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Effects of Glucose Lowering Agents in South Asian Women With Impaired Glucose Tolerance or Impaired Fasting Glucose (DIASA3)

Primary Purpose

Impaired Glucose Tolerance, Insulin Sensitivity, Glucose Metabolism Disorders

Status
Unknown status
Phase
Phase 2
Locations
Norway
Study Type
Interventional
Intervention
Metformin capsule 500 mg, Empagliflozin encapsulated tablet 10 mg, Pioglitazone encapsulated tablet 30 mg, Linagliptin encapsulated tablet 5 mg
Sponsored by
Oslo University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Impaired Glucose Tolerance

Eligibility Criteria

18 Years - 60 Years (Adult)FemaleDoes not accept healthy volunteers

Inclusion Criteria:

  1. Able and willing to give informed consent
  2. Woman ≥ 18 years of age
  3. Of South Asian origin
  4. Participated in the DIASA 1 study (i.e. has had previous gestational diabetes (GDM) in last pregnancy). A period of 3 months after the 3-year limit since childbirth after GDM is seen as acceptable for inclusion.
  5. Impaired glucose tolerance (2-hour glucose value ≥7.8 and < 11.1 mmol/l) and/or impaired fasting glucose (fasting plasma glucose ≥ 6.1 and < 7.0 mmol/l) diagnosed in DIASA 1

Exclusion Criteria:

  1. Known type 2 diabetes
  2. Known type 1 diabetes
  3. Fasting or 2-hour glucose values outside the inclusion criteria if the subject according to protocol needs to undergo an OGTT at baseline in DIASA 3
  4. Pregnant or fully lactating at randomisation or planned during study period.
  5. Not willing to practice a highly effective birth control method* prior to initial dose, during study and for 2 weeks after the last administration of study drug.
  6. Concomitant use of any antidiabetic medication
  7. Concomitant use of fibrates or rifampicin
  8. Radiological examinations iodine containing contrast the previous week before randomisation, or planned during the study period.
  9. Known serious illness such as cancer (except in situ carcinoma) during past 5 years.
  10. Previous radiation therapy directed towards the pelvic area.
  11. Heart failure New York Heart Association (NYHA) class I-IV.
  12. Estimated glomerulus filtration rate (eGFR) < 60 ml/min/1,73m2
  13. Chronic liver disease with serum levels of aspartate aminotransferase (ASAT) or alanine amino transferase (ALAT) > 5 x upper limit of normal (ULN) or known impaired liver function (INR > 1.5, Albumin < 20 g/l, Bilirubin > 20 g/l.
  14. Active infectious disease at inclusion
  15. Use of systemic corticosteroids > 14 days within last 3 months before inclusion
  16. Hypothyroidism where substitution with levothyroxine has not been stable for the last 3 months or with thyroid stimulating hormone (TSH) outside normal limits.
  17. A history of bullous pemphigoid
  18. A history of acute or chronic pancreatitis
  19. Previous or present acute metabolic acidosis.
  20. Known hypersensitivity to any of the active ingredients or additives in the study medication or placebo capsules.
  21. Macroscopic haematuria not previously examined
  22. History of major surgical procedures within 3 months prior to inclusion or planned during study period.
  23. Any condition which in the investigator's opinion would jeopardize the subject's safety or compliance with the protocol.

    • Birth control methods which may be considered as highly effective: Methods that can achieve a failure rate of less than 1% per year when used consistently and correctly are considered as highly effective birth control methods. Such methods include: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal or transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable or implantable), intrauterine device (IUD), intrauterine hormone-releasing system ( IUS), bilateral tubal occlusion, vasectomized partner or sexual abstinence.

Sites / Locations

  • Oslo University Hospital, Aker HospitalRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Active Comparator

Active Comparator

Active Comparator

Active Comparator

Arm Label

Metformin

Empagliflozin

Linagliptin

Pioglitazone

Arm Description

Metformin 500 mg x 1, morning, for 2 weeks, then Metformin 500 mg x 2, morning and evening for 10 weeks.

Empagliflozin 10 mg x 1, morning, for 2 weeks, then Empagliflozin 10 mg morning + Placebo evening for 10 weeks.

Linagliptin 5 mg x 1, morning, for 2 weeks, then Linagliptin 5 mg morning + Placebo evening for 10 weeks.

Pioglitazone 30 mg x 1, morning, for 2 weeks, then Pioglitazone 30 mg morning + Placebo evening for 10 weeks.

Outcomes

Primary Outcome Measures

Endogenous glucose production during fasting
Difference between treatment arms in change from baseline to 12 weeks in endogenous glucose production during fasting measured by the deuterated glucose tracer dilution method in umol/(kg fat free mass x minutes)

Secondary Outcome Measures

Full Information

First Posted
November 16, 2020
Last Updated
April 5, 2021
Sponsor
Oslo University Hospital
Collaborators
The Research Council of Norway, Norwegian Diabetes Association, South-Eastern Norway Regional Health Authority, University of Oslo, University Hospital, Akershus, Vestre Viken Hospital Trust, University of Glasgow
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1. Study Identification

Unique Protocol Identification Number
NCT04662866
Brief Title
Effects of Glucose Lowering Agents in South Asian Women With Impaired Glucose Tolerance or Impaired Fasting Glucose
Acronym
DIASA3
Official Title
Glucose Metabolism in South Asian Women With IGT or IFG. DIAbetes in South Asians - DIASA 3: A 12-week Intervention Trial With Oral Antidiabetic Medication to Improve Hepatic and Whole Body Insulin Sensitivity
Study Type
Interventional

2. Study Status

Record Verification Date
April 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 10, 2021 (Actual)
Primary Completion Date
December 2022 (Anticipated)
Study Completion Date
October 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Oslo University Hospital
Collaborators
The Research Council of Norway, Norwegian Diabetes Association, South-Eastern Norway Regional Health Authority, University of Oslo, University Hospital, Akershus, Vestre Viken Hospital Trust, University of Glasgow

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will test the effect of four common oral anti-diabetic agents on hepatic insulin sensitivity in South Asian women with impaired glucose tolerance or impaired fasting glucose. In a 12-week, double-blind, randomized controlled intervention trial, the following drugs will be tested head-to-head: Metformin, Pioglitazone, Empagliflozin and Linagliptin. Additional, exploratory outcomes include whole body insulin sensitivity, insulin secretion and other markers of glucose and lipid metabolism, measured by the euglycemic clamp with stable isotope tracer dilution, indirect calorimetry and CT-measurements of abdominal adipose tissue compartment volumes and hepatic and pancreatic volume and attenuation. The study is part of the DIASA - DIAbetes in South Asians - Research Programme, which aims to find ways to improve both prevention and treatment of type 2 diabetes in people of South Asian ethnicity.
Detailed Description
Background: South Asians (SA) have a high prevalence of type 2 diabetes (T2D). SA i Norway develop T2D approximately 10 years earlier than Nordic subjects (NO).T2D in SA is often poorly regulated with increased risk of complications. Research hypothesis: South Asian subjects with Impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) have a high degree of hepatic insulin resistance. Treatment with certain oral antidiabetic drugs will improve hepatic insulin sensitivity more than others. Primary objective: To assess which of four oral antidiabetic medications is most effective in improving hepatic insulin sensitivity in women of South Asian origin with IFG/IGT. Study design: Single-center, randomized, double-blind intervention trial with 4 parallel treatment arms: 1) Metformin 2) Pioglitazone 3) Empagliflozin 4) Linagliptin. Endogenous glucose production (EGP) and hepatic and whole body insulin sensitivity will be assessed by a 2-step euglycemic, hyperinsulinemic clamp with deuterated glucose tracer. In addition, glucose and lipid metabolism will be assessed by indirect calorimetry (IC), insulin secretion by an oral glucose tolerance test (OGTT), and fatty infiltration in liver by computer tomography (CT). Recruitment: From South Asian women with IFG/IGT who participated in DIASA 1. Duration of study: 14 weeks, with a total of four study visits, every 4 weeks, plus two CT scans, at baseline and 12 weeks, and one end of study follow-up telephone visit at 14 weeks. The project is expected to last a maximum of 3 years. Study population: Women ≥ 18 years of age of South Asian ethnicity with IGT/IFG. Criteria for evaluation: Efficacy outcome will include evaluation of change in EGP from baseline to 12 weeks. Laboratory parameters of glucose and lipid metabolism. Questionnaires with physical activity and food frequency. Safety and tolerability will be assessed by clinical adverse events and laboratory measurements from randomization to 14 weeks. Primary outcome: Difference between treatment arms in change in EGP from baseline to 12 weeks. Explorative outcomes: Difference between treatment arms in change from randomisation to 12 weeks in: whole body insulin sensitivity HbA1c glucose and lipid metabolism measured by IC fatty infiltration in liver and visceral adipose tissue. Statistical Methods: One-way ANOVA, Multiple regression analyses, Paired samples t-tests, longitudinal analyses.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Impaired Glucose Tolerance, Insulin Sensitivity, Glucose Metabolism Disorders

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Randomised controlled trial (RCT), 4 parallel groups
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Blinded medication
Allocation
Randomized
Enrollment
64 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Metformin
Arm Type
Active Comparator
Arm Description
Metformin 500 mg x 1, morning, for 2 weeks, then Metformin 500 mg x 2, morning and evening for 10 weeks.
Arm Title
Empagliflozin
Arm Type
Active Comparator
Arm Description
Empagliflozin 10 mg x 1, morning, for 2 weeks, then Empagliflozin 10 mg morning + Placebo evening for 10 weeks.
Arm Title
Linagliptin
Arm Type
Active Comparator
Arm Description
Linagliptin 5 mg x 1, morning, for 2 weeks, then Linagliptin 5 mg morning + Placebo evening for 10 weeks.
Arm Title
Pioglitazone
Arm Type
Active Comparator
Arm Description
Pioglitazone 30 mg x 1, morning, for 2 weeks, then Pioglitazone 30 mg morning + Placebo evening for 10 weeks.
Intervention Type
Drug
Intervention Name(s)
Metformin capsule 500 mg, Empagliflozin encapsulated tablet 10 mg, Pioglitazone encapsulated tablet 30 mg, Linagliptin encapsulated tablet 5 mg
Other Intervention Name(s)
biguanide, glitazone, sodium glucose transport inhibitor, dipeptidyl peptidase inhibitor
Intervention Description
Comparison of 4 different antihyperglycemic drugs
Primary Outcome Measure Information:
Title
Endogenous glucose production during fasting
Description
Difference between treatment arms in change from baseline to 12 weeks in endogenous glucose production during fasting measured by the deuterated glucose tracer dilution method in umol/(kg fat free mass x minutes)
Time Frame
After 12 weeks on respective drugs
Other Pre-specified Outcome Measures:
Title
Endogenous glucose production during hyperinsulinemia
Description
Difference between treatment arms in change from baseline to 12 weeks in endogenous glucose production measured by the deuterated glucose tracer dilution method during euglycaemic clamp in umol/(kg fat free mass x minutes)
Time Frame
After 12 weeks on respective drugs
Title
Whole body insulin sensitivity
Description
Difference between treatment arms in change from baseline to 12 weeks in whole body insulin sensitivity measured by euglycemic clamp derived total glucose disposal in umol/(kg fat free mass x minutes)
Time Frame
After 12 weeks on respective drugs
Title
Insulin secretion
Description
Difference between treatment arms in change in insulin secretion from baseline to 12 weeks, measured by the insulinogenic index, i.e. the change in serum insulin (pmol/l) from 0 to 30 min divided by the change in plasma glucose (mmol/l) from 0 to 30 minutes of an oral glucose tolerance test.
Time Frame
After 12 weeks on respective drugs
Title
Liver fat
Description
Explore the difference between treatment arms in change in fatty infiltration in the liver measured as the attenuation in CT-measured regions of interest from baseline to 12 weeks.
Time Frame
After 12 weeks on respective drugs
Title
Glycemia
Description
Difference between treatment arms in change in HbA1c in mmol/mol from baseline to 12 weeks .
Time Frame
After 12 weeks on respective drugs
Title
Pancreatic fat
Description
Explore the difference between treatment arms in change in fatty infiltration of the pancreas measured as the attenuation in CT-measured regions of interest
Time Frame
After 12 weeks on respective drugs
Title
Intraabdominal fat
Description
Explore the difference between treatment arms in change in visceral fat volume, in cubic centimeters, from baseline to 12 weeks, on abdominal CT scans running from the top of the diaphragm to the iliac crest.
Time Frame
After 12 weeks on respective drugs

10. Eligibility

Sex
Female
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Able and willing to give informed consent Woman ≥ 18 years of age Of South Asian origin Participated in the DIASA 1 study (i.e. has had previous gestational diabetes (GDM) in last pregnancy). A period of 3 months after the 3-year limit since childbirth after GDM is seen as acceptable for inclusion. Impaired glucose tolerance (2-hour glucose value ≥7.8 and < 11.1 mmol/l) and/or impaired fasting glucose (fasting plasma glucose ≥ 6.1 and < 7.0 mmol/l) diagnosed in DIASA 1 Exclusion Criteria: Known type 2 diabetes Known type 1 diabetes Fasting or 2-hour glucose values outside the inclusion criteria if the subject according to protocol needs to undergo an OGTT at baseline in DIASA 3 Pregnant or fully lactating at randomisation or planned during study period. Not willing to practice a highly effective birth control method* prior to initial dose, during study and for 2 weeks after the last administration of study drug. Concomitant use of any antidiabetic medication Concomitant use of fibrates or rifampicin Radiological examinations iodine containing contrast the previous week before randomisation, or planned during the study period. Known serious illness such as cancer (except in situ carcinoma) during past 5 years. Previous radiation therapy directed towards the pelvic area. Heart failure New York Heart Association (NYHA) class I-IV. Estimated glomerulus filtration rate (eGFR) < 60 ml/min/1,73m2 Chronic liver disease with serum levels of aspartate aminotransferase (ASAT) or alanine amino transferase (ALAT) > 5 x upper limit of normal (ULN) or known impaired liver function (INR > 1.5, Albumin < 20 g/l, Bilirubin > 20 g/l. Active infectious disease at inclusion Use of systemic corticosteroids > 14 days within last 3 months before inclusion Hypothyroidism where substitution with levothyroxine has not been stable for the last 3 months or with thyroid stimulating hormone (TSH) outside normal limits. A history of bullous pemphigoid A history of acute or chronic pancreatitis Previous or present acute metabolic acidosis. Known hypersensitivity to any of the active ingredients or additives in the study medication or placebo capsules. Macroscopic haematuria not previously examined History of major surgical procedures within 3 months prior to inclusion or planned during study period. Any condition which in the investigator's opinion would jeopardize the subject's safety or compliance with the protocol. Birth control methods which may be considered as highly effective: Methods that can achieve a failure rate of less than 1% per year when used consistently and correctly are considered as highly effective birth control methods. Such methods include: combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal or transdermal), progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable or implantable), intrauterine device (IUD), intrauterine hormone-releasing system ( IUS), bilateral tubal occlusion, vasectomized partner or sexual abstinence.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Anita Suntharalingam, MD
Phone
+4722894745
Email
ansunt@ous-hf.no
First Name & Middle Initial & Last Name or Official Title & Degree
Ellen Hillestad, Pharm.techn.
Phone
+4722894000
Email
elhill@ous-hf.no
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kåre I Birkeland, MD, PhD
Organizational Affiliation
Professor
Official's Role
Principal Investigator
Facility Information:
Facility Name
Oslo University Hospital, Aker Hospital
City
Oslo
ZIP/Postal Code
0424, Nydalen
Country
Norway
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Åse Halsne, RN
Phone
+4722894745
Email
asehal@ous-hf.no

12. IPD Sharing Statement

Learn more about this trial

Effects of Glucose Lowering Agents in South Asian Women With Impaired Glucose Tolerance or Impaired Fasting Glucose

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