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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
Des Moines University
About
Eligibility
Locations
Arms
Outcomes
Full info

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

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

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

    First Posted
    September 17, 2020
    Last Updated
    September 23, 2020
    Sponsor
    Des Moines University
    Collaborators
    Iowa State University
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    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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