Remote Ischemic Conditioning and Diabetic Foot Ulcers
Primary Purpose
Diabetic Foot Ulcer, Diabetic Angiopathies
Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Remote Ischemic conditioning (RIC)
Sponsored by
About this trial
This is an interventional treatment trial for Diabetic Foot Ulcer focused on measuring remote ischemic conditioning, diabetic foot ulcer, diabetic angiopathy
Eligibility Criteria
Inclusion Criteria:
- Patient any gender between the ages of 18 and under 90 at the time of consent.
- Target ulcer has a minimum area of 1.0 cm2 and a maximum area of 20.0 cm2, measured at screening after sharp debridement, as assessed by computerized planimetry.
- Target ulcer open for a minimum of 4 weeks and a maximum of 52 weeks duration prior to the screening visit.
- Target ulcer is located on the toe or lateral dorsal, or plantar aspect of the foot with no portion on the ankle.
- Target ulcer is Grade IC (ischemic, non-infected superficial wound) or IIC (ischemic non-infected wound penetrating to tendon or capsule), according to the University of Texas Diabetic Wound Classification system.
- Adequate perfusion without critical limb ischemia, confirmed by vascular assessment of the affected foot through any of the following methods: ABI >0.7
- Confirmed diagnosis of type 1 or 2 diabetes mellitus
- Patient has a glycated hemoglobin A1c (HbA1c) level of less than 12%
- If patient has two or more ulcers, they must be separated by at least 2 cm and the largest one will be included as the study DFU though all will be similarly treated
- Patient is willing to use prescribed off-loading method during the whole duration of the study
- Patient available for the entire study period all follow up visit requirements, and able and willing to adhere to protocol requirements
- Patient able and willing to give written informed consent
Exclusion Criteria:
- Target ulcer is less than 1.0 cm2 measured at consent after sharp debridement
- Target ulcer is due to a non-diabetic etiology
- Presence in target ulcer of cellulitis, osteomyelitis or other clinical evidence of infection at time of enrollment.
- Presence of any foot ulcer (whether or not on the target foot) for which systemic antibiotic treatment is required.
- A history of more than 8 weeks' treatment with immunosuppressants (including systemic corticosteroids), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within one month prior to initial screening, or treatments with such medications during the screening period.
- Patients with an amputation on the affected foot, if it impedes proper offloading of the target DFU.
- Patients with active Charcot foot, or inactive Charcot foot, if it impedes proper offloading of the target DFU.
- Women who are pregnant or considering becoming pregnant within the next 6 months.
- Patients with concurrent severe psychiatric disease that in the opinion of the investigator would impede participation in the trial.
- Presence of subject having recent or current alcohol or drug abuse.
- Patients with severe kidney disease who are currently untreated or awaiting dialysis treatment
- Participation in another study involving treatment with an investigational product within the previous 30 days.
- Any other medical or psychological conditions that, in the opinion of the Investigator may make patient's participation unreliable or may interfere with study assessments.
- Patients with history of radiation to the ulcer
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
No Intervention
Arm Label
Remote Ischemic Condition
Standard of Care
Arm Description
Outcomes
Primary Outcome Measures
Change in ulcer area and overall healing rate
Will evaluate healing rates and times for both treatment group and standard of care group using app that can take picture and measure area
Secondary Outcome Measures
VEGF
Will evaluate blood levels of VEGF in treatment group and standard of care group
SDF1a
Will evaluate blood levels of SDF1a in treatment group and standard of care group
CD34+
Will evaluate soft tissue biopsy for presence or absence of CD34+ in treatment group and standard of care group
tissue perfusion
Will evaluate overall tissue perfusion using Laser Speckle imaging for both treatment group and standard of care group
Full Information
NCT ID
NCT04567563
First Posted
September 17, 2020
Last Updated
September 23, 2020
Sponsor
Des Moines University
Collaborators
Iowa State University
1. Study Identification
Unique Protocol Identification Number
NCT04567563
Brief Title
Remote Ischemic Conditioning and Diabetic Foot Ulcers
Official Title
The Physiological Effects of Remote Ischemic Conditioning on the Healing of Diabetic Foot Ulcers
Study Type
Interventional
2. Study Status
Record Verification Date
September 2020
Overall Recruitment Status
Unknown status
Study Start Date
November 2020 (Anticipated)
Primary Completion Date
November 2022 (Anticipated)
Study Completion Date
November 2022 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Des Moines University
Collaborators
Iowa State University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
5. Study Description
Brief Summary
Study type: Randomized, double blinded, interventional, single-site study. Two groups: Active receiving RIC therapy from the LifeCuff device and standard of care treatment without RIC.
Study population: Adults (18 to 90) with diabetes myelitis presenting with diabetic foot ulcers.
Randomization and sample size: Subjects will be allocated on a 1:1 ratio, yielding a minimum per protocol population (PP Population) of 15 patients in the Active group and 15 in the control group.
Study timeline: Total amount of time from the Screening Visit to the Final Visit is approximately 16 weeks. For patients who meet inclusion criteria, they are randomized into Active or Control treatment groups. In addition they are stratified into groups based on wound etiology: neuropathic (defined as insensate at 2 or more of 5 sites verified by insensitivity to the 5.07 Semmes-Weinstein 10 g monofilament), ischemic (defined as ABI of 0.7 neuro-ischemic (meeting both of above criteria) Subjects will present at DMU Foot and Ankle Clinic on weeks 0, 3, 6, 9, and 12 for the following measurements: 40mL venous blood draw (VEGF, SDF1a) 2mm punch biopsy (CD34+) Local wound perfusion (Laser Speckle[FK2] ) Ulcer size measured by digital planimetry (TissueAnalytics)
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Foot Ulcer, Diabetic Angiopathies
Keywords
remote ischemic conditioning, diabetic foot ulcer, diabetic angiopathy
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Will have intervention group and standard of care group
Masking
None (Open Label)
Allocation
Randomized
Enrollment
50 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Remote Ischemic Condition
Arm Type
Active Comparator
Arm Title
Standard of Care
Arm Type
No Intervention
Intervention Type
Device
Intervention Name(s)
Remote Ischemic conditioning (RIC)
Intervention Description
Intervention Group: Patients will self-administer RIC treatment with the LifeCuff device 3 times a week. Treatment will be delivered at the patient's home and compliance will be monitored by the LifeCuff device. Control Group: Patients undergo typical standard of care treatment. Assessment of Ulcer Closure: Ulcers will be assessed as completely closed by the Principal Investigator through clinical judgement and photographic support. Patients that completely heal their ulcer during the healing period will complete the study and no further blood or tissue measurements will be taken
Primary Outcome Measure Information:
Title
Change in ulcer area and overall healing rate
Description
Will evaluate healing rates and times for both treatment group and standard of care group using app that can take picture and measure area
Time Frame
will be evaluated at 0, 3, 6, 9 and 12 weeks
Secondary Outcome Measure Information:
Title
VEGF
Description
Will evaluate blood levels of VEGF in treatment group and standard of care group
Time Frame
will be evaluated at 0, 3, 6, 9 and 12 weeks
Title
SDF1a
Description
Will evaluate blood levels of SDF1a in treatment group and standard of care group
Time Frame
will be evaluated at 0, 3, 6, 9 and 12 weeks
Title
CD34+
Description
Will evaluate soft tissue biopsy for presence or absence of CD34+ in treatment group and standard of care group
Time Frame
will be evaluated at 0, 3, 6, 9 and 12 weeks
Title
tissue perfusion
Description
Will evaluate overall tissue perfusion using Laser Speckle imaging for both treatment group and standard of care group
Time Frame
will be evaluated at 0, 3, 6, 9 and 12 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Patient any gender between the ages of 18 and under 90 at the time of consent.
Target ulcer has a minimum area of 1.0 cm2 and a maximum area of 20.0 cm2, measured at screening after sharp debridement, as assessed by computerized planimetry.
Target ulcer open for a minimum of 4 weeks and a maximum of 52 weeks duration prior to the screening visit.
Target ulcer is located on the toe or lateral dorsal, or plantar aspect of the foot with no portion on the ankle.
Target ulcer is Grade IC (ischemic, non-infected superficial wound) or IIC (ischemic non-infected wound penetrating to tendon or capsule), according to the University of Texas Diabetic Wound Classification system.
Adequate perfusion without critical limb ischemia, confirmed by vascular assessment of the affected foot through any of the following methods: ABI >0.7
Confirmed diagnosis of type 1 or 2 diabetes mellitus
Patient has a glycated hemoglobin A1c (HbA1c) level of less than 12%
If patient has two or more ulcers, they must be separated by at least 2 cm and the largest one will be included as the study DFU though all will be similarly treated
Patient is willing to use prescribed off-loading method during the whole duration of the study
Patient available for the entire study period all follow up visit requirements, and able and willing to adhere to protocol requirements
Patient able and willing to give written informed consent
Exclusion Criteria:
Target ulcer is less than 1.0 cm2 measured at consent after sharp debridement
Target ulcer is due to a non-diabetic etiology
Presence in target ulcer of cellulitis, osteomyelitis or other clinical evidence of infection at time of enrollment.
Presence of any foot ulcer (whether or not on the target foot) for which systemic antibiotic treatment is required.
A history of more than 8 weeks' treatment with immunosuppressants (including systemic corticosteroids), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within one month prior to initial screening, or treatments with such medications during the screening period.
Patients with an amputation on the affected foot, if it impedes proper offloading of the target DFU.
Patients with active Charcot foot, or inactive Charcot foot, if it impedes proper offloading of the target DFU.
Women who are pregnant or considering becoming pregnant within the next 6 months.
Patients with concurrent severe psychiatric disease that in the opinion of the investigator would impede participation in the trial.
Presence of subject having recent or current alcohol or drug abuse.
Patients with severe kidney disease who are currently untreated or awaiting dialysis treatment
Participation in another study involving treatment with an investigational product within the previous 30 days.
Any other medical or psychological conditions that, in the opinion of the Investigator may make patient's participation unreliable or may interfere with study assessments.
Patients with history of radiation to the ulcer
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Katherine Frush, DPM
Phone
515-271-1731
Email
katherine.frush@dmu.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Katherine Frush, DPM
Organizational Affiliation
Des Moines University
Official's Role
Principal Investigator
12. IPD Sharing Statement
Plan to Share IPD
No
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Remote Ischemic Conditioning and Diabetic Foot Ulcers
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