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Safety and Efficacy of Human Microbiota Transplantation for Overweight and Obese Type 2 Diabetes Mellitus (SETOM)

Primary Purpose

Type 2 Diabetes Mellitus, Overweight and Obesity

Status
Not yet recruiting
Phase
Phase 2
Locations
China
Study Type
Interventional
Intervention
Fecal microbiota transplant (FMT)
normal saline and glycerin/food coloring
Sponsored by
Zhujiang Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes Mellitus focused on measuring Fecal Microbiota Transplantation(FMT), Type 2 Diabetes Mellitus, obesity, Weight Loss, Diabetes Mellitus, Overweight

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • A diagnosis of T2DM (≥2 months) according to the dagnostic and typing criteria of Chinese guideline for type 2 diabetes
  • Control the blood glucose level through diet or exercise only and never receive any hypoglycemic agent in the last 8 weeks.
  • Continuous treatment with insulin and its analogues for no more than 14 days in the last year. (The duration of treatment with insulin and its analogues for gestational diabetes mellitus is not included)
  • 7.0%≤HbA1c≤10.5%
  • Fasting plasma glucose(FPG)<15mmol/L
  • 24kg/m2≤BMI≤35kg/m2
  • Give informed consent and agree to receive FMT
  • Agree to maintain the same diet and exercise habit during the whole process.

Exclusion Criteria:

  1. Diagnosed with T1D, gestational diabetes mellitus(GDM) or other special type of diabetes.
  2. Self-reported weight changes of more than 5kg or use of medication which may result in weight-gain or weight-loss including diuretic, weight loss medicine and so on in the last 90 days.
  3. Use of antibiotics in the last 12 weeks
  4. Consumption of food or preparation like yogurt, fermented foods, dietary supplements (fish oil, probiotics, prebiotics, various microorganisms, minerals, nutritional foods or herbal preparations) and so on which can affect the gut microbiota in the last 4 weeks.
  5. Pregnancy, breast-feeding, or plans to become pregnant.
  6. Previous or planned bariatric surgery.
  7. Patients with gastrointestinal disease(such as Irritable bowel syndrome, inflammatory bowel disease, peptic ulcer, gastrointestinal bleeding history, etc.) or history of gastrointestinal surgery(such as gastrectomy, gastroenterostomy, bowel resection, etc.) and are assessed to be unsuitable to participate in this clinical trial by researchers.
  8. Patients with severe diabetic complications (diabetic ketoacidosis, hyperglycemic hyperosmolar condition etc.) in the last 6 months.
  9. Patients in unstable condition and need therapy for proliferative diabetic retinopathy or maculopathy, severe diabetic neuropathy, diabetic foot or intermittent claudication in the last 6 months.
  10. Patients with severe kidney diseases and liver diseases(alanine aminotransferase(ALT)>100U/L and/or aspartate aminotransferase(AST) >100U/L, glomerular filtration rate(eGFR)< 60 mL/min/1.73m2 calculated by CKD-EPI or proteinuria 2+ or above) or systemic diseases of other viscera.
  11. History or condition of following heart disease in the last 6 months 1)Decompensated cardiac insufficiency(graded III or IV in NYHA) 2)History of unstable angina, myocardial infarction, coronary artery bypass grafting, or coronary stent implantation 3)Diagnosed with Severe arrhythmias requiring treatment(like long QT syndrome etc.), and assessed to be unsuitable to participate in this clinical trial by researchers
  12. Patients with uncontrolled hypertension (systolic blood pressure (SBP) ≥ 160mmHg or diastolic blood pressure (DBP) ≥ 100mmHg at screening time).
  13. Diagnosed with hemorrhagic stroke or ischemia stroke in the last 6 months and assessed to be unsuitable to participate in this clinical trial by researchers.
  14. History of other severe endocrine system diseases that affect glucose metabolism or body weight, such as multiple endocrine adenomas, acromegaly syndrome, Cushing's syndrome, and hyperthyroidism and assessed to be unsuitable to participate in this clinical trial by researchers.
  15. History of malignant tumor in the last 5 years(cured basal cell carcinoma of the skin and carcinoma in situ of the cervix are excluded) or malignant tumor being assessed.
  16. Patients who have psychiatric disorders or language disorders or are unable or reluctant to communicate, cooperate and be followed up or may have difficulty completing the study judged by the investigator.
  17. Patients with anemia or patients who need regular blood transfusion treatment.
  18. Patients with severe infection or trauma or history of major surgery in the last 3 months and assessed to be unsuitable to participate in this clinical trial by researchers.
  19. History of substance abuse in the last five years, including repeated and large use of dependent medication which is unrelated to medical purposes(addiction medicine and habitual medicine which can lead to physical and mental dependence are included)
  20. HIV, TP and HBsAg positive.
  21. Participated in any clinical trials of interventional medication or devices in the last 3 months.
  22. Patients who have suspected or confirmed history of alcohol or drug abuse.
  23. Patients known to be allergic to the FMT or its accessories.
  24. Patients who have used drugs that may affect blood glucose for more than 1 week in the last 12 weeks, such as oral/intravenous glucocorticoid growth hormone, estrogen/progesterone, high-dose diuretics, antipsychotic drugs, etc. (usage of low-dose diuretics (hydrochlorothiazide < 25mg/d, indapamide ≤1.5mg/d) for antihypertensive purposes are not included)
  25. Patients who are assessed to be unsuitable to participate in this clinical trial by researchers for other reasons.

Sites / Locations

  • Zhujiang Hospital of Southern Medical University

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

intervention

placebo

Arm Description

Patients who receive a fecal microbiota transplantation via a nasointestinal tube.

Patients who receive a placebo FMT via a nasointestinal tube.

Outcomes

Primary Outcome Measures

Percentage of change in weight compared with baseline.

Secondary Outcome Measures

The absolute value of change in weight compared with baseline.
Proportion of at least 5% reduction in weight.
Proportion of at least 10% reduction in weight.
Proportion of at least 15% reduction in weight.
Proportion of patients with HbA1c < 7.0%.
Proportion of patients with HbA1c < 6.5%.
Change in the level of HbA1c.
Change in FCP (fasting C-peptide) compared with baseline.
Change in FPG (fasting plasma glucose) compared with baseline.
Change in FINS (fasting serum insulin) compared with baseline.
Change in 2h-PPG (Postprandial plasma glucose) compared with baseline.
Change in the level of 2-hour postprandial C-peptide compared with baseline.
Change in the level of 2-hour postprandial serum insulin compared with baseline.
Change in BMI compared with baseline.
Change in waist circumference compared with baseline.
Change in hip circumference compared with baseline.
Change in waist hip ratio compared with baseline.
Change in body fat rate compared with baseline.
Change in visceral fat area compared with baseline.
Change in basal metabolic rate compared with baseline.
Change in TC、TG、HDL and LDL compared with baseline.
Change in Blood pressure parameter (SBP, DBP) compared with baseline.
Change in inflammatory markers (hS-CRP, IL-6) compared with baseline.
Change in gut microbiota composition compared with baseline.
Change in serum metabolic profile compared with baseline.
Safety of FMT
Rate of adverse events(reflux, aspiration, nausea, vomiting belching, abdominal distension, abdominal pain, diarrhea, constipation, infection, fever etc.).

Full Information

First Posted
December 23, 2021
Last Updated
February 13, 2022
Sponsor
Zhujiang Hospital
Collaborators
First Affiliated Hospital of Shantou University Medical College, Dongguan People's Hospital, Shenzhen Hengsheng Hospital, The Fifth People's Hospital of Zhuhai, Dongguan Wanjiang Hospital, Shaoguan Qide Hospital, People's Hospital of Wengyuan County, Shaoguan, Zhaoqing First People's Hospital, Suixi Hospital of Guangdong Medical University, Shenzhen University General Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT05253768
Brief Title
Safety and Efficacy of Human Microbiota Transplantation for Overweight and Obese Type 2 Diabetes Mellitus
Acronym
SETOM
Official Title
Safety and Efficacy of Human Microbiota Transplantation for Overweight and Obese Type 2 Diabetes Mellitus ( SETOM ): A Randomized, Double-blind, Placebo-controlled Clinical Study
Study Type
Interventional

2. Study Status

Record Verification Date
February 2022
Overall Recruitment Status
Not yet recruiting
Study Start Date
February 2022 (Anticipated)
Primary Completion Date
August 2022 (Anticipated)
Study Completion Date
August 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Zhujiang Hospital
Collaborators
First Affiliated Hospital of Shantou University Medical College, Dongguan People's Hospital, Shenzhen Hengsheng Hospital, The Fifth People's Hospital of Zhuhai, Dongguan Wanjiang Hospital, Shaoguan Qide Hospital, People's Hospital of Wengyuan County, Shaoguan, Zhaoqing First People's Hospital, Suixi Hospital of Guangdong Medical University, Shenzhen University General Hospital

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
The main purpose is to evaluate whether the percentage of body weight change from baseline to week 12 is higher than that in the placebo group. In this randomized, double-blind, placebo-controlled study, 40 patients fulfilling the study criteria and 4 healthy donors will be enrolled. Patients will be randomized(1:1) to either FMT or placebo.
Detailed Description
This is a randomized, double-blind, placebo-controlled study evaluating fecal microbiota transplantation from lean healthy donors to reduce the patients' weight. Patients wishing to participate will be evaluated whether they qualify for the study regarding the aforementioned inclusion and exclusion criteria. The details of the experiment and potential risks or discomforts involved in it will be presented, after which the patients will sign informed consent forms. In this study, patients will be randomly assigned to the experimental group and the control group in a 1:1 ratio according to a random allocation table. The table will be formulated on the basis of the random numbers generated by SPSS. The study will comprise of three parts: Baseline - two weeks of run-in and screening period. Ensure that each patient reads and signs informed consent. Collect demographic data. Ask about past medical history, current medical history, surgical history, allergy history, etc. Ask about previous medication and combination medication. Complete the FFQ questionnaire. Collect information about vital signs, physical examination, BMI, ECG, conventional index and therapeutic effect index. Collect 2 tubes of stool samples for fecal metagenomics sequencing and three tubes of blood samples for measuring serum metabolomics and inflammatory index (IL-6). Review whether patients qualify for participate in the study according to the inclusion and exclusion criteria. Dietitian will give diet, exercise lifestyle intervention guidance to patients. FMT/ placebo intervention-patients will receive three interventions every two weeks. Four donors will be recruited in this study, including 2 males and 2 females. Patients will receive 200-300ml FMT from donors with the same gender or receive the same amount of placebo FMT. FMT will be packaged in a 100ml sterile syringe or in an enema bag/surgical nutrition bag, the outer package of which will be affixed with the unique identifiable bar code label generated according to the biological specimen bank of the Department of Laboratory Medicine. The placebo FMT will be mainly composed of normal saline and glycerin and will be packaged in the same way as FMT. The night before receiving FMT or placebo FMT via nasointestinal tube, patients will go through proton pump inhibitors(oral 20mg esomeprazole or 40mg omeprazole). The end of the nasointestinal tube should reach at least the patient's duodenum, or reach the patient's jejunum if the patient cooperate. To prevent aspiration, the patient's upper body must maintain an upright posture of 45 degrees for 4 hours after the infusion. Before the first intervention, information about drug combination, vital signs, physical examination, BMI, body composition analysis and adverse events of patients will be collected, and advice of diet and lifestyle will be given to patients. Before the second intervention and before the third intervention, information about drug combination, vital signs, physical examination, BMI, renal function, liver function, blood fat, fasting blood glucose/C-peptide/insulin, body composition analysis and adverse events of patients will be collected, and advice of diet and lifestyle will be given to patients. Follow-up meetings - total follow up of 6 weeks after FMT/placebo intervention. Meetings will occur 2 weeks and 6 weeks after the third intervention. During every follow-up meeting, information about drug combination, vital signs, physical examination, BMI, inflammatory biomarkers, renal function, liver function, blood fat, HbAlc, fasting blood glucose/C-peptide/insulin, 2-hour postprandial blood glucose/C-peptide/insulin, body composition analysis and adverse events of patients will be collected, and advice of diet and lifestyle will be given to patients. In the second follow-up meeting, there will be a fecal metagenomics sequencing and a serum metabonomics analysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 2 Diabetes Mellitus, Overweight and Obesity
Keywords
Fecal Microbiota Transplantation(FMT), Type 2 Diabetes Mellitus, obesity, Weight Loss, Diabetes Mellitus, Overweight

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
40 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
intervention
Arm Type
Experimental
Arm Description
Patients who receive a fecal microbiota transplantation via a nasointestinal tube.
Arm Title
placebo
Arm Type
Placebo Comparator
Arm Description
Patients who receive a placebo FMT via a nasointestinal tube.
Intervention Type
Biological
Intervention Name(s)
Fecal microbiota transplant (FMT)
Intervention Description
Patients will randomized to a fecal microbiota transplantation by using a nasointestinal tube for 3 times in 4 weeks(0,2,4) without undergoing an enema before the treatment. The amount of FMT is 200-300ml at one time. Patients are given the same lifestyle guidance and nutritional advice.
Intervention Type
Other
Intervention Name(s)
normal saline and glycerin/food coloring
Intervention Description
Patients will receive an equivalent volume of normal saline and glycerin/food coloring via a nasointestinal tube (sham transplantation) for 3 times in 4 weeks(0,2,4) without undergoing an enema before the treatment. The amount of placebo FMT is 200-300ml at one time. Patients are given the same lifestyle guidance and nutritional advice.
Primary Outcome Measure Information:
Title
Percentage of change in weight compared with baseline.
Time Frame
12 weeks
Secondary Outcome Measure Information:
Title
The absolute value of change in weight compared with baseline.
Time Frame
6,12 weeks
Title
Proportion of at least 5% reduction in weight.
Time Frame
6,12 weeks
Title
Proportion of at least 10% reduction in weight.
Time Frame
12 weeks
Title
Proportion of at least 15% reduction in weight.
Time Frame
12 weeks
Title
Proportion of patients with HbA1c < 7.0%.
Time Frame
12 weeks
Title
Proportion of patients with HbA1c < 6.5%.
Time Frame
12 weeks
Title
Change in the level of HbA1c.
Time Frame
6,12 weeks
Title
Change in FCP (fasting C-peptide) compared with baseline.
Time Frame
6,12 weeks
Title
Change in FPG (fasting plasma glucose) compared with baseline.
Time Frame
6,12 weeks
Title
Change in FINS (fasting serum insulin) compared with baseline.
Time Frame
6,12 weeks
Title
Change in 2h-PPG (Postprandial plasma glucose) compared with baseline.
Time Frame
6,12 weeks
Title
Change in the level of 2-hour postprandial C-peptide compared with baseline.
Time Frame
6,12 weeks
Title
Change in the level of 2-hour postprandial serum insulin compared with baseline.
Time Frame
6,12 weeks
Title
Change in BMI compared with baseline.
Time Frame
6,12 weeks
Title
Change in waist circumference compared with baseline.
Time Frame
6,12 weeks
Title
Change in hip circumference compared with baseline.
Time Frame
6,12 weeks
Title
Change in waist hip ratio compared with baseline.
Time Frame
6,12 weeks
Title
Change in body fat rate compared with baseline.
Time Frame
6,12 weeks
Title
Change in visceral fat area compared with baseline.
Time Frame
6,12 weeks
Title
Change in basal metabolic rate compared with baseline.
Time Frame
6,12 weeks
Title
Change in TC、TG、HDL and LDL compared with baseline.
Time Frame
6,12 weeks
Title
Change in Blood pressure parameter (SBP, DBP) compared with baseline.
Time Frame
6,12 weeks
Title
Change in inflammatory markers (hS-CRP, IL-6) compared with baseline.
Time Frame
6,12 weeks
Title
Change in gut microbiota composition compared with baseline.
Time Frame
12 weeks
Title
Change in serum metabolic profile compared with baseline.
Time Frame
12 weeks
Title
Safety of FMT
Description
Rate of adverse events(reflux, aspiration, nausea, vomiting belching, abdominal distension, abdominal pain, diarrhea, constipation, infection, fever etc.).
Time Frame
12 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: A diagnosis of T2DM (≥2 months) according to the dagnostic and typing criteria of Chinese guideline for type 2 diabetes Control the blood glucose level through diet or exercise only and never receive any hypoglycemic agent in the last 8 weeks. Continuous treatment with insulin and its analogues for no more than 14 days in the last year. (The duration of treatment with insulin and its analogues for gestational diabetes mellitus is not included) 7.0%≤HbA1c≤10.5% Fasting plasma glucose(FPG)<15mmol/L 24kg/m2≤BMI≤35kg/m2 Give informed consent and agree to receive FMT Agree to maintain the same diet and exercise habit during the whole process. Exclusion Criteria: Diagnosed with T1D, gestational diabetes mellitus(GDM) or other special type of diabetes. Self-reported weight changes of more than 5kg or use of medication which may result in weight-gain or weight-loss including diuretic, weight loss medicine and so on in the last 90 days. Use of antibiotics in the last 12 weeks Consumption of food or preparation like yogurt, fermented foods, dietary supplements (fish oil, probiotics, prebiotics, various microorganisms, minerals, nutritional foods or herbal preparations) and so on which can affect the gut microbiota in the last 4 weeks. Pregnancy, breast-feeding, or plans to become pregnant. Previous or planned bariatric surgery. Patients with gastrointestinal disease(such as Irritable bowel syndrome, inflammatory bowel disease, peptic ulcer, gastrointestinal bleeding history, etc.) or history of gastrointestinal surgery(such as gastrectomy, gastroenterostomy, bowel resection, etc.) and are assessed to be unsuitable to participate in this clinical trial by researchers. Patients with severe diabetic complications (diabetic ketoacidosis, hyperglycemic hyperosmolar condition etc.) in the last 6 months. Patients in unstable condition and need therapy for proliferative diabetic retinopathy or maculopathy, severe diabetic neuropathy, diabetic foot or intermittent claudication in the last 6 months. Patients with severe kidney diseases and liver diseases(alanine aminotransferase(ALT)>100U/L and/or aspartate aminotransferase(AST) >100U/L, glomerular filtration rate(eGFR)< 60 mL/min/1.73m2 calculated by CKD-EPI or proteinuria 2+ or above) or systemic diseases of other viscera. History or condition of following heart disease in the last 6 months 1)Decompensated cardiac insufficiency(graded III or IV in NYHA) 2)History of unstable angina, myocardial infarction, coronary artery bypass grafting, or coronary stent implantation 3)Diagnosed with Severe arrhythmias requiring treatment(like long QT syndrome etc.), and assessed to be unsuitable to participate in this clinical trial by researchers Patients with uncontrolled hypertension (systolic blood pressure (SBP) ≥ 160mmHg or diastolic blood pressure (DBP) ≥ 100mmHg at screening time). Diagnosed with hemorrhagic stroke or ischemia stroke in the last 6 months and assessed to be unsuitable to participate in this clinical trial by researchers. History of other severe endocrine system diseases that affect glucose metabolism or body weight, such as multiple endocrine adenomas, acromegaly syndrome, Cushing's syndrome, and hyperthyroidism and assessed to be unsuitable to participate in this clinical trial by researchers. History of malignant tumor in the last 5 years(cured basal cell carcinoma of the skin and carcinoma in situ of the cervix are excluded) or malignant tumor being assessed. Patients who have psychiatric disorders or language disorders or are unable or reluctant to communicate, cooperate and be followed up or may have difficulty completing the study judged by the investigator. Patients with anemia or patients who need regular blood transfusion treatment. Patients with severe infection or trauma or history of major surgery in the last 3 months and assessed to be unsuitable to participate in this clinical trial by researchers. History of substance abuse in the last five years, including repeated and large use of dependent medication which is unrelated to medical purposes(addiction medicine and habitual medicine which can lead to physical and mental dependence are included) HIV, TP and HBsAg positive. Participated in any clinical trials of interventional medication or devices in the last 3 months. Patients who have suspected or confirmed history of alcohol or drug abuse. Patients known to be allergic to the FMT or its accessories. Patients who have used drugs that may affect blood glucose for more than 1 week in the last 12 weeks, such as oral/intravenous glucocorticoid growth hormone, estrogen/progesterone, high-dose diuretics, antipsychotic drugs, etc. (usage of low-dose diuretics (hydrochlorothiazide < 25mg/d, indapamide ≤1.5mg/d) for antihypertensive purposes are not included) Patients who are assessed to be unsuitable to participate in this clinical trial by researchers for other reasons.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Hong Chen, MD
Phone
13602759769
Email
rubychq@163.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Hong Chen, MD
Organizational Affiliation
Zhujiang Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Zhujiang Hospital of Southern Medical University
City
Guangzhou
State/Province
Guangdong
ZIP/Postal Code
510000
Country
China

12. IPD Sharing Statement

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Safety and Efficacy of Human Microbiota Transplantation for Overweight and Obese Type 2 Diabetes Mellitus

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