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RISE Adult Medication Study (RISE Adult)

Primary Purpose

Prediabetes, Type 2 Diabetes

Status
Completed
Phase
Phase 3
Locations
United States
Study Type
Interventional
Intervention
Metformin
Liraglutide
Glargine
Placebo
Sponsored by
RISE Study Group
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Prediabetes

Eligibility Criteria

20 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Fasting plasma glucose 95-125 mg/dl plus 2-hour glucose ≥140 mg/dl on 75 gm OGTT plus HbA1c ≤7.0%. There is no upper limit for the 2-hour glucose on OGTT.
  2. Age 20-65 years
  3. Body mass index (BMI) ≥25 kg/m2 but ≤50 kg/m2
  4. Self-reported diabetes <1 year in duration
  5. Drug naïve (no prior to oral glucose lowering agent(s), insulin or other injectable glucose lowering agents)

Exclusion Criteria:

  1. Underlying disease likely to limit life span and/or increase risk of intervention or an underlying condition that is likely to limit ability to participate in outcomes assessment
  2. An underlying disease that affects glucose metabolism other than type 2 diabetes
  3. Taking medications that affect glucose metabolism, or has an underlying condition that is likely to require such medications
  4. Active infections
  5. Renal disease (serum creatinine >1.4 mg/dl for men; >1.3 mg/dl for women) or serum potassium abnormality (<3.4 or >5.5 mmol/l)
  6. Anemia (hemoglobin <11 g/dl in women, <12 g/dl in men) or known coagulopathy
  7. Cardiovascular disease, including uncontrolled hypertension. Participants must be able to safely tolerate administration of intravenous fluids required during clamp studies.
  8. History of conditions that may be precipitated or exacerbated by a study drug:

    1. Pancreatitis
    2. Serum alanine transaminase (ALT) more than 3 times the upper limit of normal
    3. Excessive alcohol intake
    4. Suboptimally treated thyroid disease
    5. Medullary carcinoma of the thyroid or MEN-2 (in participant or a family history)
    6. Hypertriglyceridemia (>400 mg/dl despite treatment)
  9. Conditions or behaviors likely to affect the conduct of the RISE Study

    1. Unable or unwilling to give informed consent
    2. Unable to adequately communicate with clinic staff
    3. Another household member is a participant or staff member in RISE
    4. Current, recent or anticipated participation in another intervention research project that would interfere with any of the interventions/outcomes in RISE
    5. Weight loss of >5% in past three months for any reason other than post-partum weight loss. Participants taking weight loss drugs or using preparations taken for intended weight loss are excluded.
    6. Likely to move away from participating clinics in next two years
    7. Women of childbearing potential who are unwilling to use adequate contraception
    8. Current (or anticipated) pregnancy and lactation.
    9. Major psychiatric disorder that, in the opinion of clinic staff, would impede the conduct of RISE
  10. Additional conditions may serve as criteria for exclusion at the discretion of the local site.

Sites / Locations

  • Jesse Brown VA Medical Center
  • University of Chicago
  • Indiana University
  • VA Puget Sound Health Care System

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Placebo Comparator

Active Comparator

Arm Label

Metformin alone

Glargine followed by Metformin

Placebo

Liraglutide + Metformin

Arm Description

Metformin will be titrated to the maximum dose tolerated (up to 2000 mg/day). Participants randomized to the metformin-alone arm will be blinded to treatment.

Basal insulin glargine for 3 months titrated to achieve a morning fasting blood glucose of 80-90 mg/dl, followed by open-label metformin (titrated up to 2000 mg/day) for 9 months.

Placebo - masked to metformin-alone. Placebo will be titrated to the maximum number of tablets equivalent to maximum dose of metformin.

Liraglutide + open-label Metformin. Liraglutide will be titrated to the maximum dose tolerated (up to 1.8 mg/day) after which metformin will be titrated to the maximum dose tolerated (up to 2000 mg/day).

Outcomes

Primary Outcome Measures

ß-cell Response Measured by Hyperglycemic Clamp
Clamp measures of ß-cell response, co-primary outcomes
Insulin Sensitivity, M/I
Clamp measure of insulin sensitivity

Secondary Outcome Measures

ACPRg
First phase response from the hyperglycemic clamp
ß-cell Function Measured by Hyperglycemic Clamp Techniques at M12
Participants had 12-months of active therapy. Secondary results at the end of active intervention.

Full Information

First Posted
January 28, 2013
Last Updated
April 12, 2023
Sponsor
RISE Study Group
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
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1. Study Identification

Unique Protocol Identification Number
NCT01779362
Brief Title
RISE Adult Medication Study
Acronym
RISE Adult
Official Title
Restoring Insulin Secretion Adult Medication Study
Study Type
Interventional

2. Study Status

Record Verification Date
August 2018
Overall Recruitment Status
Completed
Study Start Date
April 2013 (undefined)
Primary Completion Date
February 2019 (Actual)
Study Completion Date
August 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
RISE Study Group
Collaborators
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The RISE Adult Medication Study is a 4-arm, 3-center, clinical trial of adults with prediabetes and early type 2 diabetes to address the hypothesis that aggressive glucose lowering will lead to recovery of beta-cell function that will be sustained after withdrawal of treatment. Adult participants (ages 20-65) will be randomized to one of the following treatment regimens: (1) blinded placebo, (2) blinded metformin alone, (3) early intensive insulin treatment with basal insulin glargine followed by open-label metformin, (4) the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide plus open-label metformin. The primary clinical question RISE will address is: Are improvements in ß-cell function following 12 months of active treatment maintained for 3 months following the withdrawal of therapy? Secondary outcomes will assess durability of glucose tolerance following withdrawal of therapy, and whether biomarkers obtained in the fasting state predict parameters of ß-cell function, insulin sensitivity and glucose tolerance and the response to an intervention.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prediabetes, Type 2 Diabetes

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
267 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Metformin alone
Arm Type
Active Comparator
Arm Description
Metformin will be titrated to the maximum dose tolerated (up to 2000 mg/day). Participants randomized to the metformin-alone arm will be blinded to treatment.
Arm Title
Glargine followed by Metformin
Arm Type
Active Comparator
Arm Description
Basal insulin glargine for 3 months titrated to achieve a morning fasting blood glucose of 80-90 mg/dl, followed by open-label metformin (titrated up to 2000 mg/day) for 9 months.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo - masked to metformin-alone. Placebo will be titrated to the maximum number of tablets equivalent to maximum dose of metformin.
Arm Title
Liraglutide + Metformin
Arm Type
Active Comparator
Arm Description
Liraglutide + open-label Metformin. Liraglutide will be titrated to the maximum dose tolerated (up to 1.8 mg/day) after which metformin will be titrated to the maximum dose tolerated (up to 2000 mg/day).
Intervention Type
Drug
Intervention Name(s)
Metformin
Other Intervention Name(s)
Glucophage
Intervention Description
Titrated to 1000 mg BID
Intervention Type
Drug
Intervention Name(s)
Liraglutide
Other Intervention Name(s)
Victoza
Intervention Description
Titrated to 1.8 mg/day
Intervention Type
Drug
Intervention Name(s)
Glargine
Other Intervention Name(s)
Insulin glargine, Lantus
Intervention Description
Titrated to target fasting glucose <90 mg/dl
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching to metformin 1000 mg BI
Primary Outcome Measure Information:
Title
ß-cell Response Measured by Hyperglycemic Clamp
Description
Clamp measures of ß-cell response, co-primary outcomes
Time Frame
3-months after medication washout (Month 15)
Title
Insulin Sensitivity, M/I
Description
Clamp measure of insulin sensitivity
Time Frame
3-months after a medication washout
Secondary Outcome Measure Information:
Title
ACPRg
Description
First phase response from the hyperglycemic clamp
Time Frame
3-months after a medication washout
Title
ß-cell Function Measured by Hyperglycemic Clamp Techniques at M12
Description
Participants had 12-months of active therapy. Secondary results at the end of active intervention.
Time Frame
Secondary analysis was on all participants with a Month 12 visit.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Fasting plasma glucose 95-125 mg/dl plus 2-hour glucose ≥140 mg/dl on 75 gm OGTT plus HbA1c ≤7.0%. There is no upper limit for the 2-hour glucose on OGTT. Age 20-65 years Body mass index (BMI) ≥25 kg/m2 but ≤50 kg/m2 Self-reported diabetes <1 year in duration Drug naïve (no prior to oral glucose lowering agent(s), insulin or other injectable glucose lowering agents) Exclusion Criteria: Underlying disease likely to limit life span and/or increase risk of intervention or an underlying condition that is likely to limit ability to participate in outcomes assessment An underlying disease that affects glucose metabolism other than type 2 diabetes Taking medications that affect glucose metabolism, or has an underlying condition that is likely to require such medications Active infections Renal disease (serum creatinine >1.4 mg/dl for men; >1.3 mg/dl for women) or serum potassium abnormality (<3.4 or >5.5 mmol/l) Anemia (hemoglobin <11 g/dl in women, <12 g/dl in men) or known coagulopathy Cardiovascular disease, including uncontrolled hypertension. Participants must be able to safely tolerate administration of intravenous fluids required during clamp studies. History of conditions that may be precipitated or exacerbated by a study drug: Pancreatitis Serum alanine transaminase (ALT) more than 3 times the upper limit of normal Excessive alcohol intake Suboptimally treated thyroid disease Medullary carcinoma of the thyroid or MEN-2 (in participant or a family history) Hypertriglyceridemia (>400 mg/dl despite treatment) Conditions or behaviors likely to affect the conduct of the RISE Study Unable or unwilling to give informed consent Unable to adequately communicate with clinic staff Another household member is a participant or staff member in RISE Current, recent or anticipated participation in another intervention research project that would interfere with any of the interventions/outcomes in RISE Weight loss of >5% in past three months for any reason other than post-partum weight loss. Participants taking weight loss drugs or using preparations taken for intended weight loss are excluded. Likely to move away from participating clinics in next two years Women of childbearing potential who are unwilling to use adequate contraception Current (or anticipated) pregnancy and lactation. Major psychiatric disorder that, in the opinion of clinic staff, would impede the conduct of RISE Additional conditions may serve as criteria for exclusion at the discretion of the local site.
Facility Information:
Facility Name
Jesse Brown VA Medical Center
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60612
Country
United States
Facility Name
University of Chicago
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60637
Country
United States
Facility Name
Indiana University
City
Indianapolis
State/Province
Indiana
ZIP/Postal Code
46202
Country
United States
Facility Name
VA Puget Sound Health Care System
City
Seattle
State/Province
Washington
ZIP/Postal Code
98108
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
A de-identified dataset will be made available through the NIDDK repository within 2 years after the final participant visit. Data can be obtained from the NIDDK repository.
Citations:
PubMed Identifier
24194506
Citation
RISE Consortium. Restoring Insulin Secretion (RISE): design of studies of beta-cell preservation in prediabetes and early type 2 diabetes across the life span. Diabetes Care. 2014;37(3):780-8. doi: 10.2337/dc13-1879. Epub 2013 Nov 5.
Results Reference
background
PubMed Identifier
28493515
Citation
Hannon TS, Kahn SE, Utzschneider KM, Buchanan TA, Nadeau KJ, Zeitler PS, Ehrmann DA, Arslanian SA, Caprio S, Edelstein SL, Savage PJ, Mather KJ; RISE Consortium. Review of methods for measuring beta-cell function: Design considerations from the Restoring Insulin Secretion (RISE) Consortium. Diabetes Obes Metab. 2018 Jan;20(1):14-24. doi: 10.1111/dom.13005. Epub 2017 Jun 22.
Results Reference
background
PubMed Identifier
35894078
Citation
Utzschneider KM, Ehrmann DA, Arslanian SA, Barengolts E, Buchanan TA, Caprio S, Edelstein SL, Hannon TS, Kahn SE, Kozedub A, Mather KJ, Nadeau KJ, Sam S, Tripputi M, Xiang AH, El Ghormli L; RISE Consortium. Weight loss and beta-cell responses following gastric banding or pharmacotherapy in adults with impaired glucose tolerance or type 2 diabetes: a randomized trial. Obesity (Silver Spring). 2022 Aug;30(8):1579-1588. doi: 10.1002/oby.23475.
Results Reference
derived
PubMed Identifier
34274407
Citation
Utzschneider KM, Tripputi MT, Kozedub A, Barengolts E, Caprio S, Cree-Green M, Edelstein SL, El Ghormli L, Hannon TS, Mather KJ, Palmer J, Nadeau KJ; RISE Consortium. Differential loss of beta-cell function in youth vs. adults following treatment withdrawal in the Restoring Insulin Secretion (RISE) study. Diabetes Res Clin Pract. 2021 Aug;178:108948. doi: 10.1016/j.diabres.2021.108948. Epub 2021 Jul 15.
Results Reference
derived
PubMed Identifier
34135015
Citation
Kahn SE, Edelstein SL, Arslanian SA, Barengolts E, Caprio S, Ehrmann DA, Hannon TS, Marcovina S, Mather KJ, Nadeau KJ, Utzschneider KM, Xiang AH, Buchanan TA; RISE Consortium; Rise Consortium Investigators:. Effect of Medical and Surgical Interventions on alpha-Cell Function in Dysglycemic Youth and Adults in the RISE Study. Diabetes Care. 2021 Sep;44(9):1948-1960. doi: 10.2337/dc21-0461. Epub 2021 Jun 16.
Results Reference
derived
PubMed Identifier
34131048
Citation
Sam S, Edelstein SL, Arslanian SA, Barengolts E, Buchanan TA, Caprio S, Ehrmann DA, Hannon TS, Tjaden AH, Kahn SE, Mather KJ, Tripputi M, Utzschneider KM, Xiang AH, Nadeau KJ; RISE Consortium; RISE Consortium Investigators. Baseline Predictors of Glycemic Worsening in Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes in the Restoring Insulin Secretion (RISE) Study. Diabetes Care. 2021 Sep;44(9):1938-1947. doi: 10.2337/dc21-0027. Epub 2021 Jun 15.
Results Reference
derived
PubMed Identifier
34131047
Citation
Kahn SE, Mather KJ, Arslanian SA, Barengolts E, Buchanan TA, Caprio S, Ehrmann DA, Hannon TS, Marcovina S, Nadeau KJ, Utzschneider KM, Xiang AH, Edelstein SL; RISE Consortium; Rise Consortium Investigators:. Hyperglucagonemia Does Not Explain the beta-Cell Hyperresponsiveness and Insulin Resistance in Dysglycemic Youth Compared With Adults: Lessons From the RISE Study. Diabetes Care. 2021 Sep;44(9):1961-1969. doi: 10.2337/dc21-0460. Epub 2021 Jun 15.
Results Reference
derived
PubMed Identifier
33436401
Citation
Arslanian SA, El Ghormli L, Kim JY, Tjaden AH, Barengolts E, Caprio S, Hannon TS, Mather KJ, Nadeau KJ, Utzschneider KM, Kahn SE; RISE Consortium. OGTT Glucose Response Curves, Insulin Sensitivity, and beta-Cell Function in RISE: Comparison Between Youth and Adults at Randomization and in Response to Interventions to Preserve beta-Cell Function. Diabetes Care. 2021 Mar;44(3):817-825. doi: 10.2337/dc20-2134. Epub 2021 Jan 12.
Results Reference
derived
PubMed Identifier
32501595
Citation
Gnesin F, Thuesen ACB, Kahler LKA, Madsbad S, Hemmingsen B. Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2020 Jun 5;6(6):CD012906. doi: 10.1002/14651858.CD012906.pub2.
Results Reference
derived
PubMed Identifier
31301210
Citation
RISE Consortium. Obesity and insulin sensitivity effects on cardiovascular risk factors: Comparisons of obese dysglycemic youth and adults. Pediatr Diabetes. 2019 Nov;20(7):849-860. doi: 10.1111/pedi.12883. Epub 2019 Jul 29.
Results Reference
derived
PubMed Identifier
31178434
Citation
RISE Consortium. Lack of Durable Improvements in beta-Cell Function Following Withdrawal of Pharmacological Interventions in Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes. Diabetes Care. 2019 Sep;42(9):1742-1751. doi: 10.2337/dc19-0556. Epub 2019 Jun 9.
Results Reference
derived
PubMed Identifier
31178433
Citation
RISE Consortium; RISE Consortium Investigators. Effects of Treatment of Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes With Metformin Alone or in Combination With Insulin Glargine on beta-Cell Function: Comparison of Responses In Youth And Adults. Diabetes. 2019 Aug;68(8):1670-1680. doi: 10.2337/db19-0299. Epub 2019 Jun 9.
Results Reference
derived
PubMed Identifier
29941498
Citation
RISE Consortium. Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: II. Observations Using the Oral Glucose Tolerance Test. Diabetes Care. 2018 Aug;41(8):1707-1716. doi: 10.2337/dc18-0243. Epub 2018 Jun 25.
Results Reference
derived
PubMed Identifier
29941497
Citation
RISE Consortium. Metabolic Contrasts Between Youth and Adults With Impaired Glucose Tolerance or Recently Diagnosed Type 2 Diabetes: I. Observations Using the Hyperglycemic Clamp. Diabetes Care. 2018 Aug;41(8):1696-1706. doi: 10.2337/dc18-0244. Epub 2018 Jun 25.
Results Reference
derived

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RISE Adult Medication Study

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