or severe hypoglycemia and occurs at night and presumably during sleep between midnight and 6:00 AM), measured during treatment phase up to week 52. * Group mean was reported and determined by Negative binomial model using Number of episodes = HbA1c at Baseline (%) + Treatment, with log (exposure in days/365.25) as an offset variable.
Baseline up to Week 52
Change From Baseline in Body Weight
Change from baseline in body weight was reported. LS mean was determined by MMRM model with Baseline + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Baseline, Week 26, Week 52
Percentage of Time in Hypoglycemia Range With Blood Glucose <70 mg/dL (3.9 mmol/L)
* Percentage of time spent in the hypoglycemia range with blood glucose \<70 mg/dL (3.9 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52 was reported. * LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52
Percentage of Time in Hypoglycemia Range With Blood Glucose <54 mg/dL (3.0 mmol/L)
* Percentage of time spent in the hypoglycemia range with blood glucose \< 54 mg/dL (3.0 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52, was reported. * LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52
Percentage of Time in Hyperglycemia Range With Blood Glucose >180 mg/dL (10.0 mmol/L)
* Percentage of time spent in the hyperglycemia range with blood glucose greater than (\>) 180 mg/dL (10.0 mmol/L), as measured during the CGM session over a 24-hour period from Week 8 to Week 12, Week 22 to Week 26, and Week 48 to Week 52 was reported. * LS mean was determined using MMRM model with Baseline + HbA1c Stratum at Baseline + Country + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Week 8 to Week 12, Week 22 to Week 26 and Week 48 to Week 52
Change From Baseline in Treatment-Related Impact Measures for Diabetes (TRIM-D) -Total Score at Week 26 and Week 52
* The TRIM-D is a participant-reported measure designed to assess the impact of diabetes treatment on individuals' functioning and well-being across different diabetes treatments. The questionnaire includes 28 items grouped into 5 sub-domains: treatment burden, daily life, diabetes management, compliance, and psychological health. Each item is assessed on a 5-point scale, with higher scores indicating better health status. All items were summed to obtain a total raw score, which was transformed to a scale of 0 to 100 to obtain a total score. The total score range is 0-100, with a higher total score indicating better overall health and well-being, while a lower total score indicates worse health or well-being. * LS mean was determined using MMRM model with Baseline + Country + HbA1c Stratum at Baseline + GLP-1 RA Use at Randomization Flag + SU Use at Randomization Flag + Treatment + Time + Treatment\*Time (Type III sum of squares) as variables.
Baseline, Week 26, Week 52
Change From Baseline in Short Form-36 Health Survey Version 2 (SF-36v2) Acute Form (Physical-Component and Mental-Component) Scores at Week 26 and Week 52
The SF-36v2 is a participant-reported measure designed to assess health status using 36 items across 8 domains: Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health. Each domain is scored individually, and information from these 8 domains is further aggregated into 2 health component summary scores, the Physical Component Summary and Mental Component Summary. Scoring of each domain and both summary scores are norm based and presented in the form of T-scores, with a mean of 50 and a standard deviation of 10. Higher scores indicate better levels of function and/or better health. Range cannot be specified in norm-based scores.
Baseline, Week 26, Week 52
Change From Baseline in EuroQuality of Life (EuroQol) - 5 Dimensions-5 Levels (EQ-5D-5L) Health State Index and EQ Visual Analog Scale (VAS) Scores at Week 26 and Week 52
The EQ-5D-5L is a multidimensional, health-related, quality-of-life instrument. It includes 5 dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) that are assessed at 5 levels of response (no problems, slight problems, moderate problems, severe problems, and unable to perform or extreme problems). The scores in the 5 dimensions were summarized into a health state index score. A single health-state index value was derived, which ranges from less than 0 (health state equivalent to death, negative values are valued as worse than death) to 1 (perfect health). The EQ VAS rates the participants' perceived health from 0 (the worst imaginable health) to 100 (the best imaginable health). This score provides a composite picture of the respondent's health status.
Baseline, Week 26, Week 52
Eignungskriterien

Zugelassene Altersgruppen
Erwachsene, Ältere Erwachsene
Mindestalter
18 Years
Zugelassene Geschlechter
Alle

  • Have diagnosis of Type 2 diabetes (T2D) according to the World Health Organization Criteria

  • Have an Hemoglobin A1c (HbA1c) of 7.0 percent (%) - 10.5% inclusive, at screening

  • Are on a stable treatment with 1 to 3 antihyperglycemic medication for at least 3 months prior to screening and willing to continue the stable treatment for the duration of the study

  • These antihyperglycemic medications are accepted in the study

    • dipeptidyl peptidase-4 (DPP-4) inhibitors
    • sodium-glucose cotransporter 2 (SGLT2) inhibitors
    • biguanides, such as metformin
    • alpha-glucosidase inhibitors
    • glucagon-like peptide-1 (GLP-1) receptor agonists, oral or injectable
    • Sulfonylureas, or
    • Thiazolidinediones.

  • Are insulin naïve.

Exceptions:

  • short-term insulin treatment for a maximum of 14 days, prior to screening, and prior insulin treatment for gestational diabetes

    • Have a body mass index of less than or equal to (≤) 45 kilogram/square meter (kg/m²).

  • Have a diagnosis of Type 1 diabetes (T1D), latent autoimmune diabetes, or a specific type of diabetes other than T2D, for example, monogenic diabetes, diseases of the exocrine pancreas, or drug-induced or chemical-induced diabetes.

  • Have a history of greater than (>) 1 episode of ketoacidosis or hyperosmolar state or coma requiring hospitalization within 6 months prior to screening. Have had severe hypoglycemia episodes within 6 months prior to screening. Have a history of renal transplantation, are currently receiving renal dialysis, or have an estimated glomerular filtration rate.

  • Have known hemoglobinopathy, hemolytic anemia or sickle cell anemia, or any other traits of hemoglobin abnormalities known to interfere with the measurement of HbA1c.

  • Have had New York Heart Association Class IV heart failure or any of these cardiovascular conditions within 3 months prior to screening

    • Acute myocardial infarction
    • Cerebrovascular accident (stroke), or
    • Coronary bypass surgery.
    • Have had gastric bypass (bariatric) surgery, restrictive bariatric surgery, for example Lap-Band, or sleeve gastrectomy within 1 year prior to screening
    • Have had significant weight gain or loss within 3 months prior to screening, for example, greater than or equal to (≥) 5%.
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113 Studienstandorte in 11 Ländern

Baden-Wurttemberg

Praxis Sauter & Sauter & Vorbach, Wangen, Baden-Wurttemberg, 88239, Germany

North Rhine-Westphalia

InnoDiab Forschung Gmbh, Essen, North Rhine-Westphalia, 45136, Germany
Medizentrum Essen Borbeck, Essen, North Rhine-Westphalia, 45355, Germany

Rhineland-Palatinate

Diabetologikum Ludwigshafen/Die Praxis am Ludwigsplatz, Ludwigshafen am Rhein, Rhineland-Palatinate, 67059, Germany

Saarland

Zentrum für klinische Studien, Saint Ingbert, Saarland, 66386, Germany

Saxony

Universitaetsklinikum Carl Gustav Carus Dresden, Dresden, Saxony, 01307, Germany

Schleswig-Holstein

RED-Institut GmbH, Oldenburg in Holstein, Schleswig-Holstein, 23758, Germany
Diabeteszentrum Hamburg West, Hamburg, 22607, Germany

California

Neighborhood Healthcare Institute of Health, Escondido, California, 92025, United States
Valley Research, Fresno, California, 93720, United States
NorCal Medical Research, Inc, Greenbrae, California, 94904, United States
Catalina Research Institute, LLC, Montclair, California, 91763, United States
Southern California Dermatology, Inc., Santa Ana, California, 92701, United States

Colorado

New West Physicians Clinical Research, Golden, Colorado, 80401, United States

Connecticut

New England Research Associates, LLC, Bridgeport, Connecticut, 06606, United States

Florida

East Coast Institute for Research, LLC, Jacksonville, Florida, 32204, United States

Georgia

East Coast Institute for Research - Canton, Canton, Georgia, 30114, United States
Rophe Adult and Pediatric Medicine/SKYCRNG, Union City, Georgia, 30291, United States

Illinois

Central Illinois Diabetes and Clinical Research a Division of Prairie Education and Research Cooperative, Springfield, Illinois, 62711, United States

Indiana

Qualmedica Research, LLC, Evansville, Indiana, 47715, United States

Iowa

Iowa Diabetes and Endocrinology Research Center, West Des Moines, Iowa, 50265, United States

Kentucky

Qualmedica Research, Bowling Green, Kentucky, 42101, United States

Maryland

MedStar Health Research Institute (MedStar Physician Based Research Network), Hyattsville, Maryland, 20782, United States
Endocrine and Metabolic Consultants, Rockville, Maryland, 20852, United States

Mississippi

SKY Clinical Research Network Group-Quinn, Ridgeland, Mississippi, 39157, United States

Missouri

Clinvest Research LLC, Springfield, Missouri, 65807, United States

New York

Clarity Clinical Research, East Syracuse, New York, 13057, United States
Great Lakes Medical Research, LLC, Westfield, New York, 14787, United States

North Carolina

Monroe Biomedical Research, Monroe, North Carolina, 28112, United States
Lucas Research, Inc, Morehead City, North Carolina, 28557, United States

Oklahoma

Intend Research, LLC, Norman, Oklahoma, 73069, United States

Pennsylvania

Jefferson Clinical Research Institute (JCRI), Philadelphia, Pennsylvania, 19114, United States

South Carolina

Tribe Clinical Research, LLC, Greenville, South Carolina, 29607, United States

Texas

Dallas Diabetes Research Center, Dallas, Texas, 75230, United States
Juno Research, Houston, Texas, 77040, United States
Southern Endocrinology Associates, Mesquite, Texas, 75149, United States
North Hills Family Medicine/North Hills Medical Research, North Richland Hills, Texas, 76180, United States

Washington

Multicare Institute for Research and Innovation, Spokane, Washington, 99202, United States

Espírito Santo

CEDOES, Vitória, Espírito Santo, 29055450, Brazil

Paraná

Cline Research Center, Curitiba, Paraná, 80030-480, Brazil

São Paulo

Centro de Pesquisa Sao Lucas, Campinas, São Paulo, 13034-685, Brazil
Hospital São Lucas de Copacabana, Rio de Janeiro, 22061-080, Brazil
CPQuali Pesquisa Clínica, São Paulo, 01228-000, Brazil
CPCLIN, São Paulo, 01228-200, Brazil
CEPIC - Centro Paulista de Investigação Clínica, São Paulo, 04266-010, Brazil

Ontario

LMC Diabetes & Endocrinology, Brampton, Ontario, L6S 0C6, Canada
Aggarwal and Associates Limited, Brampton, Ontario, L6T 0G1, Canada
LMC Manna Research, Ottawa, Ontario, K2J 0V2, Canada
Bluewater Clinical Research Group Inc., Sarnia, Ontario, N7T 4X3, Canada
Centricity Research Etobicoke Endocrinology, Toronto, Ontario, M9R 4E1, Canada
Fadia El Boreky Medicine, Waterloo, Ontario, N2J 1C4, Canada

Quebec

9109-0126 Quebec Inc., Montreal, Quebec, H4N 2W2, Canada

Beijing Municipality

Beijing Pinggu District Hospital, Beijing, Beijing Municipality, 101200, China

Chongqing Municipality

Chongqing General Hospital, Chongqing, Chongqing Municipality, 400014, China

Hebei

Hebei Medical University - Harrison International Peace Hospital, Hengshui Shi, Hebei, 053000, China

Heilongjiang

The First Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China

Henan

The First Affiliated Hospital of Henan University of Science &Technology, Luoyang Shi, Henan, 471003, China
The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450014, China

Hunan

The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
The First People's Hospital of Yueyang, Yueyang, Hunan, 414000, China

Jiangsu

Changzhou No.2 People's Hospital, Changzhou, Jiangsu, 213164, China
The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210011, China
Nanjing First Hospital, Nanjing, Jiangsu, 210012, China
Nanjing Medical University - Nanjing Jiangning Hospital, Nanjing, Jiangsu, 211100, China
The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
Wuxi People's Hospital, Wuxi, Jiangsu, 214023, China
The Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, Jiangsu, 214400, China
Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212000, China

Jiangxi

The Third Hospital of Nanchang, Nanchang, Jiangxi, 330009, China

Shandong

Jinan Central Hospital, Jinan, Shandong, 250013, China

Shanghai Municipality

Shanghai Putuo District Center Hospital, Shanghai, Shanghai Municipality, 200062, China

Sichuan

West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
Chengdu Fifth People's Hospital, Chengdu, Sichuan, 611130, China

Tianjin Municipality

Tianjin Medical University General Hospital, Tianjin, Tianjin Municipality, 300052, China
Tianjin Medical University Zhu Xianyi Memorial Hospital, Tianjin, Tianjin Municipality, 300070, China

Zhejiang

Zhejiang Hospital, Hangzhou, Zhejiang, 310013, China
Ningbo First Hospital, Ningbo, Zhejiang, 315010, China

Chrudim

INTENDIA klinika s.r.o., Chrudim III, Chrudim, 537 01, Czechia

Jihočeský kraj

MUDr. Alena Vachova, České Budějovice, Jihočeský kraj, 37011, Czechia

Moravskoslezský kraj

MUDr. Tomas Edelsberger, Krnov, Moravskoslezský kraj, 79401, Czechia

Pardubice

Diahelp s.r.o, Pardubice V, Pardubice, 530 02, Czechia

Praha 4

Milan Kvapil s.r.o., Diabetologicka ambulance, Prague, Praha 4, 14900, Czechia

Praha-vých

Diacentrum Brandys n.L. s.r.o., Brandýs nad Labem, Praha-vých, 25001, Czechia

Rychnov Nad Kněžnou

MUDr. Tomas Hrdina, Opočno, Rychnov Nad Kněžnou, 517 73, Czechia

Attikí (Region)

Iatriko Paleou Falirou Medical Center, Palaió Fáliro, Attikí (Region), 17562, Greece

Attikí

Alexandra Hospital, Athens, Attikí, 11528, Greece

Thessaloníki

Thermi Clinic, Thessaloniki, Thessaloníki, 570 01, Greece
Athens Euroclinic, Athens, 115 21, Greece

Aichi-ken

Tosaki Clinic for Diabetes and Endocrinology, Nagoya, Aichi-ken, 468-0009, Japan

Chiba

Kashiwa City Hospital, Kashiwa, Chiba, 277-0825, Japan
Tokuyama Clinic, Mihama-ku,Chiba City, Chiba, 261-0004, Japan

Hiroshima

Nippon Kokan Fukuyama Hospital, Fukuyama-shi, Hiroshima, 721-0927, Japan

Hokkaido

Hasegawa Medical Clinic, Chitose, Hokkaido, 066-0032, Japan
Manda Memorial Hospital, Sapporo, Hokkaido, 060-0062, Japan

Ibaraki

MinamiAkatsukaClinic, Mito, Ibaraki, 311-4153, Japan
Nakakinen clinic, Naka, Ibaraki, 311-0113, Japan

Kanagawa

Hayashi Diabetes Internal Medicine Clinic, Chigasaki, Kanagawa, 253-0044, Japan
Medical Corporation Yuga Tsuruma Kaneshiro Diabetes Clinic, Yamato-shi, Kanagawa, 242-0004, Japan

Saitama

Shimizu Clinic Fusa, Saitama-shi, Saitama, 336-0967, Japan

Tokyo

Kumanomae Nishimura Clinic, Arakawa-ku, Tokyo, 116-0012, Japan
Fukuwa Clinic, Chuo-ku, Tokyo, 104-0031, Japan
Hachioji Diabetes Clinic, Hachioji-shi, Tokyo, 192-0083, Japan
Medical Corporation Sato Medical clinic, Ootaku, Tokyo, 143-0015, Japan
Tomonaga Clinic, Shinjuku, Tokyo, 160-0022, Japan
Yoshimura Clinic, Kumamoto, 861-8039, Japan
Abe Clinic, Ōita, 870-0039, Japan
Investigacion En Salud Y Metabolismo Sc, Chihuahua City, 31217, Mexico
Centro de Endocrinologia y Nutricion, Caguas, 00725, Puerto Rico
Private Practice - Dr. Paola Mansilla-Letelier, Guaynabo, 00970, Puerto Rico

Kang-won-do

Kangwon National University Hospital, Chuncheon, Kang-won-do, 24289, South Korea

Kyǒnggi-do

Hanyang University Guri Hospital, Guri-si, Kyǒnggi-do, 11923, South Korea

Seoul-teuk

Severance Hospital, Yonsei University Health System, Seoul, Seoul-teuk, 03722, South Korea