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Exploratory Study of the Efficacy of Standard of Care Revascularization of the Lower Extremity

Primary Purpose

Diabetic Peripheral Neuropathy

Status
Unknown status
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Revascularization
Sponsored by
Diabetes and Glandular Disease Clinic
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetic Peripheral Neuropathy focused on measuring Diabetes, Type 1 Diabetes, Type 2 Diabetes, Neuropathy, Diabetic Peripheral Neuropathy, Peripheral Artery Disease, PAD

Eligibility Criteria

30 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male or female age 30 to 80 years (inclusive at first screening visit)
  2. Clinical diagnosis of type 1 or type 2 diabetes as diagnosed by HbA1c ≥ 6.5% or current treatment
  3. Clinical signs and symptoms of diabetic peripheral neuropathy bilaterally affecting the lower extremities, in the investigator's opinion, which may include neuropathic symptoms (e.g., numbness, tingling, burning sensation, sharp pains, sensitivity to touch) and decreased distal sensation (e.g., decreased vibration, pinprick or pain sensation, monofilament)
  4. HbA1c ≤ 11% (historical results allowed if performed within the past 90 days)
  5. Females of child-bearing potential who are willing to use contraceptive measures to prevent pregnancy for the duration of the study
  6. Willing to attend all scheduled study visits and undergo all study procedures
  7. Clinical diagnosis of Peripheral Artery Disease (PAD)
  8. Be able to understand, speak, read and write English
  9. Have medical insurance or financial means to cover the cost of the revascularization procedure and follow-up visits with the Interventional Radiologist

Exclusion Criteria:

  1. Inability to undergo angiogram with revascularization
  2. Unilateral neuropathic findings or symptoms
  3. Vitamin B-12 level < 400 pg/ml (historical results allowed if performed within the past 30 days) *
  4. Known causes of peripheral neuropathy other than diabetes, e.g., Amyloidosis, Tangier disease, Fabry's disease, hereditary sensory autonomic neuropathy, alcohol-related neuropathy, drug-induced neuropathy (e.g., chemotherapy, antibiotics, anti-retroviral agents, other neurotoxic agents) hypothyroidism that is not well controlled, rheumatoid arthritis or autoimmune disorders requiring treatment with corticosteroids, anti-tumor necrosis factor or immune-modulating medicines
  5. Known history of Hepatitis B, C, or HIV
  6. Lower limb amputation, including toe
  7. Lower extremity inoperable occlusive vascular disease
  8. Inability to provide informed consent
  9. History of bleeding disorders
  10. History of diabetic ulcers to the lower extremities
  11. History of any surgical bypass of the lower extremities prior to randomization
  12. History of previous revascularization of the lower extremities prior to randomization
  13. End Stage Renal Disease (ESRD) requiring or on dialysis
  14. Thyroid Stimulating Hormone -TSH >10.0 uu/mL*
  15. Potassium > 5.5 mmol/L. *
  16. Calcium < 8.5 mg/dL or > 11mg/dL *
  17. Hemoglobin < 9.0 g/dL *
  18. Female that is pregnant, breastfeeding or intends to become pregnant during the study period
  19. Clinically significant abnormal ECG findings, in the opinion of the Investigator
  20. Participation in another clinical trial with investigational drug or device at time of screening
  21. Any other clinically significant disorders or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study or unable to comply with the protocol requirements

Sites / Locations

  • Diabetes and Glandular Disease Clinic, P.A.

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Single Arm

Arm Description

This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.

Outcomes

Primary Outcome Measures

Intra-epidermal Nerve Fiber Density
Change from baseline in intra-epidermal nerve fiber density (IENFD) via skin biopsy of the revascularized foot over the extensor digitorum brevis muscle (EDBM) at week 26.

Secondary Outcome Measures

Intra-epidermal Nerve Fiber Density
Number and percent of participants whose IENFD have increased by at least 20% from baseline
Utah Early Neuropathy Scale
Number and percentage of participants with improvement on Utah Neuropathy Scale (UENS)
Sural Nerve Action Potential Amplitude
Number and percentage of participants with improvement of sural nerve action potential amplitude
Sudoscan
Number and percentage of participants with 20% improvement on Sudoscan
Intra-epidermal Nerve Fiber Density
Number and percentage of participants with improvement of intra-epidermal nerve fiber density
Neuropathic Pain Syndrome Inventory
Improvement in quality of life as measured by the Neuropathic Pain Syndrome Inventory
Patency of Lateral Plantar Artery
Number and percentage of participants with patency of lateral plantar artery per ultrasound

Full Information

First Posted
January 20, 2021
Last Updated
January 20, 2021
Sponsor
Diabetes and Glandular Disease Clinic
Collaborators
Modern Vascular, LLC
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1. Study Identification

Unique Protocol Identification Number
NCT04720170
Brief Title
Exploratory Study of the Efficacy of Standard of Care Revascularization of the Lower Extremity
Official Title
Revascularization of the Lateral Plantar Artery and Anterior Pedal Loop of the Foot as Treatment for Diabetic Peripheral Neuropathy.
Study Type
Interventional

2. Study Status

Record Verification Date
January 2021
Overall Recruitment Status
Unknown status
Study Start Date
February 15, 2021 (Anticipated)
Primary Completion Date
July 15, 2021 (Anticipated)
Study Completion Date
September 15, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Diabetes and Glandular Disease Clinic
Collaborators
Modern Vascular, LLC

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 purpose of this study is to evaluate the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for diabetic peripheral neuropathy.
Detailed Description
This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain. Participants who satisfy eligibility criteria may undergo standard of care revascularization of one lower extremity as required, with the addition of revascularization of the lateral plantar artery and anterior pedal loop followed by a 26-week follow-up phase. Standard of Care revascularization will be performed in any limb with ≥ 50% stenosis as determined by intra-vascular ultrasound (IVUS) at the time of planned study intervention. Participants will be evaluated prior to intervention and at 2, 4, 14 and 26 weeks after the pedal loop intervention.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetic Peripheral Neuropathy
Keywords
Diabetes, Type 1 Diabetes, Type 2 Diabetes, Neuropathy, Diabetic Peripheral Neuropathy, Peripheral Artery Disease, PAD

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
26 week, single arm, single site
Masking
None (Open Label)
Allocation
N/A
Enrollment
30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Single Arm
Arm Type
Other
Arm Description
This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.
Intervention Type
Procedure
Intervention Name(s)
Revascularization
Intervention Description
Angiogram and IVUS with revascularization of the lateral plantar artery and pedal arch on target foot.
Primary Outcome Measure Information:
Title
Intra-epidermal Nerve Fiber Density
Description
Change from baseline in intra-epidermal nerve fiber density (IENFD) via skin biopsy of the revascularized foot over the extensor digitorum brevis muscle (EDBM) at week 26.
Time Frame
26 weeks
Secondary Outcome Measure Information:
Title
Intra-epidermal Nerve Fiber Density
Description
Number and percent of participants whose IENFD have increased by at least 20% from baseline
Time Frame
14 and 26 weeks
Title
Utah Early Neuropathy Scale
Description
Number and percentage of participants with improvement on Utah Neuropathy Scale (UENS)
Time Frame
14 and 26 weeks
Title
Sural Nerve Action Potential Amplitude
Description
Number and percentage of participants with improvement of sural nerve action potential amplitude
Time Frame
14 and 26 weeks
Title
Sudoscan
Description
Number and percentage of participants with 20% improvement on Sudoscan
Time Frame
14 and 26 weeks
Title
Intra-epidermal Nerve Fiber Density
Description
Number and percentage of participants with improvement of intra-epidermal nerve fiber density
Time Frame
14 weeks
Title
Neuropathic Pain Syndrome Inventory
Description
Improvement in quality of life as measured by the Neuropathic Pain Syndrome Inventory
Time Frame
14 and 26 weeks
Title
Patency of Lateral Plantar Artery
Description
Number and percentage of participants with patency of lateral plantar artery per ultrasound
Time Frame
14 and 26 weeks
Other Pre-specified Outcome Measures:
Title
Medial Plantar Sural Nerve Action Potential Amplitude
Description
Number of participants with 20% change in medial plantar sural nerve action potential amplitude (SNAP) via nerve conduction study
Time Frame
14 and 26 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
30 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female age 30 to 80 years (inclusive at first screening visit) Clinical diagnosis of type 1 or type 2 diabetes as diagnosed by HbA1c ≥ 6.5% or current treatment Clinical signs and symptoms of diabetic peripheral neuropathy bilaterally affecting the lower extremities, in the investigator's opinion, which may include neuropathic symptoms (e.g., numbness, tingling, burning sensation, sharp pains, sensitivity to touch) and decreased distal sensation (e.g., decreased vibration, pinprick or pain sensation, monofilament) HbA1c ≤ 11% (historical results allowed if performed within the past 90 days) Females of child-bearing potential who are willing to use contraceptive measures to prevent pregnancy for the duration of the study Willing to attend all scheduled study visits and undergo all study procedures Clinical diagnosis of Peripheral Artery Disease (PAD) Be able to understand, speak, read and write English Have medical insurance or financial means to cover the cost of the revascularization procedure and follow-up visits with the Interventional Radiologist Exclusion Criteria: Inability to undergo angiogram with revascularization Unilateral neuropathic findings or symptoms Vitamin B-12 level < 400 pg/ml (historical results allowed if performed within the past 30 days) * Known causes of peripheral neuropathy other than diabetes, e.g., Amyloidosis, Tangier disease, Fabry's disease, hereditary sensory autonomic neuropathy, alcohol-related neuropathy, drug-induced neuropathy (e.g., chemotherapy, antibiotics, anti-retroviral agents, other neurotoxic agents) hypothyroidism that is not well controlled, rheumatoid arthritis or autoimmune disorders requiring treatment with corticosteroids, anti-tumor necrosis factor or immune-modulating medicines Known history of Hepatitis B, C, or HIV Lower limb amputation, including toe Lower extremity inoperable occlusive vascular disease Inability to provide informed consent History of bleeding disorders History of diabetic ulcers to the lower extremities History of any surgical bypass of the lower extremities prior to randomization History of previous revascularization of the lower extremities prior to randomization End Stage Renal Disease (ESRD) requiring or on dialysis Thyroid Stimulating Hormone -TSH >10.0 uu/mL* Potassium > 5.5 mmol/L. * Calcium < 8.5 mg/dL or > 11mg/dL * Hemoglobin < 9.0 g/dL * Female that is pregnant, breastfeeding or intends to become pregnant during the study period Clinically significant abnormal ECG findings, in the opinion of the Investigator Participation in another clinical trial with investigational drug or device at time of screening Any other clinically significant disorders or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study or unable to comply with the protocol requirements
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Terri L Ryan, RN
Phone
210-614-8612
Ext
1630
Email
terri.ryan@dgdclinic.com
First Name & Middle Initial & Last Name or Official Title & Degree
Josette M Negrete, BAAS
Phone
210-614-8612
Ext
1515
Email
josette.negrete@dgdclinic.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Dallas Broadway, MD
Organizational Affiliation
Modern Vascular, LLC
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Mark S Kipnes, MD
Organizational Affiliation
Diabetes and Glandular Disease Clinic, P.A.
Official's Role
Principal Investigator
Facility Information:
Facility Name
Diabetes and Glandular Disease Clinic, P.A.
City
San Antonio
State/Province
Texas
ZIP/Postal Code
78229
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
Study protocol and Informed Consent
IPD Sharing Time Frame
Starting 6 months after publication
Citations:
PubMed Identifier
15030944
Citation
Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004 Apr;108(3):248-257. doi: 10.1016/j.pain.2003.12.024.
Results Reference
result
PubMed Identifier
11719828
Citation
Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001 Nov;44(11):1973-88. doi: 10.1007/s001250100001.
Results Reference
result
PubMed Identifier
10382594
Citation
Ibrahim S, Harris ND, Radatz M, Selmi F, Rajbhandari S, Brady L, Jakubowski J, Ward JD. A new minimally invasive technique to show nerve ischaemia in diabetic neuropathy. Diabetologia. 1999 Jun;42(6):737-42. doi: 10.1007/s001250051222.
Results Reference
result
PubMed Identifier
2376302
Citation
Malik RA, Masson EA, Sharma AK, Lye RH, Ah-See AK, Compton AM, Tomlinson DR, Hanley SP, Boulton AJ. Hypoxic neuropathy: relevance to human diabetic neuropathy. Diabetologia. 1990 May;33(5):311-8. doi: 10.1007/BF00403326.
Results Reference
result
PubMed Identifier
3094772
Citation
Newrick PG, Wilson AJ, Jakubowski J, Boulton AJ, Ward JD. Sural nerve oxygen tension in diabetes. Br Med J (Clin Res Ed). 1986 Oct 25;293(6554):1053-4. doi: 10.1136/bmj.293.6554.1053.
Results Reference
result
PubMed Identifier
1845025
Citation
Ram Z, Sadeh M, Walden R, Adar R. Vascular insufficiency quantitatively aggravates diabetic neuropathy. Arch Neurol. 1991 Dec;48(12):1239-42. doi: 10.1001/archneur.1991.00530240043016.
Results Reference
result
PubMed Identifier
18844788
Citation
Singleton JR, Bixby B, Russell JW, Feldman EL, Peltier A, Goldstein J, Howard J, Smith AG. The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy. J Peripher Nerv Syst. 2008 Sep;13(3):218-27. doi: 10.1111/j.1529-8027.2008.00180.x.
Results Reference
result
PubMed Identifier
8307254
Citation
Tesfaye S, Harris N, Jakubowski JJ, Mody C, Wilson RM, Rennie IG, Ward JD. Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography. Diabetologia. 1993 Dec;36(12):1266-74. doi: 10.1007/BF00400804.
Results Reference
result
PubMed Identifier
8721781
Citation
Veves A, Donaghue VM, Sarnow MR, Giurini JM, Campbell DR, LoGerfo FW. The impact of reversal of hypoxia by revascularization on the peripheral nerve function of diabetic patients. Diabetologia. 1996 Mar;39(3):344-8. doi: 10.1007/BF00418351.
Results Reference
result
PubMed Identifier
1478366
Citation
Young MJ, Veves A, Walker MG, Boulton AJ. Correlations between nerve function and tissue oxygenation in diabetic patients: further clues to the aetiology of diabetic neuropathy? Diabetologia. 1992 Dec;35(12):1146-50. doi: 10.1007/BF00401368.
Results Reference
result
PubMed Identifier
8591818
Citation
Young MJ, Veves A, Smith JV, Walker MG, Boulton AJ. Restoring lower limb blood flow improves conduction velocity in diabetic patients. Diabetologia. 1995 Sep;38(9):1051-4. doi: 10.1007/BF00402174.
Results Reference
result
Links:
URL
https://doi.org/10.1007/s001250100001
Description
PubMed ID:11719828
URL
https://doi.org/10.1007/s001250051222
Description
PubMed ID:10382594
URL
https://doi.org/10.1007/BF00403326
Description
PubMed ID:2376302
URL
https://doi.org/10.1136/bmj.293.6554.1053
Description
PubMed ID:3094772
URL
https://doi.org/10.1007/BF00400804
Description
PubMed ID:8307254
URL
https://doi.org/10.1007/BF00418351
Description
PubMed ID:8721781
URL
https://doi.org/10.1007/BF00401368
Description
PubMed ID:1478366
URL
https://doi.org/10.1007/BF00402174
Description
PubMed ID:8591818

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Exploratory Study of the Efficacy of Standard of Care Revascularization of the Lower Extremity

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