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Comparison of Exenatide vs. Biphasic Insulin Aspart 30 on Glucose Variability in Type 2 Diabetes

Primary Purpose

Type 2 Diabetes Mellitus

Status
Completed
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Exenatide
Biphasic insulin Aspart 30
Sponsored by
Xijing Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes Mellitus focused on measuring Chinese population

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Provision of informed consent prior to any study specific procedures.
  • Men and women (non-pregnant and using a medically approved birth-control method) aged between 18 and 70 years at screening.
  • Confirmed type 2 diabetes with history of at least half a year.
  • Treatment with stable, maximum tolerated doses of metformin (≧1500mg/d, ≧3 months).
  • HbA1c ≥ 7.5% and ≤ 10.0% at screening or within 4 weeks prior to screening (by local laboratory).
  • Body mass index: 21-35 kg/m^2.

Exclusion Criteria:

  • Women who are pregnant, intending to become pregnant during the study period, currently lactating females, or women of child-bearing potential not using highly effective, medically approved birth control methods.
  • Diagnosis or history of:

    1. Type 1 diabetes mellitus, diabetes resulting from pancreatic injury or secondary forms of diabetes, e.g., acromegaly or Cushing's syndrome.
    2. Acute metabolic diabetic complications such as ketoacidosis or hyperosmolar coma within the past 6 months.
  • Previous treatment with any dipeptide peptidase-4 (DPP4) inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonists within the past one year.
  • History of hypersensitivity reaction (e.g., anaphylaxis, angioedema, exfoliative skin conditions) to dipeptide peptidase-4 inhibitor (DPP4) or Acarbose.
  • Treatment with any anti-diabetic medication for more than 7 consecutive days other than metformin in the last 3months prior to screening.
  • Treatment with systemic glucocorticoids (oral, intravenous) for more than consecutive 7 days within the past 6 months.
  • Triglycerides (fasting) > 4.5 mmol/L (> 400 mg/dL) at screening or within 4 weeks prior to screening (by local laboratory).
  • Patients with clinically apparent liver disease characterized by either one of the following:

    1. Alanine transaminase (ALT) or aspartate aminotransferase (AST) > 3x upper limit of normal (ULN) confirmed on two consecutive measurements (by local laboratory) within 4 weeks prior to screening period
    2. Impaired excretory (e.g. hyperbilirubinemia) and/or synthetic function, or other conditions of decompensated liver disease such as coagulopathy, hepatic encephalopathy, hypoalbuminemia, ascites and bleeding from oesophageal varices.
    3. Acute viral or active autoimmune, alcoholic, or other types of hepatitis.
  • Patients with moderate /severe renal impairment or end-stage renal disease (estimated Glomerular Filtration Rate ≤ 60 mL/min calculated by using the abbreviated equation developed by the Modification of Diet in Renal Disease (MDRD) study with modification for the Chinese population) at screening or within 4 weeks prior to screening (by local laboratory)
  • Congestive heart failure defined as New York Heart Association (NYHA) class III or IV.
  • Significant cardiovascular history within the past 3 months prior to screening defined as: myocardial infarction, coronary angioplasty or bypass graft(s), valvular disease or repair, unstable angina pectoris, transient ischemic attack, or cerebrovascular accident.
  • History of chronic pancreatitis or idiopathic acute pancreatitis.
  • History of gastrointestinal disease including gastroenterostomy, enterectomy, Roemheld Syndrome, severe hernia, intestinal obstruction, intestinal ulcer.
  • History of genetic galactose intolerance, Lapp lactase deficiency and glucose-galactose malabsorption.
  • History of medullary thyroid carcinoma.
  • Diagnosed and/or treated malignancy (except for basal cell skin cancer, in situ carcinoma of the cervix, or in situ prostate cancer) within the past 5 years.
  • History of organ transplant or acquired immunodeficiency syndrome (AIDS).
  • History of alcohol abuse or illegal drug abuse within the past 12 months.
  • Potentially unreliable patients and those judged by the Investigator to be unsuitable for the study.

Sites / Locations

  • Xijing Hospital, Fourth Military Medical university

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Exenatide

Biphasic insulin Aspart 30

Arm Description

Exenatide (Colorless transparent liquid, comes in a prefilled pen.5ug/10ug, AstraZeneca) should be initiated, 60 minutes pre-breakfast and pre-supper, at 5ug twice a day for 4 weeks and then titrated up at 10ug twice a day until the completion of the study.

Biphasic insulin Aspart 30 (Colorless transparent liquid, 100u/mL, 3ml each, Novo Nordisk), subcutaneous injection, starting at a dose of 0.2-0.4 IU/kg, or 10~12 IU/d assigned in pre-breakfast and pre-supper in a 1:1 ratio. The adjustment of insulin dose is instructed to achieve an optimal balance between glycaemic control and risk of hypoglycaemia as dictated by best clinical practice, titrated to glucose targets of fasting plasma glucose (FPG) and pre-supper <7 mmol/L.

Outcomes

Primary Outcome Measures

Change of mean amplitude of glycemic excursions

Secondary Outcome Measures

HbA1c
Hours of hypoglycemia as measured by continuous glucose monitoring system (CGMS)
Blood pressure
Lipids
Body mass index
Waist circumference
Monocyte chemotactic protein-1 (MCP-1)
High-sensitivity C-reactive protein (hs-CRP)
Urinary albumin
Number of participants with adverse events/severe adverse events
Number of participants with clinical hypoglycemia

Full Information

First Posted
May 11, 2015
Last Updated
November 11, 2018
Sponsor
Xijing Hospital
Collaborators
Air Force Military Medical University, China, First Affiliated Hospital Xi'an Jiaotong University, Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, Chang'An Hospital, Xi'an Gaoxin Hospital, Xi'an Central Hospital, Shaanxi Aerospace Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT02449603
Brief Title
Comparison of Exenatide vs. Biphasic Insulin Aspart 30 on Glucose Variability in Type 2 Diabetes
Official Title
Comparison of Exenatide vs. Biphasic Insulin Aspart 30 on Glucose Variability in Type 2 Diabetes : a Randomised Open Parallel-controlled Study
Study Type
Interventional

2. Study Status

Record Verification Date
November 2018
Overall Recruitment Status
Completed
Study Start Date
November 2015 (Actual)
Primary Completion Date
April 2018 (Actual)
Study Completion Date
April 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Xijing Hospital
Collaborators
Air Force Military Medical University, China, First Affiliated Hospital Xi'an Jiaotong University, Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, Chang'An Hospital, Xi'an Gaoxin Hospital, Xi'an Central Hospital, Shaanxi Aerospace Hospital

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This is a multi-centre, open-label, randomized, parallel trial to compare the effect of Exenatide versus Biphasic insulin Aspart 30 on glucose variability and inflammatory markers in type 2 diabetes mellitus (T2DM) patients inadequately controlled with metformin monotherapy.
Detailed Description
Studies have showed that fluctuations of glucose seem to have more deleterious effects than sustained hyperglycaemia in the development of diabetic complications. The present randomized controlled trial was designed with primary aim to evaluate glycaemic fluctuation in the comparison between twice-daily Exenatide and other treatment paradigm (e.g. insulin Aspart 30).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes Mellitus
Keywords
Chinese population

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
150 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Exenatide
Arm Type
Experimental
Arm Description
Exenatide (Colorless transparent liquid, comes in a prefilled pen.5ug/10ug, AstraZeneca) should be initiated, 60 minutes pre-breakfast and pre-supper, at 5ug twice a day for 4 weeks and then titrated up at 10ug twice a day until the completion of the study.
Arm Title
Biphasic insulin Aspart 30
Arm Type
Active Comparator
Arm Description
Biphasic insulin Aspart 30 (Colorless transparent liquid, 100u/mL, 3ml each, Novo Nordisk), subcutaneous injection, starting at a dose of 0.2-0.4 IU/kg, or 10~12 IU/d assigned in pre-breakfast and pre-supper in a 1:1 ratio. The adjustment of insulin dose is instructed to achieve an optimal balance between glycaemic control and risk of hypoglycaemia as dictated by best clinical practice, titrated to glucose targets of fasting plasma glucose (FPG) and pre-supper <7 mmol/L.
Intervention Type
Drug
Intervention Name(s)
Exenatide
Other Intervention Name(s)
Byetta
Intervention Type
Drug
Intervention Name(s)
Biphasic insulin Aspart 30
Primary Outcome Measure Information:
Title
Change of mean amplitude of glycemic excursions
Time Frame
from baseline to Week 16
Secondary Outcome Measure Information:
Title
HbA1c
Time Frame
at baseline and Week 16
Title
Hours of hypoglycemia as measured by continuous glucose monitoring system (CGMS)
Time Frame
at baseline and Week 16
Title
Blood pressure
Time Frame
at baseline and Week 16
Title
Lipids
Time Frame
at baseline and Week 16
Title
Body mass index
Time Frame
at baseline and Week 16
Title
Waist circumference
Time Frame
at baseline and Week 16
Title
Monocyte chemotactic protein-1 (MCP-1)
Time Frame
at baseline and Week 16
Title
High-sensitivity C-reactive protein (hs-CRP)
Time Frame
at baseline and Week 16
Title
Urinary albumin
Time Frame
at baseline and Week 16
Title
Number of participants with adverse events/severe adverse events
Time Frame
from baseline to Week 16
Title
Number of participants with clinical hypoglycemia
Time Frame
from baseline to Week 16

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Provision of informed consent prior to any study specific procedures. Men and women (non-pregnant and using a medically approved birth-control method) aged between 18 and 70 years at screening. Confirmed type 2 diabetes with history of at least half a year. Treatment with stable, maximum tolerated doses of metformin (≧1500mg/d, ≧3 months). HbA1c ≥ 7.5% and ≤ 10.0% at screening or within 4 weeks prior to screening (by local laboratory). Body mass index: 21-35 kg/m^2. Exclusion Criteria: Women who are pregnant, intending to become pregnant during the study period, currently lactating females, or women of child-bearing potential not using highly effective, medically approved birth control methods. Diagnosis or history of: Type 1 diabetes mellitus, diabetes resulting from pancreatic injury or secondary forms of diabetes, e.g., acromegaly or Cushing's syndrome. Acute metabolic diabetic complications such as ketoacidosis or hyperosmolar coma within the past 6 months. Previous treatment with any dipeptide peptidase-4 (DPP4) inhibitor or glucagon-like peptide-1 (GLP-1) receptor agonists within the past one year. History of hypersensitivity reaction (e.g., anaphylaxis, angioedema, exfoliative skin conditions) to dipeptide peptidase-4 inhibitor (DPP4) or Acarbose. Treatment with any anti-diabetic medication for more than 7 consecutive days other than metformin in the last 3months prior to screening. Treatment with systemic glucocorticoids (oral, intravenous) for more than consecutive 7 days within the past 6 months. Triglycerides (fasting) > 4.5 mmol/L (> 400 mg/dL) at screening or within 4 weeks prior to screening (by local laboratory). Patients with clinically apparent liver disease characterized by either one of the following: Alanine transaminase (ALT) or aspartate aminotransferase (AST) > 3x upper limit of normal (ULN) confirmed on two consecutive measurements (by local laboratory) within 4 weeks prior to screening period Impaired excretory (e.g. hyperbilirubinemia) and/or synthetic function, or other conditions of decompensated liver disease such as coagulopathy, hepatic encephalopathy, hypoalbuminemia, ascites and bleeding from oesophageal varices. Acute viral or active autoimmune, alcoholic, or other types of hepatitis. Patients with moderate /severe renal impairment or end-stage renal disease (estimated Glomerular Filtration Rate ≤ 60 mL/min calculated by using the abbreviated equation developed by the Modification of Diet in Renal Disease (MDRD) study with modification for the Chinese population) at screening or within 4 weeks prior to screening (by local laboratory) Congestive heart failure defined as New York Heart Association (NYHA) class III or IV. Significant cardiovascular history within the past 3 months prior to screening defined as: myocardial infarction, coronary angioplasty or bypass graft(s), valvular disease or repair, unstable angina pectoris, transient ischemic attack, or cerebrovascular accident. History of chronic pancreatitis or idiopathic acute pancreatitis. History of gastrointestinal disease including gastroenterostomy, enterectomy, Roemheld Syndrome, severe hernia, intestinal obstruction, intestinal ulcer. History of genetic galactose intolerance, Lapp lactase deficiency and glucose-galactose malabsorption. History of medullary thyroid carcinoma. Diagnosed and/or treated malignancy (except for basal cell skin cancer, in situ carcinoma of the cervix, or in situ prostate cancer) within the past 5 years. History of organ transplant or acquired immunodeficiency syndrome (AIDS). History of alcohol abuse or illegal drug abuse within the past 12 months. Potentially unreliable patients and those judged by the Investigator to be unsuitable for the study.
Facility Information:
Facility Name
Xijing Hospital, Fourth Military Medical university
City
Xi'an
State/Province
Shaanxi
ZIP/Postal Code
710032
Country
China

12. IPD Sharing Statement

Citations:
PubMed Identifier
32856226
Citation
Wang L, Liu X, Yang W, Lai J, Yu X, Liu J, Gao X, Ming J, Ma K, Xu J, Tian Z, He Q, Ji Q. Comparison of Blood Glucose Variability Between Exenatide and Biphasic Insulin Aspart 30 in Chinese Participants with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A Multicenter, Open-Label, Randomized Trial. Diabetes Ther. 2020 Oct;11(10):2313-2328. doi: 10.1007/s13300-020-00904-z. Epub 2020 Aug 27.
Results Reference
derived
PubMed Identifier
27009108
Citation
Xu S, Liu X, Ming J, Ji Q. Comparison of exenatide with biphasic insulin aspart 30 on glucose variability in type 2 diabetes: study protocol for a randomized controlled trial. Trials. 2016 Mar 24;17:160. doi: 10.1186/s13063-016-1258-8.
Results Reference
derived

Learn more about this trial

Comparison of Exenatide vs. Biphasic Insulin Aspart 30 on Glucose Variability in Type 2 Diabetes

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