RISE Adult Medication Study (RISE Adult)
Prediabetes, Type 2 Diabetes
About this trial
This is an interventional treatment trial for Prediabetes
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.
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
Active Comparator
Active Comparator
Placebo Comparator
Active Comparator
Metformin alone
Glargine followed by Metformin
Placebo
Liraglutide + Metformin
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).