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Assessment of Pancreatic Beta Cell Mass and Function by Positron Emission Tomography Imaging in Human Diabetes Mellitus

Primary Purpose

type1diabetes, Type2diabetes, Pre Diabetes

Status
Recruiting
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
68Ga-exendin-4
mixed meal test
Sponsored by
Azienda Ospedaliero-Universitaria di Parma
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for type1diabetes focused on measuring diabetes, beta-cell, exendin, PET-CT

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Age ≥18 years; ≤ 75 years Both sexes Good health Absence of exclusion criteria Able to understand methods, goals, and implications of the research and of delivering a free, written informed consent Exclusion Criteria: Hemoglobin < 12 g/dl HbA1c > 10% Pregnancy or breast-feeding If not in menopause, women not using effective birth control methods or not willing to undergo a pregnancy test History of severe psychiatric disorder or alcohol abuse Recent head traumas (<6 months) Active neurologic diseases Claustrophobia Active malignant neoplasms Severe kidney and/or liver disease Recent (<6 months) major adverse cardiovascular events Heart failure (class NYHA 3-4) Drugs known to affect beta cell function and/or insulin sensitivity Current or past treatment with GLP1R-agonists Intolerance to exenatide Endocrine diseases, other than diabetes mellitus, known to affect beta cell function and/or insulin sensitivity, except well controlled hypothyroidism or adrenal insufficiency COPD on day time oxygen therapy Any current acute disease

Sites / Locations

  • Azienda Ospedaliero Universitaria di ParmaRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm 7

Arm Type

Other

Other

Other

Other

Other

Other

Other

Arm Label

long standing type 1 diabetes (> 20 yrs)

newly diagnosed type 1 diabetes (< 5yrs)

long standing type 2 diabetes (> 20 yrs)

newly diagnosed type 2 diabetes (<6 months)

pre-diabetes

hyperinsulinemic

control

Arm Description

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

68Ga-exendin4 PET-CT scan +mixed meal test

Outcomes

Primary Outcome Measures

BCF x M
BCFxM=parameters derived from mixed meal test Beta cell function(BCF)=BCFxM/BCM
pancreatic beta cell mass (BCM)
Beta cell mass index (BCM) = 68GA-exendin-4 Standard Uptake Value (SUV)*pancreatic volume
pancreatic beta cell function (BCF)
BCFxM/BCM

Secondary Outcome Measures

Full Information

First Posted
December 1, 2022
Last Updated
December 20, 2022
Sponsor
Azienda Ospedaliero-Universitaria di Parma
Collaborators
University of Parma
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1. Study Identification

Unique Protocol Identification Number
NCT05662189
Brief Title
Assessment of Pancreatic Beta Cell Mass and Function by Positron Emission Tomography Imaging in Human Diabetes Mellitus
Official Title
Assessment of Pancreatic Beta Cell Mass and Function With the Aid of Positron Emission Tomography Imaging in Human Diabetes Mellitus
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
March 15, 2022 (Actual)
Primary Completion Date
October 2023 (Anticipated)
Study Completion Date
December 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Azienda Ospedaliero-Universitaria di Parma
Collaborators
University of Parma

4. Oversight

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

5. Study Description

Brief Summary
The goals of this project are to build an experimental tool to dissect out in vivo pancreatic beta cell mass (BCM) and beta cell function (BCF) and to assess for the first time these two determinants of beta cell functional mass (BCFxM) in obesity and in various stages of type 1 and type 2 diabetes mellitus.
Detailed Description
Pancreatic beta cell functional mass (BCFxM) can be loosely defined as the product of beta cell mass (BCM) multiplied by beta cell function (BCF). Current in vivo methods (e.g. hyperglycemic clamp, intravenous glucose tolerance test, oral glucose tolerance test, mixed meal tolerance test) actually assess BCFxM, not beta cell function per se. Loss of BCFxM is at the heart of the etiology and pathogenesis of both type 1 (2) and type 2 diabetes mellitus. In the former, destruction of beta cell mass by autoimmune insulitis is the the primary determinant of BCFxM loss. In the latter, beta cell mass loss is about 25-35% and keeps increasing with the duration of the disease, but an additional key role is played by the loss of beta cell function. Previous dogma held that in type 1 diabetes complete destruction of beta cells was achieved within ≈5 years from diagnosis. Recent data have challenged this concept and shown that residues of both beta cells and BCFxM (i.e. nutrient-stimulated C-peptide secretion, which is equimolar and simultaneous to insulin secretion and is a much better biomarker of BCFxM than insulin concentration) are detectable even decades after diagnosis. Exendin-4 has been already labeled with a positron emitting nuclide and made amenable to PET imaging for diagnostic purposes. Under rigorous experimental conditions, beta cell standardized uptake per volume (SUV) of the ligand could be assessed. Furthermore, current PET-CT instruments can also provide a measure of pancreatic volume BCFxM can be determined accurately by mathematical modeling of relatively simple tests, such as a mixed meal. The investigators will assess the relative roles of beta cell mass (BCM) and beta cell function (BCF) in two polar BCFxM groups : people with long-standing type 1 diabetes (close to 0 BCFxM) and obese people with normal glucose regulation (highest expected BCFxM), i.e. the investigators will test our method in a negative control (type 1 diabetes) and in a strongly positive control (uncomplicated obesity). A group of lean controls will be studied to ascertain that their BCMs, as determined by 68GA-exendin-4 PET-CT, fall, as they should, in the intermediate range between type 1 diabetes and obesity.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
type1diabetes, Type2diabetes, Pre Diabetes, Hyperinsulinism
Keywords
diabetes, beta-cell, exendin, PET-CT

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Obese people with normal glucose regulation , patients with long standing or newly diagnosed type 1 diabetes, patients with long standing or newly diagnosed type 2 diabetes, subjects with pre-diabetes, and lean healthy age- and gender-matched controls will participate in two study sessions on two separate days: Session A (Endocrinology and Metabolic Diseases Unit) - Quantitation of beta cell functional mass (BCFxM) by mixed-meal test Session B (Nuclear Medicine Unit) - Quantitation of beta cell mass (BCM) by PET-CT scan.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
70 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
long standing type 1 diabetes (> 20 yrs)
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
newly diagnosed type 1 diabetes (< 5yrs)
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
long standing type 2 diabetes (> 20 yrs)
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
newly diagnosed type 2 diabetes (<6 months)
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
pre-diabetes
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
hyperinsulinemic
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Arm Title
control
Arm Type
Other
Arm Description
68Ga-exendin4 PET-CT scan +mixed meal test
Intervention Type
Drug
Intervention Name(s)
68Ga-exendin-4
Intervention Description
68Ga-exendin4 PET-CT scan
Intervention Type
Other
Intervention Name(s)
mixed meal test
Intervention Description
before and after a standardized mixed meal venous blood samples will be collected at time intervals to measure plasma glucose, C-peptide,insulin, glucagon, glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) curves
Primary Outcome Measure Information:
Title
BCF x M
Description
BCFxM=parameters derived from mixed meal test Beta cell function(BCF)=BCFxM/BCM
Time Frame
through study completion, an average of 3 months after enrolment
Title
pancreatic beta cell mass (BCM)
Description
Beta cell mass index (BCM) = 68GA-exendin-4 Standard Uptake Value (SUV)*pancreatic volume
Time Frame
through study completion, an average of 3 months after enrolment
Title
pancreatic beta cell function (BCF)
Description
BCFxM/BCM
Time Frame
through study completion, an average of 3 months after enrolment

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: Age ≥18 years; ≤ 75 years Both sexes Good health Absence of exclusion criteria Able to understand methods, goals, and implications of the research and of delivering a free, written informed consent Exclusion Criteria: Hemoglobin < 12 g/dl HbA1c > 10% Pregnancy or breast-feeding If not in menopause, women not using effective birth control methods or not willing to undergo a pregnancy test History of severe psychiatric disorder or alcohol abuse Recent head traumas (<6 months) Active neurologic diseases Claustrophobia Active malignant neoplasms Severe kidney and/or liver disease Recent (<6 months) major adverse cardiovascular events Heart failure (class NYHA 3-4) Drugs known to affect beta cell function and/or insulin sensitivity Current or past treatment with GLP1R-agonists Intolerance to exenatide Endocrine diseases, other than diabetes mellitus, known to affect beta cell function and/or insulin sensitivity, except well controlled hypothyroidism or adrenal insufficiency COPD on day time oxygen therapy Any current acute disease
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Riccardo Bonadonna, MD
Phone
+390521033307
Email
riccardo.bonadonna@unipr.it
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Riccardo Bonadonna, MD
Organizational Affiliation
Azienda Ospedaliero Universitaria di Parma, University of Parma
Official's Role
Principal Investigator
Facility Information:
Facility Name
Azienda Ospedaliero Universitaria di Parma
City
Parma
State/Province
Pr
ZIP/Postal Code
43126
Country
Italy
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Raffaella Aldigeri, MSc
Phone
+390521033306
Email
raffaella.aldigeri@unipr.it
First Name & Middle Initial & Last Name & Degree
Alessandra Dei Cas, PhD
First Name & Middle Initial & Last Name & Degree
Livia Ruffini, MD

12. IPD Sharing Statement

Learn more about this trial

Assessment of Pancreatic Beta Cell Mass and Function by Positron Emission Tomography Imaging in Human Diabetes Mellitus

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