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The Late Effects of Ethanol Intake on the Glucose Response to Subcutaneous Glucagon in Type 1 Diabetes (ALCO1)

Primary Purpose

Hypoglycemia, Diabetes Mellitus, Type 1

Status
Completed
Phase
Phase 4
Locations
Denmark
Study Type
Interventional
Intervention
Alcohol
Placebo
Sponsored by
Hvidovre University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hypoglycemia focused on measuring Glucagon, Ethanol

Eligibility Criteria

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

Inclusion Criteria:

  • Age 18 - 70 years
  • T1D ≥ 3 year
  • BMI 20-28 kg/m2
  • CSII ≥ 1 year
  • Caucasian origin
  • Hypoglycaemia awareness (assessed by Gold, Clarke and Pedersen-Bjergaard methods)
  • Use of carbohydrate counting and the insulin pump bolus calculator for all meals
  • Ethanol exposure once within 1 year consisting of at least 4 drinks (1 drink contains 12 gram ethanol) within four hours

Exclusion Criteria:

  • Allergy or intolerance to lactose or Glucagen®(Novo Nordisk, Bagsværd, DK)
  • Allergy for ethanol or any food ingredients that will be used in the study.
  • Impaired renal function (eGFR < 60 ml/min/1.73m2)
  • Liver disease with ALAT > 2.5 times the upper limit of the reference interval
  • Gastropareses (beat-beat variation < 10 beats per min and/or orthostatic systolic blood pressure > 20 mmHg)
  • Insomnia, sleep apnoea or any troubles with sleeping that according to the investigator's assessment makes the individual unsuitable for study participation.
  • Aldehyde dehydrogenase deficiency as determined by a screening questionnaire
  • Unable to refrain from the consumption of ethanol at least 24 hours prior to study start
  • History of drinking problems or alcoholism, regardless of whether active or in remission.
  • Use of benzodiazepines or barbiturates or opiates or other central nervous system depressant drugs that could act synergistically with ethanol to lower the level of consciousness
  • History of drug abuse
  • Current participation in another diabetes-related clinical trial that, in the judgment of the principle investigator, will compromise the results of the study or the safety of the subject.
  • Use of anti-diabetic medicine (other than insulin), corticosteroids or other drugs affecting glucose metabolism during the study period or within 30 days prior to study start
  • Use of medications that are known to cause QT interval prolongation
  • Presence of pheochromocytoma
  • Other concomitant medical or psychological condition that according to the investigator's assessment makes the individual unsuitable for study participation
  • Females who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods.
  • Females who have different basal insulin pattern depending on their menstrual cycle.
  • Inability to understand the individual information and to give informed consent.

Sites / Locations

  • Hvidovre University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Ethanol

Non-ethanol

Arm Description

Drinking a cocktail of ethanol (0.8 g ethanol per kg body weight), diet lemonade and water of 1:1:1 (volume distribution).

Drinking a cocktail of diet lemonade and water of 1:2 (volume distribution).

Outcomes

Primary Outcome Measures

Increase in plasma glucose
The primary endpoint is difference in increase in plasma glucose value after the first injection of 100 µg s.c. glucagon on study nights with ethanol vs. study nights without ethanol consumption.

Secondary Outcome Measures

Peak plasma glucose
Maximal plasma glucose after the first and second glucagon injection
Increase in plasma glucose
Increase in plasma glucose caused by the second glucagon injection.
Total AUC(0-120)
Total area under the glucose curve from 0-120 minutes after each glucagon injection
PI-AUC(0-120)
positive incremental area under the glucose curve from 0-120 minutes after each glucagon injection
Tmax
Time-to-peak glucose value after each glucagon injection glucagon injection
Time above 4.0mM
Duration of glucose above 4.0 mmol/l after first and second glucagon injection
Time above baseline
Duration of glucose above baseline after first and second glucagon injection
Rescue rates
Numbers of first and second glucagon injections that raises PG > 4.9 mmol/l
Hyperglycemia rates
Number of first and second glucagon injections that raises PG > 7.1 mmol/l
Changes in plasma ketone bodies, measured as area under the curve
Changes in plasma ketone bodies, measured as incremental peak
Changes in plasma glucagon, measured as area under the curve
Changes in plasma glucagon, measured as incremental peak
Changes in insulin, measured as area under the curve
Changes in insulin, measured as incremental peak
Changes in growth hormones, measured as area under the curve
Changes in growth hormones, measured as incremental peak
Changes in serum corticole, measured as area under the curve
Changes in serum corticole, measured as incremental peak
Changes in plasma ethanol, measured as area under the curve
Changes in plasma ethanol, measured as incremental peak
Changes in free fatty acids, measured as area under the curve
Changes in free fatty acids, measured as incremental peak
Changes in triglycerides, measured as area under the curve
Changes in triglycerides, measured as incremental peak
Average in blood pressure
Average heart rate
Intensity of hypoglycemia
Average changes in Edinburgh Hypoglycaemia Scale over time during insulin and glucagon phase
Cognitive impairment
Average scores in cognitive test 30 min before each glucagon injection.
Side effects
Average visual analogue scale score from 0-180 min for nausea and headache after glucagon injection
Incidence of vomiting
Incidence of vomiting after 0-4 hours after each glucagon injection.
Meal induced glucose excursion
Total and incremental area under the glucose curve from 0-120 and 0-240 min after eating the mixed meal
Meal induced hormonal changes
Total and incremental area under the glucose curve from 0-120 and 0-240 min after eating the mixed meal
Nocturnal changes in plasma glucose
Area under the curve during sleep
Nocturnal changes in corticol
Area under the curve during sleep
Nocturnal changes in growth hormone
Area under the curve during sleep
Nocturnal changes in ketones
Area under the curve during sleep
Nocturnal changes in ethanol
Area under the curve during sleep
Nocturnal changes in glucagon
Area under the curve during sleep
Difference between the first second glucagon injection and between both study visits in peak change plasma glucose
Difference between glucagon injections on both study visits in positive incremental area under the glucose curve from 0-120 minutes
Difference between glucagon injections on both study visits in total area under the glucose curve from 0-120 minutes
Difference between glucagon injections on both study visits in time-to-peak glucose value
Difference between glucagon injections on both study visits in duration of glucose above 4.0 mmol/l after first and second glucagon injection
Difference between glucagon injections on both study visits in duration of glucose above baseline after first and second glucagon injection
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - Mean absolute relative difference (MARD) values of glucose sensors compared with YSI from 7 PM- 8 AM.
Intentions to treat analysis
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - Precision absolute relative difference (PARD) 120 min before and 120 after each glucagon injection.
Intentions to treat analysis
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - MARD values between glucose sensors 0-120 minutes after each glucagon injection.
Intentions to treat analysis
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in range (glucose sensor value =4.0-10.0mmol/l)
Intentions to treat analysis
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in hypoglycaemia (glucose sensor value < 4.0 mmol/l)
Intentions to treat analysis
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in hyperglycaemia (glucose sensor value >10.0mmol/l)
Intentions to treat analysis
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Number of hypoglycaemia episodes (glucose sensor value < 4.0 mmol/l)
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol - Clarke- Error Grid analysis for both sensors compared with YSI during study visit
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol - PARD values from day 1-7
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol - PARD values <4.0 mmol/L from day 1-7
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol - PARD values 4.0-10.0 mmol/L from day 1-7
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol PARD values >10.0 mmol/L from day 1-7
Intentions to treat analysis
Difference in glucose sensor data between the study period with and without alcohol - Number of hypoglycaemia episodes (glucose sensor value < 4.0 mmol/l)
Intentions to treat analysis

Full Information

First Posted
August 11, 2016
Last Updated
July 20, 2017
Sponsor
Hvidovre University Hospital
Collaborators
Danish Diabetes Academy, University of Copenhagen
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1. Study Identification

Unique Protocol Identification Number
NCT02881060
Brief Title
The Late Effects of Ethanol Intake on the Glucose Response to Subcutaneous Glucagon in Type 1 Diabetes
Acronym
ALCO1
Official Title
The Late Effects of Ethanol Intake on the Glucose Response to Subcutaneous Glucagon in Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
July 2017
Overall Recruitment Status
Completed
Study Start Date
August 2016 (undefined)
Primary Completion Date
January 26, 2017 (Actual)
Study Completion Date
January 26, 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Hvidovre University Hospital
Collaborators
Danish Diabetes Academy, University of Copenhagen

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Objective: Because many people with type 1 diabetes drink ethanol and because glucagon is used to treat mild hypoglycaemia, it is essential to determine whether ethanol will impair the effectiveness of glucagon to increase glucose, which may impair the effectiveness of the dual hormone treatment in preventing hypoglycaemia. The purpose of this study is to determine, whether ethanol influences the glucose response to subcutaneous glucagon during mild hypoglycaemia. The investigators hypothesize that prior evening ethanol consumption does not reduce the effect of a glucagon bolus to raise plasma glucose compared with no prior ethanol consumption. The study aims: To determine the late effects of ethanol on the efficacy of subcutaneous glucagon to restore plasma glucose after an episode of mild hypoglycemia. To determine the late effects of ethanol on the counter-regulatory hormones and hypoglycaemia awareness during mild hypoglycaemia A double-blinded placebo-controlled study will be conducted. Participants will serve as their own controls. Eligible participants will after an informed consent complete two study visits, one with and one without ethanol consumption, in a random order. On each study visit, participants are induced a insulin induced hypoglycemia, seven-eight hours after a meal with or without ethanol. Once plasma glucose is below 3.9 mmol/l, a subcutaneous injection of 100 mcg glucagon is administered. Two hours later a second bolus is administered.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypoglycemia, Diabetes Mellitus, Type 1
Keywords
Glucagon, Ethanol

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
12 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ethanol
Arm Type
Active Comparator
Arm Description
Drinking a cocktail of ethanol (0.8 g ethanol per kg body weight), diet lemonade and water of 1:1:1 (volume distribution).
Arm Title
Non-ethanol
Arm Type
Placebo Comparator
Arm Description
Drinking a cocktail of diet lemonade and water of 1:2 (volume distribution).
Intervention Type
Dietary Supplement
Intervention Name(s)
Alcohol
Other Intervention Name(s)
Cocktail
Intervention Type
Dietary Supplement
Intervention Name(s)
Placebo
Other Intervention Name(s)
Mocktail
Primary Outcome Measure Information:
Title
Increase in plasma glucose
Description
The primary endpoint is difference in increase in plasma glucose value after the first injection of 100 µg s.c. glucagon on study nights with ethanol vs. study nights without ethanol consumption.
Time Frame
0-120 min after the first glucagon injection
Secondary Outcome Measure Information:
Title
Peak plasma glucose
Description
Maximal plasma glucose after the first and second glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Increase in plasma glucose
Description
Increase in plasma glucose caused by the second glucagon injection.
Time Frame
0-120 min after the second glucagon injection
Title
Total AUC(0-120)
Description
Total area under the glucose curve from 0-120 minutes after each glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
PI-AUC(0-120)
Description
positive incremental area under the glucose curve from 0-120 minutes after each glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Tmax
Description
Time-to-peak glucose value after each glucagon injection glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Time above 4.0mM
Description
Duration of glucose above 4.0 mmol/l after first and second glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Time above baseline
Description
Duration of glucose above baseline after first and second glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Rescue rates
Description
Numbers of first and second glucagon injections that raises PG > 4.9 mmol/l
Time Frame
0-240 min after the first glucagon injection
Title
Hyperglycemia rates
Description
Number of first and second glucagon injections that raises PG > 7.1 mmol/l
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma ketone bodies, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma ketone bodies, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma glucagon, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma glucagon, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in insulin, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in insulin, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in growth hormones, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in growth hormones, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in serum corticole, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in serum corticole, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma ethanol, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in plasma ethanol, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in free fatty acids, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in free fatty acids, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Changes in triglycerides, measured as area under the curve
Time Frame
0-240 min after the first glucagon injection
Title
Changes in triglycerides, measured as incremental peak
Time Frame
0-240 min after the first glucagon injection
Title
Average in blood pressure
Time Frame
0-240 min after the first glucagon injection
Title
Average heart rate
Time Frame
0-240 min after the first glucagon injection
Title
Intensity of hypoglycemia
Description
Average changes in Edinburgh Hypoglycaemia Scale over time during insulin and glucagon phase
Time Frame
0-240 min after the first glucagon injection
Title
Cognitive impairment
Description
Average scores in cognitive test 30 min before each glucagon injection.
Time Frame
0-240 min after the first glucagon injection
Title
Side effects
Description
Average visual analogue scale score from 0-180 min for nausea and headache after glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Incidence of vomiting
Description
Incidence of vomiting after 0-4 hours after each glucagon injection.
Time Frame
0-240 min after the first glucagon injection
Title
Meal induced glucose excursion
Description
Total and incremental area under the glucose curve from 0-120 and 0-240 min after eating the mixed meal
Time Frame
0-3 hours after meal
Title
Meal induced hormonal changes
Description
Total and incremental area under the glucose curve from 0-120 and 0-240 min after eating the mixed meal
Time Frame
0-3 hours after meal
Title
Nocturnal changes in plasma glucose
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Nocturnal changes in corticol
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Nocturnal changes in growth hormone
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Nocturnal changes in ketones
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Nocturnal changes in ethanol
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Nocturnal changes in glucagon
Description
Area under the curve during sleep
Time Frame
0-6 hours after start of sleep
Title
Difference between the first second glucagon injection and between both study visits in peak change plasma glucose
Time Frame
0-240 min after the first glucagon injection
Title
Difference between glucagon injections on both study visits in positive incremental area under the glucose curve from 0-120 minutes
Time Frame
0-240 min after the first glucagon injection
Title
Difference between glucagon injections on both study visits in total area under the glucose curve from 0-120 minutes
Time Frame
0-240 min after the first glucagon injection
Title
Difference between glucagon injections on both study visits in time-to-peak glucose value
Time Frame
0-240 min after the first glucagon injection
Title
Difference between glucagon injections on both study visits in duration of glucose above 4.0 mmol/l after first and second glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Difference between glucagon injections on both study visits in duration of glucose above baseline after first and second glucagon injection
Time Frame
0-240 min after the first glucagon injection
Title
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - Mean absolute relative difference (MARD) values of glucose sensors compared with YSI from 7 PM- 8 AM.
Description
Intentions to treat analysis
Time Frame
0-10 hours after meal
Title
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - Precision absolute relative difference (PARD) 120 min before and 120 after each glucagon injection.
Description
Intentions to treat analysis
Time Frame
0-10 hours after meal
Title
Difference in glucose sensor data on study night with alcohol vs. study night without alcohol - MARD values between glucose sensors 0-120 minutes after each glucagon injection.
Description
Intentions to treat analysis
Time Frame
0-10 hours after meal
Title
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in range (glucose sensor value =4.0-10.0mmol/l)
Description
Intentions to treat analysis
Time Frame
0-2 days after the first glucagon injection
Title
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in hypoglycaemia (glucose sensor value < 4.0 mmol/l)
Description
Intentions to treat analysis
Time Frame
0-2 days after the first glucagon injection
Title
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Time in hyperglycaemia (glucose sensor value >10.0mmol/l)
Description
Intentions to treat analysis
Time Frame
0-2 days after the first glucagon injection
Title
Difference in glucose sensor data within 2 days after study night with alcohol vs. study night without alcohol - Number of hypoglycaemia episodes (glucose sensor value < 4.0 mmol/l)
Description
Intentions to treat analysis
Time Frame
0-2 days after the first glucagon injection
Title
Difference in glucose sensor data between the study period with and without alcohol - Clarke- Error Grid analysis for both sensors compared with YSI during study visit
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits
Title
Difference in glucose sensor data between the study period with and without alcohol - PARD values from day 1-7
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits
Title
Difference in glucose sensor data between the study period with and without alcohol - PARD values <4.0 mmol/L from day 1-7
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits
Title
Difference in glucose sensor data between the study period with and without alcohol - PARD values 4.0-10.0 mmol/L from day 1-7
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits
Title
Difference in glucose sensor data between the study period with and without alcohol PARD values >10.0 mmol/L from day 1-7
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits
Title
Difference in glucose sensor data between the study period with and without alcohol - Number of hypoglycaemia episodes (glucose sensor value < 4.0 mmol/l)
Description
Intentions to treat analysis
Time Frame
-2 to 4 days after study visits

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: Age 18 - 70 years T1D ≥ 3 year BMI 20-28 kg/m2 CSII ≥ 1 year Caucasian origin Hypoglycaemia awareness (assessed by Gold, Clarke and Pedersen-Bjergaard methods) Use of carbohydrate counting and the insulin pump bolus calculator for all meals Ethanol exposure once within 1 year consisting of at least 4 drinks (1 drink contains 12 gram ethanol) within four hours Exclusion Criteria: Allergy or intolerance to lactose or Glucagen®(Novo Nordisk, Bagsværd, DK) Allergy for ethanol or any food ingredients that will be used in the study. Impaired renal function (eGFR < 60 ml/min/1.73m2) Liver disease with ALAT > 2.5 times the upper limit of the reference interval Gastropareses (beat-beat variation < 10 beats per min and/or orthostatic systolic blood pressure > 20 mmHg) Insomnia, sleep apnoea or any troubles with sleeping that according to the investigator's assessment makes the individual unsuitable for study participation. Aldehyde dehydrogenase deficiency as determined by a screening questionnaire Unable to refrain from the consumption of ethanol at least 24 hours prior to study start History of drinking problems or alcoholism, regardless of whether active or in remission. Use of benzodiazepines or barbiturates or opiates or other central nervous system depressant drugs that could act synergistically with ethanol to lower the level of consciousness History of drug abuse Current participation in another diabetes-related clinical trial that, in the judgment of the principle investigator, will compromise the results of the study or the safety of the subject. Use of anti-diabetic medicine (other than insulin), corticosteroids or other drugs affecting glucose metabolism during the study period or within 30 days prior to study start Use of medications that are known to cause QT interval prolongation Presence of pheochromocytoma Other concomitant medical or psychological condition that according to the investigator's assessment makes the individual unsuitable for study participation Females who are pregnant, breast-feeding or intend to become pregnant or are not using adequate contraceptive methods. Females who have different basal insulin pattern depending on their menstrual cycle. Inability to understand the individual information and to give informed consent.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ajenthen Ranjan, MD
Organizational Affiliation
Hvidovre University Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Hvidovre University Hospital
City
Hvidovre
ZIP/Postal Code
2650
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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The Late Effects of Ethanol Intake on the Glucose Response to Subcutaneous Glucagon in Type 1 Diabetes

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