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The Role of Endogenous Glucagon-like Peptide 1 (GLP-1) in Type 2 Diabetes Mellitus (T2DM) (DFG_5)

Primary Purpose

Diabetes Mellitus, Type 2

Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
exendin(9-39)amide
saline
duodenal meal
duodenal saline
Sponsored by
Ludwig-Maximilians - University of Munich
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Diabetes Mellitus, Type 2 focused on measuring GLP-1, Exendin(9-39), Insulin, Glucagon, T2DM, incretin effect, human physiology

Eligibility Criteria

30 Years - 70 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • male or female (postmenopausal, surgically sterile or using double-barrier method of contraception) healthy subjects and patients with type 2 diabetes mellitus (T2DM)
  • must be able to complete a 1 week wash-out of current anti-diabetic medications
  • Age 30-70 years
  • HbA1c (Hemoglobin A1c) ≤11% at screening
  • Body mass index (BMI) <40 kg/m2
  • Patients with type 2 diabetes mellitus (T2DM): Must have a fasting blood glucose of ≤12.2 mmol/L (240 mg/dL) at screening
  • Able to provide written informed consent prior to study participation
  • Able to communicate well with the investigator and comply with the requirements of the study

Exclusion Criteria:

  • Patients with type 1 diabetes mellitus (T1DM), diabetes as a result of pancreatic injury, or secondary forms of diabetes (eg Cushing, acromegaly)
  • Need for insulin within the previous 3 months
  • Use of Thiazolidinediones in the previous 4 weeks
  • Significant concomitant disease or complications of diabetes (i.e. nephropathy, autonomic dysfunction, orthostasis).
  • Treatment with systemic steroids and thyroid hormone (unstable dosage).
  • Patients with any history of gastrointestinal surgery, e.g. partial bowel resections, partial gastric resections, etc.
  • Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation.
  • Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing.
  • Significant illness within the two weeks prior to dosing.
  • Past medical history of clinically significant ECG abnormalities or a family history of a prolonged QT-interval syndrome.
  • History of clinically significant drug allergy; history of atopic allergy (asthma, urticaria, eczematous dermatitis). A known hypersensitivity to the study drug or drugs similar to the study drug.
  • history of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection;
  • history or clinical evidence of pancreatic injury or pancreatitis;
  • history or presence of impaired renal function as indicated by abnormal creatinine or urea val-ues or abnormal urinary constituents (e.g., albuminuria);
  • evidence of urinary obstruction or difficulty in voiding at screening;
  • Polymorphonuclears <1500/µL at inclusion or platelet count < 100,000/μL at screening and baseline.
  • History of immunocompromise.
  • Evidence of liver disease as indicated by abnormal transaminases and alkaline phosphatase exceeding twice the upper limit of the normal range, and serum bilirubin should not exceed the value of 27 µmol/L (1.6 mg/dL).

Sites / Locations

  • Ludwig Maximilians-University, Clinical Research Unit
  • Clinical Research unit, Dept. of Internal Medicine II - Großhadern, University of Munich

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

intravenous infusion

intraduodenal perfusion

Arm Description

Outcomes

Primary Outcome Measures

The incretin effect
The incretin effect is the difference between postprandial plasma concentrations of insulin and C-peptide, respectively, and those during the isoglycemic fasting control experiment. The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.

Secondary Outcome Measures

Plasma concentrations of glucagon
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Plasma concentrations of insulin
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Plasma concentrations of C-peptide
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Plasma concentrations of Glucagon-like peptide-1(7-36) (GLP-1(7-36))
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Plasma concentrations of Glucose-dependent insulinotropic polpypeptide (GIP)
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.

Full Information

First Posted
October 2, 2011
Last Updated
October 5, 2011
Sponsor
Ludwig-Maximilians - University of Munich
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1. Study Identification

Unique Protocol Identification Number
NCT01449019
Brief Title
The Role of Endogenous Glucagon-like Peptide 1 (GLP-1) in Type 2 Diabetes Mellitus (T2DM)
Acronym
DFG_5
Official Title
The Contribution of Glucagon-like Peptide 1 (GLP-1) to the Entero-insulinar Axis in Healthy Subjects and Patients With Type 2 Diabetes Mellitus (T2DM)
Study Type
Interventional

2. Study Status

Record Verification Date
October 2011
Overall Recruitment Status
Completed
Study Start Date
December 2006 (undefined)
Primary Completion Date
August 2007 (Actual)
Study Completion Date
July 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ludwig-Maximilians - University of Munich

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of the study is to determine the contribution of endogenous Glucagon-like peptide 1 (GLP-1) to the postprandial secretion of insulin and glucagon and the incretin effect in healthy subjects and patients with type 2 diabetes mellitus (T2DM).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2
Keywords
GLP-1, Exendin(9-39), Insulin, Glucagon, T2DM, incretin effect, human physiology

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 1
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
24 (Actual)

8. Arms, Groups, and Interventions

Arm Title
intravenous infusion
Arm Type
Active Comparator
Arm Title
intraduodenal perfusion
Arm Type
Experimental
Intervention Type
Drug
Intervention Name(s)
exendin(9-39)amide
Intervention Description
intravenous infusion of exendin(9-39)
Intervention Type
Drug
Intervention Name(s)
saline
Intervention Description
intravenous infusion of saline
Intervention Type
Other
Intervention Name(s)
duodenal meal
Intervention Description
duodenal perfusion of a meal
Intervention Type
Other
Intervention Name(s)
duodenal saline
Intervention Description
duodenal perfusion of saline
Primary Outcome Measure Information:
Title
The incretin effect
Description
The incretin effect is the difference between postprandial plasma concentrations of insulin and C-peptide, respectively, and those during the isoglycemic fasting control experiment. The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion
Secondary Outcome Measure Information:
Title
Plasma concentrations of glucagon
Description
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion
Title
Plasma concentrations of insulin
Description
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion
Title
Plasma concentrations of C-peptide
Description
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion
Title
Plasma concentrations of Glucagon-like peptide-1(7-36) (GLP-1(7-36))
Description
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion
Title
Plasma concentrations of Glucose-dependent insulinotropic polpypeptide (GIP)
Description
The AUC is calculated after priming intravenous infusion (saline or exendin(9-39)) and under steady state duodenal meal perfusion.
Time Frame
Area Under Curve (AUC) Time Frame: from 0 to 90 minutes under duodenal meal perfusion

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: male or female (postmenopausal, surgically sterile or using double-barrier method of contraception) healthy subjects and patients with type 2 diabetes mellitus (T2DM) must be able to complete a 1 week wash-out of current anti-diabetic medications Age 30-70 years HbA1c (Hemoglobin A1c) ≤11% at screening Body mass index (BMI) <40 kg/m2 Patients with type 2 diabetes mellitus (T2DM): Must have a fasting blood glucose of ≤12.2 mmol/L (240 mg/dL) at screening Able to provide written informed consent prior to study participation Able to communicate well with the investigator and comply with the requirements of the study Exclusion Criteria: Patients with type 1 diabetes mellitus (T1DM), diabetes as a result of pancreatic injury, or secondary forms of diabetes (eg Cushing, acromegaly) Need for insulin within the previous 3 months Use of Thiazolidinediones in the previous 4 weeks Significant concomitant disease or complications of diabetes (i.e. nephropathy, autonomic dysfunction, orthostasis). Treatment with systemic steroids and thyroid hormone (unstable dosage). Patients with any history of gastrointestinal surgery, e.g. partial bowel resections, partial gastric resections, etc. Participation in any clinical investigation within 4 weeks prior to dosing or longer if required by local regulation. Donation or loss of 400 mL or more of blood within 8 weeks prior to dosing. Significant illness within the two weeks prior to dosing. Past medical history of clinically significant ECG abnormalities or a family history of a prolonged QT-interval syndrome. History of clinically significant drug allergy; history of atopic allergy (asthma, urticaria, eczematous dermatitis). A known hypersensitivity to the study drug or drugs similar to the study drug. history of major gastrointestinal tract surgery such as gastrectomy, gastroenterostomy, or bowel resection; history or clinical evidence of pancreatic injury or pancreatitis; history or presence of impaired renal function as indicated by abnormal creatinine or urea val-ues or abnormal urinary constituents (e.g., albuminuria); evidence of urinary obstruction or difficulty in voiding at screening; Polymorphonuclears <1500/µL at inclusion or platelet count < 100,000/μL at screening and baseline. History of immunocompromise. Evidence of liver disease as indicated by abnormal transaminases and alkaline phosphatase exceeding twice the upper limit of the normal range, and serum bilirubin should not exceed the value of 27 µmol/L (1.6 mg/dL).
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Joerg Schirra, MD
Organizational Affiliation
Clinical Research Unit (CRU), Department of Internal Medicine, Campus Großhadern, Clinical Center of Ludwig-Maximilians-University of Munich
Official's Role
Principal Investigator
Facility Information:
Facility Name
Ludwig Maximilians-University, Clinical Research Unit
City
Munich
ZIP/Postal Code
80999
Country
Germany
Facility Name
Clinical Research unit, Dept. of Internal Medicine II - Großhadern, University of Munich
City
Munich
ZIP/Postal Code
81377
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
22721966
Citation
Woerle HJ, Carneiro L, Derani A, Goke B, Schirra J. The role of endogenous incretin secretion as amplifier of glucose-stimulated insulin secretion in healthy subjects and patients with type 2 diabetes. Diabetes. 2012 Sep;61(9):2349-58. doi: 10.2337/db11-1701. Epub 2012 Jun 20.
Results Reference
derived

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The Role of Endogenous Glucagon-like Peptide 1 (GLP-1) in Type 2 Diabetes Mellitus (T2DM)

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