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The Effects of Liraglutide on Sudomotor Function and Inflammation in Type 2 Diabetes

Primary Purpose

Autonomic Nervous System Diseases, Sweat Gland Diseases, Diabetic Neuropathy With Neurologic Complication

Status
Unknown status
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Liraglutide 6 mg Solution for Injection
Placebo
Sponsored by
Eastern Virginia Medical School
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Autonomic Nervous System Diseases

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. established type 2 diabetes (diabetes duration of >6 months and <10 years).
  2. Age 18-80 years
  3. HbA1c at screening ≤ 10%
  4. Subjects on stable (≥3 months prior to Screening) Standard of Care background diabetic therapy. Diabetic treatment regimens include diet and exercise alone or in association with oral anti-diabetic drugs (monotherapy or combinations) and/or long-acting insulin.

Exclusion Criteria:

  1. Presence of type 1 diabetes mellitus (defined as C-peptide <1 ng /ml, <35y and prone to ketoacidosis)
  2. Treatment with rapid-acting or short-acting insulin within the last 3 months
  3. Proliferative retinopathy or maculopathy requiring acute treatment
  4. Impaired renal function , defined as serum creatinine ≥ 125 µmol/L (≥1.4 mg/dL) for males and ≥ 110 µmol/L (≥1.24 mg/dL) for females
  5. Impaired liver function, defined as aspartate transaminase (AST) or alanine transaminase (ALT), ≥ 2.5 times the upper limit of normal
  6. Presence of clinically significant peripheral or autonomic neuropathy that is clearly of non-diabetic origin
  7. Uncontrolled treated/untreated hypertension (systolic blood pressure (BP) ≥180 or diastolic blood pressure (BP) ≥100 at screening)
  8. Clinically significant active macrovascular disease including myocardial infarction or cerebrovascular event within the past 6 months. Other exclusions include coronary artery bypass graft or coronary angioplasty in the previous 3 months, unstable angina pectoris (chest pain at rest, worsening chest pain, or admission to the emergency room (ER) or hospital for chest pain) within the previous 3 months, and/or congestive heart failure (NYHA Class III-IV)
  9. Subjects known to be Hepatitis B surface antigen or Hepatitis C antibody positive with active hepatitis.
  10. Active infection (e.g., human immunodeficiency virus (HIV), hepatitis), or a history of severe infection during the 30 days prior to screening
  11. Evidence of immunocompromised status, including but not limited to individuals who have undergone organ transplantation, who are known to be HIV positive, or who are taking immunosuppressive drugs or chronic systemic corticosteroid treatment.
  12. Major surgical procedure during the 30 days prior to screening
  13. Diagnosis and/or treatment of malignancy (except for basal cell or squamous cell skin cancer, in-situ carcinoma of the cervix, or in-situ prostate cancer) within the past 5 years
  14. Known clinically significant gastric emptying abnormality (e.g. severe gastroparesis), or history of gastric bypass (bariatric) surgery
  15. Thyroid stimulating hormone (TSH) outside of normal limits at screening, or presence of a thyroid nodule detected on physical examination that has not been fully evaluated
  16. Thyroid hormone therapy that has not been stable for ≥6 weeks prior to Screening
  17. Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN-2)
  18. History of acute or chronic pancreatitis
  19. Subjects taking medications that are known to affect autonomic function need to be at a stable dose of those medications ≥ 3 months prior to inclusion in the study
  20. Other clinically significant, active (over the past 12 months) disease of the gastrointestinal, pulmonary, neurological, genitourinary or hematological system that, in the opinion of the investigator, would compromise the subject's participation in the study, might confound the results of the study or pose additional risk in administering the study drug
  21. Recurrent severe hypoglycemia and/or hypoglycemia unawareness.
  22. Concurrent participation in another clinical trial with use of an experimental drug or device within 30 days of study entry.
  23. Known or suspected history of alcohol or substance abuse
  24. Mental incapacity, unwillingness or language barrier precluding adequate understanding of or cooperation with the study.
  25. Women of childbearing potential (WOCBP*) who are pregnant, breast-feeding or intend to become pregnant
  26. WOCBP* must have a negative pregnancy test at Screening and must agree to use adequate contraceptive methods** during the study and for one additional menstrual cycle following the end-of-treatment visit
  27. Known or suspected hypersensitivity to study product(s) or related products
  28. Patients with low vitamin B12 levels will be excluded
  29. Current use or use 6 months prior to study participation of dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon like peptide-1 (GLP-1) agonists will be excluded
  30. Liraglutide has not been studied in combination with prandial insulin. Patients who use prandial insulin may be excluded

Sites / Locations

  • Strelitz Diabetes CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Liraglutide 6 mg Solution for Injection

Arm Description

Same formulation as active medication minus the active ingredient. Patients will start with 0.1 mL of liraglutide placebo and will escalate the dose every week in 0.1 ml increments until the 0.3 ml dose is reached. Escalation will be done according to patients' tolerance and glucose control

After randomization, patients will undergo a treatment dose escalation phase. Liraglutide will be started at 0.6 mg SQ QD for 1 week, increased to 1.2 mg subcutaneous, per day (SQ, QD) for 1 week, and then increased and maintained on 1.8 mg SQ QD or maximally tolerated dose if self monitored blood glucose (SMBG) is at goal. Escalation will be done according to patients' tolerance and glucose control

Outcomes

Primary Outcome Measures

Sudomotor Function
Changes in peripheral autonomic function using sudorimetry (Sudoscan) after 1 year of treatment.

Secondary Outcome Measures

Inflammatory Markers C-Reactive Protein (CRP)
Changes on markers of inflammation and oxidative/nitrosative stress including C-reactive protein (CRP)
Inflammatory Markers IL-1β
Changes on markers of inflammation and oxidative/nitrosative stress including IL-1β
Inflammatory Markers IL6
Changes on markers of inflammation and oxidative/nitrosative stress including IL6
Inflammatory Markers Tumor Necrosis factor α (TNF α)
Changes on markers of inflammation and oxidative/nitrosative stress including Tumor Necrosis factor α (TNF α)

Full Information

First Posted
February 2, 2018
Last Updated
February 7, 2019
Sponsor
Eastern Virginia Medical School
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1. Study Identification

Unique Protocol Identification Number
NCT03426085
Brief Title
The Effects of Liraglutide on Sudomotor Function and Inflammation in Type 2 Diabetes
Official Title
The Effects of Liraglutide on Sudomotor Function and Inflammation in Type 2 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
February 2019
Overall Recruitment Status
Unknown status
Study Start Date
May 2016 (undefined)
Primary Completion Date
April 2020 (Anticipated)
Study Completion Date
August 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Eastern Virginia Medical School

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to conduct an interventional, one year, randomized, double blind, placebo-controlled trial with Liraglutide in patients with type 2 diabetes (diabetes duration of >6 months and <10 years, HbA1c <10%) to evaluate its effects on the peripheral autonomic nervous system, as well as inflammatory markers, and measures of oxidative and nitrosative stress.
Detailed Description
The investigators propose to examine the effects of GLP-1 receptor agonist Liraglutide on autonomic sudomotor function and endothelial and neurovascular functions as well as markers of inflammation in patients with type 2 diabetes mellitus (T2DM). The primary objective will be changes in peripheral autonomic function using sudorimetry (Sudoscan) after 1 year of treatment. The secondary objectives include changes on markers of inflammation and oxidative/nitrosative stress including C-reactive protein (CRP), interleukin 1 beta (IL-1β), Interleukin 6 (IL6), interleukin 12 (IL12), interleukin 10 (IL10), tumor necrosis factor α (TNF α), plasminogen activator Inhibitor 1 (PAI-1), superoxide dismutase (SOD), nitrotyrosine, carboxymethyl-lysine (CML), thiobarbituric acid reactive substances (TBARS), and asymmetric dimethylarginine (ADMA). Additional objectives include changes in neurovascular and endothelial function, measured by continuous Laser Doppler assessment of skin blood flow in response to different stimuli; and changes in sensory-motor peripheral nerve function, measured by clinical neuropathy scores (NSS & NIS), quantitative sensory testing and nerve conduction testing. The aim of this study is to capture patients early in the disease process, when autonomic dysfunction is still potentially reversible. Several studies have shown the presence of autonomic imbalance in the early stages of diabetes and even in the pre-diabetic state (impaired glucose tolerance, impaired fasting glucose, and metabolic syndrome). We hypothesize that by treating type 2 diabetic patients with Liraglutide early in the disease process (<10 years of diagnosis), we will be able to improve peripheral autonomic imbalance, endothelial and neurovascular function, and reduce inflammation and oxidative/nitrosative stress. This will shed further insight into the mechanisms by which glucagon-like peptide-1 (GLP-1) exerts a neuroprotective role and improves the inflammatory process. The possibility of improving autonomic imbalance, endothelial function and inflammation may have important impact in the development of new potential therapeutic strategies to abrogate the microvascular complications of diabetes

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Autonomic Nervous System Diseases, Sweat Gland Diseases, Diabetic Neuropathy With Neurologic Complication

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
44 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Same formulation as active medication minus the active ingredient. Patients will start with 0.1 mL of liraglutide placebo and will escalate the dose every week in 0.1 ml increments until the 0.3 ml dose is reached. Escalation will be done according to patients' tolerance and glucose control
Arm Title
Liraglutide 6 mg Solution for Injection
Arm Type
Experimental
Arm Description
After randomization, patients will undergo a treatment dose escalation phase. Liraglutide will be started at 0.6 mg SQ QD for 1 week, increased to 1.2 mg subcutaneous, per day (SQ, QD) for 1 week, and then increased and maintained on 1.8 mg SQ QD or maximally tolerated dose if self monitored blood glucose (SMBG) is at goal. Escalation will be done according to patients' tolerance and glucose control
Intervention Type
Drug
Intervention Name(s)
Liraglutide 6 mg Solution for Injection
Intervention Type
Other
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Sudomotor Function
Description
Changes in peripheral autonomic function using sudorimetry (Sudoscan) after 1 year of treatment.
Time Frame
One Year
Secondary Outcome Measure Information:
Title
Inflammatory Markers C-Reactive Protein (CRP)
Description
Changes on markers of inflammation and oxidative/nitrosative stress including C-reactive protein (CRP)
Time Frame
One year
Title
Inflammatory Markers IL-1β
Description
Changes on markers of inflammation and oxidative/nitrosative stress including IL-1β
Time Frame
One Year
Title
Inflammatory Markers IL6
Description
Changes on markers of inflammation and oxidative/nitrosative stress including IL6
Time Frame
One Year
Title
Inflammatory Markers Tumor Necrosis factor α (TNF α)
Description
Changes on markers of inflammation and oxidative/nitrosative stress including Tumor Necrosis factor α (TNF α)
Time Frame
One Year

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: established type 2 diabetes (diabetes duration of >6 months and <10 years). Age 18-80 years HbA1c at screening ≤ 10% Subjects on stable (≥3 months prior to Screening) Standard of Care background diabetic therapy. Diabetic treatment regimens include diet and exercise alone or in association with oral anti-diabetic drugs (monotherapy or combinations) and/or long-acting insulin. Exclusion Criteria: Presence of type 1 diabetes mellitus (defined as C-peptide <1 ng /ml, <35y and prone to ketoacidosis) Treatment with rapid-acting or short-acting insulin within the last 3 months Proliferative retinopathy or maculopathy requiring acute treatment Impaired renal function , defined as serum creatinine ≥ 125 µmol/L (≥1.4 mg/dL) for males and ≥ 110 µmol/L (≥1.24 mg/dL) for females Impaired liver function, defined as aspartate transaminase (AST) or alanine transaminase (ALT), ≥ 2.5 times the upper limit of normal Presence of clinically significant peripheral or autonomic neuropathy that is clearly of non-diabetic origin Uncontrolled treated/untreated hypertension (systolic blood pressure (BP) ≥180 or diastolic blood pressure (BP) ≥100 at screening) Clinically significant active macrovascular disease including myocardial infarction or cerebrovascular event within the past 6 months. Other exclusions include coronary artery bypass graft or coronary angioplasty in the previous 3 months, unstable angina pectoris (chest pain at rest, worsening chest pain, or admission to the emergency room (ER) or hospital for chest pain) within the previous 3 months, and/or congestive heart failure (NYHA Class III-IV) Subjects known to be Hepatitis B surface antigen or Hepatitis C antibody positive with active hepatitis. Active infection (e.g., human immunodeficiency virus (HIV), hepatitis), or a history of severe infection during the 30 days prior to screening Evidence of immunocompromised status, including but not limited to individuals who have undergone organ transplantation, who are known to be HIV positive, or who are taking immunosuppressive drugs or chronic systemic corticosteroid treatment. Major surgical procedure during the 30 days prior to screening Diagnosis and/or treatment of malignancy (except for basal cell or squamous cell skin cancer, in-situ carcinoma of the cervix, or in-situ prostate cancer) within the past 5 years Known clinically significant gastric emptying abnormality (e.g. severe gastroparesis), or history of gastric bypass (bariatric) surgery Thyroid stimulating hormone (TSH) outside of normal limits at screening, or presence of a thyroid nodule detected on physical examination that has not been fully evaluated Thyroid hormone therapy that has not been stable for ≥6 weeks prior to Screening Personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2 (MEN-2) History of acute or chronic pancreatitis Subjects taking medications that are known to affect autonomic function need to be at a stable dose of those medications ≥ 3 months prior to inclusion in the study Other clinically significant, active (over the past 12 months) disease of the gastrointestinal, pulmonary, neurological, genitourinary or hematological system that, in the opinion of the investigator, would compromise the subject's participation in the study, might confound the results of the study or pose additional risk in administering the study drug Recurrent severe hypoglycemia and/or hypoglycemia unawareness. Concurrent participation in another clinical trial with use of an experimental drug or device within 30 days of study entry. Known or suspected history of alcohol or substance abuse Mental incapacity, unwillingness or language barrier precluding adequate understanding of or cooperation with the study. Women of childbearing potential (WOCBP*) who are pregnant, breast-feeding or intend to become pregnant WOCBP* must have a negative pregnancy test at Screening and must agree to use adequate contraceptive methods** during the study and for one additional menstrual cycle following the end-of-treatment visit Known or suspected hypersensitivity to study product(s) or related products Patients with low vitamin B12 levels will be excluded Current use or use 6 months prior to study participation of dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon like peptide-1 (GLP-1) agonists will be excluded Liraglutide has not been studied in combination with prandial insulin. Patients who use prandial insulin may be excluded
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Henri K Parson, PhD
Phone
7574467976
Email
parsonhk@evms.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Joshua F Edwards, MPH
Phone
7574460335
Email
edwardj@evms.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Aaron Vinik, MD, PhD
Organizational Affiliation
Eastern Virginia Medical School
Official's Role
Principal Investigator
Facility Information:
Facility Name
Strelitz Diabetes Center
City
Norfolk
State/Province
Virginia
ZIP/Postal Code
23510
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Henri K Parson, PhD
Phone
757-446-7976
Email
parsonhk@evms.edu
First Name & Middle Initial & Last Name & Degree
Joshua F Edwards, MPH
Phone
7574460335
Email
edwardj@evms.edu
First Name & Middle Initial & Last Name & Degree
Aaron I Vinik, MD, PhD

12. IPD Sharing Statement

Learn more about this trial

The Effects of Liraglutide on Sudomotor Function and Inflammation in Type 2 Diabetes

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