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Comparison of Hepatic Directed Vesicle (HDV)-Insulin Lispro Versus Insulin Lispro to Further Improve Glycemic Control

Primary Purpose

Diabetes Mellitus, Type 1

Status
Completed
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
HDV insulin lispro 100 UNT/ML
Insulin Lispro 100 UNT/ML
Sponsored by
Diasome Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1

Eligibility Criteria

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

Inclusion Criteria:

  1. Male or female of age 18 to 65 years, inclusive. Females of child-bearing potential must use a standard and effective means of birth control for the duration of the study
  2. T1DM ≥12 months
  3. C-peptide <0.6 ng/mL (single retest allowed)
  4. Treatment with rapid analog insulin for the previous 6 months and willing to use insulin vial and syringe to deliver rapid acting insulin during the study
  5. Currently using either insulin glargine (U100 only) or insulin degludec for basal insulin therapy for at least 4 weeks prior to study
  6. Not using insulin pump delivery systems during the previous 3 months
  7. Familiarity with continuous glucose monitoring (CGM) technology; subjects need to be not currently using CGM; subjects will NOT use unblinded CGM during the treatment period of the trial
  8. Willingness to use insulin lispro as the analog bolus insulin during the study period
  9. BMI ≥18.0 kg/m2 and ≤35.0 kg/m2
  10. 6.9%≤A1C≤7.9% (single retest allowed)

Exclusion Criteria:

  1. Known or suspected allergy to any component of any of the study drugs in this trial.
  2. A patient who has unstable proliferative retinopathy or maculopathy, and/or severe neuropathy, in particular autonomic neuropathy, as judged by the Investigator
  3. As judged by the investigator, clinically significant active disease of the gastrointestinal, cardiovascular (including a history of arrhythmia or conduction delays on ECG), hepatic, neurological, renal, genitourinary, or hematological systems, or uncontrolled hypertension (diastolic blood pressure ≥ 100 mmHg and/or systolic blood pressure ≥ 160 mmHg after 5 minutes in the supine position).
  4. History of any illness or disease that in the opinion of the Investigator might confound the results of the trial or pose additional risk in administering the study drugs to the patient.
  5. As judged by the Investigator, clinically significant findings in routine laboratory data
  6. Use of drugs that may interfere with the interpretation of trial results or are known to cause clinically relevant interference with insulin action, glucose utilization, or recovery from hypoglycemia
  7. Use of oral anti-diabetic or non-insulin anti-diabetic injection therapies (e.g. SGLT-2 inhibitors, pramlintide, GLP-1 agonists, etc.) during the 4 weeks prior to randomization
  8. Current smokers; if a former smoker, no tobacco products (inhaled, oral or buccal) for the previous 3 months
  9. Use of e-cigarettes or other nicotine-containing products for the previous 3 months
  10. Current addiction to alcohol or substances of abuse as determined by the Investigator.
  11. Pregnancy, breast-feeding, the intention of becoming pregnant, or not using adequate contraceptive measures (adequate contraceptive measures consist of sterilization, intra-uterine device [IUD], oral or injectable contraceptives, barrier methods or abstinence as per investigator discretion).
  12. Mental incapacity, unwillingness, or language barriers precluding adequate understanding or cooperation in this study
  13. Symptomatic gastroparesis.
  14. Receipt of any investigational drug within 4 weeks of Visit 2 in this study
  15. Any condition (intrinsic or extrinsic) that in the judgment of the Investigator will interfere with trial participation or evaluation of data

Sites / Locations

  • Barbara Davis Center for Diabetes, University of Colorado
  • Baptist Diabetes Associates
  • Lucas Research, Inc.
  • Texas Diabetes and Endocrinology
  • Texas Diabetes and Endocrinology

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

HDV insulin lispro 100 UNT/mL

insulin lispro 100 UNT/ML

Arm Description

insulin lispro with 0.8 ml HDV added to a 10 ml vial of insulin lispro, injected subcutaneous before meals as needed. Study duration of 7 weeks (6 weeks of treatment)

insulin lispro with 0.8 ml sterile water for injection added to a 10 ml vial of insulin lispro, injected subcutaneous before meals as needed. Study duration of 7 weeks (6 weeks of treatment)

Outcomes

Primary Outcome Measures

The amount of time, in minutes, glucose levels are within range (70-180 mg/dL)
evaluate continuous glucose monitoring (CGM) profiles during treatment with HDV insulin lispro versus insulin lispro alone, with specific focus on time in range (70-180 mg/dL)

Secondary Outcome Measures

The number of events that blood glucose is equal to or less than 70 mg/dL
evaluate hypoglycemia frequency and severity during treatment with HDV insulin lispro versus insulin lispro alone
The number of events blood glucose is less than 54 mg/dL
evaluate hypoglycemia frequency and severity during treatment with HDV insulin lispro versus insulin lispro alone
Postprandial glucose levels in mg/dL following test meal challenge
evaluate glucose response to a standardized test meal challenge following six weeks of treatment with HDV insulin lispro versus insulin lispro alone
HbA1c levels in percentage (%) at beginning of trial compared to HbA1c levels at the end of the study
evaluate overall glycemic control (A1C) following six weeks of treatment with HDV insulin lispro versus insulin lispro alone
Self-Monitoring Blood Glucose (SMBG) results in mg/dL before and after every meal
evaluate self-monitoring of blood glucose (SMBG) values before and after meals during treatment with HDV insulin lispro versus insulin lispro alone
Total doses of insulin used (in number of units of insulin injected) during the study
compare insulin doses (prandial, basal and total) during HDV insulin lispro treatment versus insulin lispro alone

Full Information

First Posted
March 1, 2017
Last Updated
July 29, 2018
Sponsor
Diasome Pharmaceuticals
Collaborators
Integrium
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1. Study Identification

Unique Protocol Identification Number
NCT03096392
Brief Title
Comparison of Hepatic Directed Vesicle (HDV)-Insulin Lispro Versus Insulin Lispro to Further Improve Glycemic Control
Official Title
A Randomized Controlled Comparison of Hepatic Directed Vesicle (HDV)-Insulin Lispro Versus Insulin Lispro Alone to Further Improve Glycemic Control in Type 1 Diabetes Mellitus Subjects With Good Glycemic Control
Study Type
Interventional

2. Study Status

Record Verification Date
April 2017
Overall Recruitment Status
Completed
Study Start Date
April 18, 2017 (Actual)
Primary Completion Date
November 15, 2017 (Actual)
Study Completion Date
March 18, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Diasome Pharmaceuticals
Collaborators
Integrium

4. Oversight

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

5. Study Description

Brief Summary
Multi-Center, double blind, active comparator controlled multiple dose safety, tolerability and efficacy study
Detailed Description
This is a double blind, active comparator controlled multiple dose safety, tolerability and efficacy study comparing HDV insulin lispro with insulin lispro in 40 Type 1 Diabetes Mellitus Subjects with Good Glycemic Control, with specific focus on time in range (70-180 mg/dL). Subjects will be screened and then monitored with one week of baseline CGM. They will then be randomized to one of two treatment groups: (A) six weeks of treatment with HDV-lispro (B) six weeks of treatment with insulin lispro diluted with sterile water alone. All subjects will use insulin glargine or insulin degludec for basal insulin coverage throughout the trial. Fasting glucose goals will be 70-120 mg/dL, with recommendations for dosage adjustments made twice weekly according to a simple dosing algorithm based on mean fasting glucose values during the previous 3-4 days. Subjects will receive standard diabetes education refresher training at the beginning of the trial, including review of insulin dose administration and titration, carbohydrate counting (or other dietary planning as deemed appropriate by the investigator), avoidance of hypoglycemia, and management of exercise and stress. Post meal (60-90 min after start of meal) goals will be <140 mg/dL. A test meal study (standardized liquid test meal) to be conducted at the beginning of treatment (baseline study) and at the end of the six week treatment period (treatment comparison study). Subjects will also perform blinded continuous glucose monitoring during 4 weeks of study (i.e weeks 1,3,5 and 7 of study) Throughout study, subjects will be asked to perform frequent self-monitoring of blood glucose (SMBG), at least 6 times per day (before and 60-90 minutes after each meal) during 3 or more days of each week. This will serve as data for therapeutic decision-making as well as for data collection.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Model Description
Double blind, active comparator controlled (insulin lispro) to HDV insulin lispro, multiple dose safety, tolerability and efficacy study
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
All subjects, investigators, monitors, sponsor and sponsor representatives are blinded to the treatment group and treatment to patients are randomized. The group randomizing the subjects, the pharmacist preparing the drug, the party shipping the drug are unblinded but do not have contact with the blinded parties. An unblinded monitor will monitor any activities performed by unblinded parties.
Allocation
Randomized
Enrollment
46 (Actual)

8. Arms, Groups, and Interventions

Arm Title
HDV insulin lispro 100 UNT/mL
Arm Type
Experimental
Arm Description
insulin lispro with 0.8 ml HDV added to a 10 ml vial of insulin lispro, injected subcutaneous before meals as needed. Study duration of 7 weeks (6 weeks of treatment)
Arm Title
insulin lispro 100 UNT/ML
Arm Type
Active Comparator
Arm Description
insulin lispro with 0.8 ml sterile water for injection added to a 10 ml vial of insulin lispro, injected subcutaneous before meals as needed. Study duration of 7 weeks (6 weeks of treatment)
Intervention Type
Drug
Intervention Name(s)
HDV insulin lispro 100 UNT/ML
Other Intervention Name(s)
Hepatic Directed Vesicle insulin lispro 100 UNT/ML
Intervention Description
HDV is the active excipient, added to insulin lispro. HDV binds to a portion of the insulin lispro.
Intervention Type
Drug
Intervention Name(s)
Insulin Lispro 100 UNT/ML
Other Intervention Name(s)
Humalog
Intervention Description
Sterile Water for Injection is added to the insulin lispro, to dilute the insulin lispro equal to the HDV insulin lispro
Primary Outcome Measure Information:
Title
The amount of time, in minutes, glucose levels are within range (70-180 mg/dL)
Description
evaluate continuous glucose monitoring (CGM) profiles during treatment with HDV insulin lispro versus insulin lispro alone, with specific focus on time in range (70-180 mg/dL)
Time Frame
6 weeks
Secondary Outcome Measure Information:
Title
The number of events that blood glucose is equal to or less than 70 mg/dL
Description
evaluate hypoglycemia frequency and severity during treatment with HDV insulin lispro versus insulin lispro alone
Time Frame
6 weeks
Title
The number of events blood glucose is less than 54 mg/dL
Description
evaluate hypoglycemia frequency and severity during treatment with HDV insulin lispro versus insulin lispro alone
Time Frame
6 weeks
Title
Postprandial glucose levels in mg/dL following test meal challenge
Description
evaluate glucose response to a standardized test meal challenge following six weeks of treatment with HDV insulin lispro versus insulin lispro alone
Time Frame
6 weeks
Title
HbA1c levels in percentage (%) at beginning of trial compared to HbA1c levels at the end of the study
Description
evaluate overall glycemic control (A1C) following six weeks of treatment with HDV insulin lispro versus insulin lispro alone
Time Frame
6 weeks
Title
Self-Monitoring Blood Glucose (SMBG) results in mg/dL before and after every meal
Description
evaluate self-monitoring of blood glucose (SMBG) values before and after meals during treatment with HDV insulin lispro versus insulin lispro alone
Time Frame
6 weeks
Title
Total doses of insulin used (in number of units of insulin injected) during the study
Description
compare insulin doses (prandial, basal and total) during HDV insulin lispro treatment versus insulin lispro alone
Time Frame
6 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: Male or female of age 18 to 65 years, inclusive. Females of child-bearing potential must use a standard and effective means of birth control for the duration of the study T1DM ≥12 months C-peptide <0.6 ng/mL (single retest allowed) Treatment with rapid analog insulin for the previous 6 months and willing to use insulin vial and syringe to deliver rapid acting insulin during the study Currently using either insulin glargine (U100 only) or insulin degludec for basal insulin therapy for at least 4 weeks prior to study Not using insulin pump delivery systems during the previous 3 months Familiarity with continuous glucose monitoring (CGM) technology; subjects need to be not currently using CGM; subjects will NOT use unblinded CGM during the treatment period of the trial Willingness to use insulin lispro as the analog bolus insulin during the study period BMI ≥18.0 kg/m2 and ≤35.0 kg/m2 6.9%≤A1C≤7.9% (single retest allowed) Exclusion Criteria: Known or suspected allergy to any component of any of the study drugs in this trial. A patient who has unstable proliferative retinopathy or maculopathy, and/or severe neuropathy, in particular autonomic neuropathy, as judged by the Investigator As judged by the investigator, clinically significant active disease of the gastrointestinal, cardiovascular (including a history of arrhythmia or conduction delays on ECG), hepatic, neurological, renal, genitourinary, or hematological systems, or uncontrolled hypertension (diastolic blood pressure ≥ 100 mmHg and/or systolic blood pressure ≥ 160 mmHg after 5 minutes in the supine position). History of any illness or disease that in the opinion of the Investigator might confound the results of the trial or pose additional risk in administering the study drugs to the patient. As judged by the Investigator, clinically significant findings in routine laboratory data Use of drugs that may interfere with the interpretation of trial results or are known to cause clinically relevant interference with insulin action, glucose utilization, or recovery from hypoglycemia Use of oral anti-diabetic or non-insulin anti-diabetic injection therapies (e.g. SGLT-2 inhibitors, pramlintide, GLP-1 agonists, etc.) during the 4 weeks prior to randomization Current smokers; if a former smoker, no tobacco products (inhaled, oral or buccal) for the previous 3 months Use of e-cigarettes or other nicotine-containing products for the previous 3 months Current addiction to alcohol or substances of abuse as determined by the Investigator. Pregnancy, breast-feeding, the intention of becoming pregnant, or not using adequate contraceptive measures (adequate contraceptive measures consist of sterilization, intra-uterine device [IUD], oral or injectable contraceptives, barrier methods or abstinence as per investigator discretion). Mental incapacity, unwillingness, or language barriers precluding adequate understanding or cooperation in this study Symptomatic gastroparesis. Receipt of any investigational drug within 4 weeks of Visit 2 in this study Any condition (intrinsic or extrinsic) that in the judgment of the Investigator will interfere with trial participation or evaluation of data
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Douglas B Muchmore, MD
Organizational Affiliation
Chief Medical Officer
Official's Role
Study Director
Facility Information:
Facility Name
Barbara Davis Center for Diabetes, University of Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Facility Name
Baptist Diabetes Associates
City
Miami
State/Province
Florida
ZIP/Postal Code
33156
Country
United States
Facility Name
Lucas Research, Inc.
City
Morehead City
State/Province
North Carolina
ZIP/Postal Code
28557
Country
United States
Facility Name
Texas Diabetes and Endocrinology
City
Austin
State/Province
Texas
ZIP/Postal Code
78731
Country
United States
Facility Name
Texas Diabetes and Endocrinology
City
Austin
State/Province
Texas
ZIP/Postal Code
78749
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
Not planned

Learn more about this trial

Comparison of Hepatic Directed Vesicle (HDV)-Insulin Lispro Versus Insulin Lispro to Further Improve Glycemic Control

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