Basal Plus GLP1-ra on Glycemic Variability in CKD
Primary Purpose
Diabetes Mellitus, Diabetic Kidney Disease
Status
Recruiting
Phase
Phase 4
Locations
Hong Kong
Study Type
Interventional
Intervention
Dulaglutide
Insulin Degludec
Continuous glucose monitor
Sponsored by
About this trial
This is an interventional treatment trial for Diabetes Mellitus
Eligibility Criteria
Inclusion Criteria:
- Type 2 diabetes mellitus diagnosed for at least 6 months
- Male or female age ≥ 18 years old and ≤ 75 years old.
- Body mass index between 18 and 40 kg/m2 inclusive
- HbA1c ≥ 6.5% and ≤ 9.0% at screening
- Women who are not pregnant, lactating or planning a pregnancy during their participation in the clinical study.
- Patients with CKD stage 3 or 4 as defined by estimated glomerular filtration rate between 15-59 ml/min/m2 by the modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at screening
- Willingness, ability and commitment to comply with the testing, procedure and follow-up outlined in this protocol including (but not limited to) and use of pre-specified glucose monitoring devices.
- In the opinion of the investigator, absence of any physical limitations, addictive diseases, or underlying medical conditions (including mental health) that may preclude the patient from being a suitable study candidate.
- Written informed consent to participate in the study provided by the patient.
- Willing and capable of use of a continuous glucose monitor as judged by the investigator
Exclusion Criteria:
- Type 1 diabetes
- Currently pregnant, as demonstrated by a positive pregnancy test at screening or planning pregnancy
- Treatment with GLP-1 RA or insulin degludec in the past three months
- Any active acute or chronic disease or condition that, in the opinion of the investigator, might interfere with the performance of this study.
- Any active acute or chronic infectious disease that, in the opinion of the investigator, would pose an excessive risk to study staff.
- Current use or recent exposure to any medication that in the opinion of the investigator could have an influence on the patient's ability to participate in this study or on the performance of the test device.
- Extensive skin changes/diseases that preclude wearing the CGM on normal skin at the proposed application sites (e.g., extensive psoriasis, recent burns or severe sunburn, extensive eczema, extensive scarring, extensive tattoos, dermatitis herpetiformis).
- Have a known allergy to medical-grade adhesives
- Known current or recent alcohol or drug abuse
- Diabetic ketoacidosis, hyperosmolar hyperglycaemic state or myocardial infarction in the six months prior to screening
- Patients on renal replacement therapy or likely require kidney transplant or dialysis during the study period
- Currently participating in another investigational study protocol where the testing or results may interfere with study compliance, diagnostic results, or data collection.
- An identified protected vulnerable patient (including but not limited to those in detention, or a prisoner).
Sites / Locations
- Prince of Wales HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
GLP1-ra plus basal insulin (BGLP)
Basal bolus insulin (BB)
Arm Description
Dulaglutide and insulin degludec in combination with CGM
Insulin aspart/lispro and insulin degludec in combination with CGM
Outcomes
Primary Outcome Measures
Glycemic variability
% coefficient of variation on blinded CGM
Secondary Outcome Measures
percent time in range
percent time 3.9-10 mmol/l on CGM
percent time below range
percent time below 3.9 mmol/l and below 3.0 mmol/l
percent time above range
percent time above 10 mmol/l and 13.9 mmol/l
HbA1c
HbA1c
Self reported hypoglycemia
level 1,2 and 3 hypoglycemia, biochemically confirmed
Self monitored glucose profiles
Fasting and postprandial
Body weight
Body weight
Insulin doses
Insulin doses
eGFR
estimated glomerular filrate rate by CKD-EPI equation
uACR
urine albumin creatinine ratio
Diabetes Treatment Satisfaction
Chinese version of Diabetes Treatment Satisfaction Questionnaire, higher score better
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05218915
Brief Title
Basal Plus GLP1-ra on Glycemic Variability in CKD
Official Title
Effect of Glucagon-like Peptide 1 Receptor Agonist in Combination With Insulin on Glycaemic Variability and Time-in-range in Diabetic Kidney Disease: a Randomised Controlled Trial
Study Type
Interventional
2. Study Status
Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
January 28, 2022 (Actual)
Primary Completion Date
June 30, 2024 (Anticipated)
Study Completion Date
January 3, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Elaine Chow
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
To compare GLP-1 RA plus basal insulin (BGLP) versus basal-bolus (BB) insulin regimens on glycemic variability (GV) and time in range (TIR) in diabetes patients CKD stage 3-4
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Diabetic Kidney Disease
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
GLP1-ra plus basal insulin (BGLP)
Arm Type
Experimental
Arm Description
Dulaglutide and insulin degludec in combination with CGM
Arm Title
Basal bolus insulin (BB)
Arm Type
Active Comparator
Arm Description
Insulin aspart/lispro and insulin degludec in combination with CGM
Intervention Type
Drug
Intervention Name(s)
Dulaglutide
Intervention Description
Dulaglutide once weekly subcutaneous
Intervention Type
Drug
Intervention Name(s)
Insulin Degludec
Intervention Description
Insulin degludec once daily
Intervention Type
Device
Intervention Name(s)
Continuous glucose monitor
Intervention Description
Dexcom G6 CGM system
Primary Outcome Measure Information:
Title
Glycemic variability
Description
% coefficient of variation on blinded CGM
Time Frame
16 weeks
Secondary Outcome Measure Information:
Title
percent time in range
Description
percent time 3.9-10 mmol/l on CGM
Time Frame
week 16 and 26
Title
percent time below range
Description
percent time below 3.9 mmol/l and below 3.0 mmol/l
Time Frame
week 16 and 26
Title
percent time above range
Description
percent time above 10 mmol/l and 13.9 mmol/l
Time Frame
week 16 and 26
Title
HbA1c
Description
HbA1c
Time Frame
week 16 and 26
Title
Self reported hypoglycemia
Description
level 1,2 and 3 hypoglycemia, biochemically confirmed
Time Frame
26 weeks
Title
Self monitored glucose profiles
Description
Fasting and postprandial
Time Frame
26 weeks
Title
Body weight
Description
Body weight
Time Frame
week 16 and 26
Title
Insulin doses
Description
Insulin doses
Time Frame
week 16 and 26
Title
eGFR
Description
estimated glomerular filrate rate by CKD-EPI equation
Time Frame
week 16 and 26
Title
uACR
Description
urine albumin creatinine ratio
Time Frame
week 16 and 26
Title
Diabetes Treatment Satisfaction
Description
Chinese version of Diabetes Treatment Satisfaction Questionnaire, higher score better
Time Frame
week 16 and 26
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Type 2 diabetes mellitus diagnosed for at least 6 months
Male or female age ≥ 18 years old and ≤ 75 years old.
Body mass index between 18 and 40 kg/m2 inclusive
HbA1c ≥ 6.5% and ≤ 9.0% at screening
Women who are not pregnant, lactating or planning a pregnancy during their participation in the clinical study.
Patients with CKD stage 3 or 4 as defined by estimated glomerular filtration rate between 15-59 ml/min/m2 by the modified Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation at screening
Willingness, ability and commitment to comply with the testing, procedure and follow-up outlined in this protocol including (but not limited to) and use of pre-specified glucose monitoring devices.
In the opinion of the investigator, absence of any physical limitations, addictive diseases, or underlying medical conditions (including mental health) that may preclude the patient from being a suitable study candidate.
Written informed consent to participate in the study provided by the patient.
Willing and capable of use of a continuous glucose monitor as judged by the investigator
Exclusion Criteria:
Type 1 diabetes
Currently pregnant, as demonstrated by a positive pregnancy test at screening or planning pregnancy
Treatment with GLP-1 RA or insulin degludec in the past three months
Any active acute or chronic disease or condition that, in the opinion of the investigator, might interfere with the performance of this study.
Any active acute or chronic infectious disease that, in the opinion of the investigator, would pose an excessive risk to study staff.
Current use or recent exposure to any medication that in the opinion of the investigator could have an influence on the patient's ability to participate in this study or on the performance of the test device.
Extensive skin changes/diseases that preclude wearing the CGM on normal skin at the proposed application sites (e.g., extensive psoriasis, recent burns or severe sunburn, extensive eczema, extensive scarring, extensive tattoos, dermatitis herpetiformis).
Have a known allergy to medical-grade adhesives
Known current or recent alcohol or drug abuse
Diabetic ketoacidosis, hyperosmolar hyperglycaemic state or myocardial infarction in the six months prior to screening
Patients on renal replacement therapy or likely require kidney transplant or dialysis during the study period
Currently participating in another investigational study protocol where the testing or results may interfere with study compliance, diagnostic results, or data collection.
An identified protected vulnerable patient (including but not limited to those in detention, or a prisoner).
Facility Information:
Facility Name
Prince of Wales Hospital
City
Sha Tin
Country
Hong Kong
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Elaine Chow, PhD
Phone
852 3505 3149
Email
e.chow@cuhk.edu.hk
First Name & Middle Initial & Last Name & Degree
Sharon Kwong
12. IPD Sharing Statement
Plan to Share IPD
No
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Basal Plus GLP1-ra on Glycemic Variability in CKD
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