Investigational Study of Delayed Release Metformin (DREAM-T2D)
Diabetes Mellitus, Type 2
About this trial
This is an interventional treatment trial for Diabetes Mellitus, Type 2
Eligibility Criteria
Inclusion Criteria:
- Is male or female and at least 18 years old
- Has body mass index 20.0 to 45.0 kg/m2 (inclusive)
- Has T2DM
- Has HbA1c of 7.0% to 9.5%, inclusive, at Visit 1A and HbA1c value of 7.0% to 10.5%, inclusive, at Week -2 (Visit 3/3A as applicable)
- Has an eGFR value of ≥30 mL/min/1.73 m2 based on the CKD-EPI equation at Visit 1A and Visit 3/3A (Week -2)
- Stable treatment with a metformin preparation or a combination product containing metformin for 8 weeks prior to Visit 1A
If treated with the following medications, must be on a stable regimen for a minimum of 6 weeks prior to Visit 1B
- Drugs known to affect body weight, including prescription medications (e.g., phentermine, phentermine/topiramate, orlistat, lorcaserin, bupropion/naltrexone) and over-the-counter anti-obesity agents
- Hormone replacement therapy (female patients) and testosterone (male patients)
- Oral contraceptives (female patients)
- Antihypertensive agents including ACEi/ARB
- Lipid-lowering agents
- Thyroid replacement therapy
- Antidepressant agents
- Ability to understand and willingness to adhere to protocol requirements
Exclusion Criteria:
- Is currently on dialysis, has been on any dialysis within 1 year of Visit 1B, or is expected to undergo dialysis during the study period
- Has a history of lactic acidosis
- Has a fasting plasma glucose (FPG) value >240 mg/dL (>13.3 mmol/L) at Week -2 (Visit 3/3A as applicable)
- An alanine aminotransferase or aspartate aminotransferase result >2.5 × upper limit of normal (ULN) or a bilirubin result >1.5 × ULN at Visit 1B or Visit 3/3A (Week -2) (except in case of documented Gilbert's syndrome)
- Has a fasting plasma lactate value >2 mol at Visit 1B
- Has a bicarbonate value ≤20 mEq/L at both Visit 1A and 1B. If bicarbonate value is <20 at Visit 3/3A or 4, patient may be excluded if the investigator considers this clinically significant
- A history of >5% weight change within 12 weeks prior to Visit 1A
- Has mean BP measurements >180 mmHg (systolic BP) or >100 mmHg (diastolic BP) at Visit 1A or Visit 3/3A, which can be rechecked within 1 week (Note: re-screening is allowed 6 weeks after initiation/modification of antihypertensive agents if the patient is screen failed due to BP only)
- Oral antidiabetic agent or insulin use that is not stable for 8 weeks prior to randomization (i.e., change in oral medication dose or basal insulin dose increased or decreased by more than 20% during the 8 weeks prior to Visit 4 [Day 1])
Has been treated, is currently being treated, or is expected to require or undergo treatment with any of the following excluded medications:
- Prescribed metformin preparation after initiation of metformin washout following Visit 1B
- Greater than 10 consecutive days of systemic corticosteroids by oral, intravenous, or intramuscular route within 12 weeks of Visit 1B; inhaled, intranasal, ophthalmic, topical, or intra-articular corticosteroids are not exclusionary
- Planned use of proton pump inhibitors after Visit 2 (Week -6); such use could potentially affect the DR and PK of Metformin DR. Proton pump inhibitor treatment may be replaced by other treatment (such as H2 receptor antagonists [excluding ranitidine], or calcium carbonate antacids) prior to Visit 4 (Day 1), if appropriate per the judgment of the Investigator
- Cationic drugs that are eliminated by renal tubular secretion (e.g., amiloride, digoxin, morphine, procainamide, flecainide, quinidine, quinine, ranitidine, triamterene, trimethoprim, and vancomycin) within 1 week of Visit 3 (Week 2)
- Iodinated contrast dye within 1 week prior to Visit 3 (Week -2)
- Investigational drug within 8 weeks (or 5 half-lives of the investigational drug, whichever is greater) of the date of the first dose of randomized study medication
- Metformin DR or double-blind matching placebo for Metformin DR at any time prior to Visit 1B
Has a clinically significant medical condition as judged by the Investigator that could potentially affect study participation and/or personal well-being, including but not limited to the following conditions:
- Hepatic disease
- Gastrointestinal disease, including but not limited to:
i. History or presence of inflammatory bowel disease or other severe gastrointestinal disease, particularly those that may impact gastric emptying, such as gastroparesis and pyloric stenosis ii. Prior or expected surgical gastrointestinal procedure that may impact the gut hormonal response to study medication such as gastric bypass surgery or gastric banding surgery iii. Active diagnosis of pancreatitis c. Endocrine disorder other than T2DM or hypothyroidism on replacement therapy d. Cardiovascular disease, including history of stroke, decompensated heart failure New York Heart Association Class III or IV, myocardial infarction, unstable angina pectoris, or coronary arterial bypass graft or angioplasty within 3 months prior to Visit 1A (screening) e. Central nervous system diseases such as epilepsy f. Psychiatric or neurological disorders that in the Investigator's opinion would cause the patient to be noncompliant with study procedures g. Organ transplantation h. Chronic or acute infection requiring systemic antibiotic treatment i. Orthostatic hypotension or syncope j. Active malignancy within the past 5 years with exception of basal cell and squamous cell carcinoma
- Known allergy or hypersensitivity to Metformin DR, Metformin IR, or placebo or any inactive component of study medication, active comparator, or placebo, unless the reaction is deemed irrelevant to the study by the Investigator (prior history of gastrointestinal intolerance to metformin is not exclusionary)
- Has a history of diabetic ketoacidosis or hyperosmolar non-ketotic hyperglycemia within 1 year prior to Visit 1B
- A physical, psychological, or historical finding that, in the Investigator's opinion, would make the patient unsuitable for the study
- Any verified clinically significant abnormality identified on physical examination, laboratory tests, ECG, vital signs, or any adverse event (AE) at the time of Visit 1B through Visit 4 that, in the judgment of the Investigator or any Sub-investigator, would preclude safe completion of the study or constrains efficacy assessment
- Currently abuses drugs or alcohol or has a known history of abuse that in the Investigator's opinion would cause the patient to be noncompliant with study procedures
- Had a blood transfusion or experienced significant blood loss (i.e., >500 mL), including loss due to blood donation, within 8 weeks prior to Visit 1B, or is planning to donate blood or have a blood transfusion during the study
- Prior or planned major surgery of any kind (requiring overnight hospitalization) within 6 months of Visit 1B
- Patients insufficiently compliant with study medication during the placebo run-in phase (<85% or >115%) as assessed at Visit 4
- Is screening for the study at more than one clinical site or is participating in any other clinical study
- Is currently pregnant (confirmed by serum pregnancy test at Visit 1B) or breastfeeding or plans to become pregnant during the course of the study
- Women of childbearing potential not willing to use highly effective method(s) of birth control during the entire study, or who are unwilling or unable to be tested for pregnancy
- If the patient has evidence of coronavirus disease 2019 (COVID-19) within 2 weeks prior to enrolment (a positive COVID-19 test or suspicion of COVID-19 infection), the patient cannot be enrolled in the study
- Is employed by Anji Pharma (that is an employee, contract worker, or designee of the company).
Sites / Locations
- Lenzmeier Family Medicine/CCT Research
- Aventiv Research
- Kidney & Hypertension Center / DaVita Clinical Research
- California Institute of Renal Research
- Academic Medical Research Institute
- Valley Renal Medical Group Research
- San Fernando Valley Health Institute
- AGA Clinical Trials
- East Coast Institutue for Research
- East Coast Institute for Research, LLC
- West Orange Endocrinology
- Metabolic Research Institute, Inc
- Georgia Nephrology Research Institute
- In-Quest Medical Research - Peachtree
- Louisville Metabolic and Atherosclerosis Research Center Inc. (L-MARC)
- Methodist Physicians Clinic / CCT Research
- Midwest Regional Health Services
- DaVita Clinical Research
- Hassman Research Institute
- Albuquerque Clinical Trials, Inc.
- Carolina Institute for Clinical Research
- Lucas Research
- Eastern Nephrology Associates
- Family Medicine of SayeBrook
- South Carolina Clinical Research LLC
- WR-ClinSearch
- Texas Diabetes & Endocrinology
- Office of Osvaldo A Brusco, MD
- Galenos Research
- Endocrine IPS, PLLC
- Clinical Advancement Center, PLLC
- Manassas Clinical Research Center
- IACT Health
- Instituto de Ensino e Pesquisa Clinica do Ceara
- Centro de Pesquisas em Diabetes e Doencas Endrocrino-Metabolica Ltda
- Universidade Federal Do Para (UFPA) - Insitituto de Ciencas de Saude (ICS)
- Centro de Diabetes Curitiba
- Cline Research Center
- IBPClin Instituto Brasil de Pesquisa Clinica
- Hospital Sao Vicente de Paulo
- Centro de Pesquisas em Diabetes Ltda
- Loema - Instituto de Pesquisa Clinica
- Instituto de Pesquisa Clinica de Campinas
- ASOMC Endocrinology and Metabolic Diseases
- Medical Cetner Teodora
- Multiprofile Hospital for Active Treatment
- Fourth Multipfoile Hospital for Active Treatment
- Medical Center New Rehabilition Cetner EOOD
- Diagnostic Culsultative Cetner "Equita" EOOD
- Medical Center Leo Clinical EOOD
- BC Diabetes
- LMC Manna Research (Barrie)
- LMC Manna Research (Brampton)
- Stephen S. Chow Medicine Professional Corporation
- LMC Manna Research (Etobicoke)
- LMC Manna Research (Ottawa)
- LMC Manna Research (Bayview)
- LMC Manna Research (Montreal)
- Diahaza s.r.o.
- Diabetologicka ambulance
- Interni Ambulance
- Endodiab s.r.o.
- Diabet2 s.r.o.
- Diabetologicka a podiatricka ambulance, Milan Kvapil s.r.o.
- ResTrial s.r.o.
- Borbanya Praxis EU Kft
- Lausmed Kft
- Principal SMO Ltd
- DRC Gyogyszervizsgalo Kozpont Kft
- Bajscy-Zsilinszky Hospital
- Magyar Honvedseg Egeszsegugyl Koxpont
- Borbanya Praxis EU k ft
- Zala Megyei Szent Rafael Korhaz
- NZOZ NEUROMED M.iM. Nastaj Sp.P.
- Malopolskie Centrum Kliniczne
- Niepubliczny Zakład Opieki Zdrowotnej Specjalistyczny Ośrodek Internistyczno-Diabetologiczny
- Centrum Medyczne Pratia
- Pro Familia Altera Sp. z.o.o.
- Diamond Medical Center
- NBR Polska
- Centralny Szpital Kliniczny Ministerstwa Spraw Wewnetrznych i Administracji
- Centrum Badan Klinicznych Piotr Napora Lekarze Spolka Partnerska, Centrum Badan Klinicznych Osrodek Badan Wczesnej Fazy
- Hospital Universitario Virgen del Rocio
- Hospital Universitario Vall d'Hebron
- Hospital Universitario Virgen de la Victoria
- Nuevas Tecnologias en Diabetes y Endocrinologia
- Hospital Vithas Sevilla
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Placebo Comparator
Active Comparator
Investigational Arm (Metformin DR plus metformin IR placebo)
Placebo Arm (Metformin DR placebo plus metformin IR placebo)
Active Control Arm (Metformin DR placebo plus metformin IR)
Group A will receive 1800 mg Metformin DR qAM + placebo for 1500 mg metformin IR in divided doses (2×placebo for metformin IR 500 mg qAM and 1×placebo for metformin IR 500 mg qPM).
Group B will receive placebo for 1800 mg Metformin DR qAM + placebo for 1500 mg metformin IR in divided doses (2× placebo for metformin IR 500 mg qAM and 1×placebo for metformin IR 500 mg qPM).
Group C will receive placebo for 1800 mg Metformin DR qAM + 1500 mg metformin IR in divided doses (2× metformin IR 500 mg qAM and 1× metformin IR 500 mg qPM).