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G-Pen Compared to Glucagen Hypokit for Severe Hypoglycemia Rescue in Adults With Type 1 Diabetes

Primary Purpose

Insulin Hypoglycemia, Type 1 Diabetes Mellitus, Severe Hypoglycemia

Status
Completed
Phase
Phase 3
Locations
International
Study Type
Interventional
Intervention
G-Pen
Novo Glucagon
Sponsored by
Xeris Pharmaceuticals
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Insulin Hypoglycemia focused on measuring glucagon, hypoglycemia

Eligibility Criteria

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

Inclusion Criteria:

  1. Males and non-pregnant females diagnosed with type 1 diabetes (T1D) for at least 24 months.
  2. Current usage of daily insulin treatment that includes having an assigned "correction factor" for managing hyperglycemia.
  3. Age 18 to 75 years, inclusive.
  4. Random serum C-peptide concentration < 0.6 ng/mL.
  5. Willingness to follow all study procedures, including attending all clinic visits.
  6. Subject has provided informed consent as evidenced by a signed and dated informed consent form (ICF) completed before any trial-related activities occur.

Exclusion Criteria:

  1. Pregnancy
  2. Glycated hemoglobin (HbA1c) > 10% at Screening.
  3. Body mass index (BMI) > 40 kg/m2.
  4. Renal insufficiency (serum creatinine greater than 3.0 mg/dL) or end-stage renal disease requiring renal replacement therapy.
  5. Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) equal to or greater than 3 times the upper limit of normal.
  6. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3.0 g/dL.
  7. Hematocrit < 30%.
  8. Blood pressure (BP) readings at Screening where systolic blood pressure (SBP) < 90 or > 150 mm Hg, and diastolic blood pressure (DBP) < 50 or > 100 mm Hg.
  9. Clinically significant electrocardiogram (ECG) abnormalities.
  10. Use of total insulin dose per day > 2 U/kg.
  11. Inadequate venous access.
  12. Congestive heart failure, New York Heart Association (NYHA) class III or IV.
  13. History of myocardial infarction, unstable angina, or revascularization within the past 6 months.
  14. History of a cerebrovascular accident in the past 6 months or with major neurological deficits.
  15. Active malignancy within 5 years from Screening, except basal cell or squamous cell skin cancers. Any history of breast cancer or malignant melanoma will be exclusionary.
  16. Major surgical operation within 30 days prior to Screening.
  17. Current seizure disorder (other than with suspect or documented hypoglycemia).
  18. Current bleeding disorder, treatment with warfarin, or platelet count below 50 × 109 per liter.
  19. History of pheochromocytoma or disorder with increased risk of pheochromocytoma (multiple endocrine neoplasia type 2 (MEN 2), neurofibromatosis, or Von Hippel-Lindau disease).
  20. History of insulinoma.
  21. History of allergies to glucagon or glucagon-like products, or any history of significant hypersensitivity to glucagon or any related products or to any of the excipients (DMSO and trehalose) in the investigational formulation.
  22. History of glycogen storage disease.
  23. Subject tests positive for human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV) infection (hepatitis B surface antigen positive [HBsAg+]) at Screening.
  24. Active substance other than tetrahydrocannabinol (THC) or alcohol abuse (more than 21 drinks per week for male subjects or 14 drinks per week for female subject).
  25. Administration of glucagon within 7 days of Screening.
  26. Participation in other studies involving administration of an investigational drug or device within 30 days or 5 half-lives, whichever is longer, before Screening for the current study and during participation in the current study.
  27. Any other reason the Investigator deems exclusionary.

Sites / Locations

  • Diablo Clinical Research
  • Atlanta Diabetes Associates
  • PPD-Las Vegas Clinical Research Unit
  • Rainier Research Center
  • Medizinische Universität Graz-Center for Medical Research
  • LMC Diabetes & Endocrinology
  • AltaSciences

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

G-Pen followed by Novo Glucagon

Novo Glucagon followed by G-Pen

Arm Description

1 mg G-Pen at the first treatment visit followed by 1 mg Novo Glucagon at the second treatment visit

1 mg Novo Glucagon at the first treatment visit followed by 1 mg G-Pen at the second treatment visit

Outcomes

Primary Outcome Measures

Severe Hypoglycemia Rescue
Number of subjects with an increase in plasma glucose concentration from below 54 mg/dL (3 mmol/L) to greater than 70 mg/dL (3.89 mmol/L) or an increase in plasma glucose concentration > 20 mg/dL (> 1.11 mmol/L) within 30 minutes after administration of glucagon

Secondary Outcome Measures

Plasma Glucose Response 1
Number of subjects with an increase in plasma glucose concentration from below 54 mg/dL (3 mmol/L) to greater than 70 mg/dL (3.89 mmol/L) within 30 minutes of a decision to dose
Plasma Glucose Response 2
Number of subjects with an increase in plasma glucose concentration > 20 mg/dL (> 1.11 mmol/L) after administration of glucagon.
Administration Time
Mean time (minutes) to administer study drug from a decision to dose
Hypoglycemia Resolution
Mean time (minutes) to complete resolution of the overall sensation of hypoglycemia from a decision to dose

Full Information

First Posted
November 8, 2018
Last Updated
May 12, 2020
Sponsor
Xeris Pharmaceuticals
Collaborators
Empiristat, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03738865
Brief Title
G-Pen Compared to Glucagen Hypokit for Severe Hypoglycemia Rescue in Adults With Type 1 Diabetes
Official Title
G-Pen (Glucagon Injection) Compared to GlucaGen® Hypokit® (Glucagon) for Induced Hypoglycemia Rescue in Adults With T1D: A Phase 3 Multi-center, Randomized, Controlled, Single Blind, 2-way Crossover Study to Evaluate Efficacy and Safety
Study Type
Interventional

2. Study Status

Record Verification Date
May 2020
Overall Recruitment Status
Completed
Study Start Date
September 27, 2018 (Actual)
Primary Completion Date
March 29, 2019 (Actual)
Study Completion Date
April 2, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Xeris Pharmaceuticals
Collaborators
Empiristat, Inc.

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
This is a multi-center, randomized, controlled, single-blind, two-way crossover efficacy and safety study in subjects with Type 1 diabetes mellitus. The study involves two daytime clinical research center (CRC) visits with random assignment to receive G-Pen glucagon 1 mg during one period and Novo Glucagon 1 mg during the other. Each daytime visit is preceded by an overnight stay in the CRC. In the morning of the inpatient study visit, the subject is brought into a state of severe hypoglycemia through IV administration of regular insulin diluted in normal saline. After a hypoglycemic state with plasma glucose < 54 mg/dL (3 mmol/L) is verified, the subject is administered a dose of G-Pen or Novo Glucagon via subcutaneous injection. Plasma glucose levels are monitored for up to 180 minutes post-dosing, with a value of >70.0 mg/dL (3.89 mmol/L) or an increase of > 20 mg/dL (>1.11 mmol/L) within 30 minutes of glucagon administration indicating a positive response. After 3 hours, the subject is given a meal and discharged when medically stable. After a wash-out period of 7 to 28 days, subjects return to the CRC, and the procedures are repeated with each subject crossed over to the other treatment. A follow-up visit as a safety check is conducted 2-7 days following administration of the final dose of study drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Insulin Hypoglycemia, Type 1 Diabetes Mellitus, Severe Hypoglycemia
Keywords
glucagon, hypoglycemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Masking
Participant
Allocation
Randomized
Enrollment
132 (Actual)

8. Arms, Groups, and Interventions

Arm Title
G-Pen followed by Novo Glucagon
Arm Type
Experimental
Arm Description
1 mg G-Pen at the first treatment visit followed by 1 mg Novo Glucagon at the second treatment visit
Arm Title
Novo Glucagon followed by G-Pen
Arm Type
Active Comparator
Arm Description
1 mg Novo Glucagon at the first treatment visit followed by 1 mg G-Pen at the second treatment visit
Intervention Type
Drug
Intervention Name(s)
G-Pen
Other Intervention Name(s)
glucagon
Intervention Description
1 mg subcutaneous injection of G-Pen (glucagon injection) administered via auto-injector
Intervention Type
Drug
Intervention Name(s)
Novo Glucagon
Other Intervention Name(s)
Glucagen Hypokit
Intervention Description
1 mg subcutaneous injection of Novo Glucagon (glucagon injection)
Primary Outcome Measure Information:
Title
Severe Hypoglycemia Rescue
Description
Number of subjects with an increase in plasma glucose concentration from below 54 mg/dL (3 mmol/L) to greater than 70 mg/dL (3.89 mmol/L) or an increase in plasma glucose concentration > 20 mg/dL (> 1.11 mmol/L) within 30 minutes after administration of glucagon
Time Frame
At 30 minutes following administration of study drug
Secondary Outcome Measure Information:
Title
Plasma Glucose Response 1
Description
Number of subjects with an increase in plasma glucose concentration from below 54 mg/dL (3 mmol/L) to greater than 70 mg/dL (3.89 mmol/L) within 30 minutes of a decision to dose
Time Frame
At 30 minutes following a decision to administer study drug
Title
Plasma Glucose Response 2
Description
Number of subjects with an increase in plasma glucose concentration > 20 mg/dL (> 1.11 mmol/L) after administration of glucagon.
Time Frame
At 0-30 minutes following a decision to administer study drug
Title
Administration Time
Description
Mean time (minutes) to administer study drug from a decision to dose
Time Frame
At 0-10 minutes from a decision to administer study drug
Title
Hypoglycemia Resolution
Description
Mean time (minutes) to complete resolution of the overall sensation of hypoglycemia from a decision to dose
Time Frame
At 0-90 minutes following administration of study drug

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: Males and non-pregnant females diagnosed with type 1 diabetes (T1D) for at least 24 months. Current usage of daily insulin treatment that includes having an assigned "correction factor" for managing hyperglycemia. Age 18 to 75 years, inclusive. Random serum C-peptide concentration < 0.6 ng/mL. Willingness to follow all study procedures, including attending all clinic visits. Subject has provided informed consent as evidenced by a signed and dated informed consent form (ICF) completed before any trial-related activities occur. Exclusion Criteria: Pregnancy Glycated hemoglobin (HbA1c) > 10% at Screening. Body mass index (BMI) > 40 kg/m2. Renal insufficiency (serum creatinine greater than 3.0 mg/dL) or end-stage renal disease requiring renal replacement therapy. Serum alanine aminotransferase (ALT) or aspartate aminotransferase (AST) equal to or greater than 3 times the upper limit of normal. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3.0 g/dL. Hematocrit < 30%. Blood pressure (BP) readings at Screening where systolic blood pressure (SBP) < 90 or > 150 mm Hg, and diastolic blood pressure (DBP) < 50 or > 100 mm Hg. Clinically significant electrocardiogram (ECG) abnormalities. Use of total insulin dose per day > 2 U/kg. Inadequate venous access. Congestive heart failure, New York Heart Association (NYHA) class III or IV. History of myocardial infarction, unstable angina, or revascularization within the past 6 months. History of a cerebrovascular accident in the past 6 months or with major neurological deficits. Active malignancy within 5 years from Screening, except basal cell or squamous cell skin cancers. Any history of breast cancer or malignant melanoma will be exclusionary. Major surgical operation within 30 days prior to Screening. Current seizure disorder (other than with suspect or documented hypoglycemia). Current bleeding disorder, treatment with warfarin, or platelet count below 50 × 109 per liter. History of pheochromocytoma or disorder with increased risk of pheochromocytoma (multiple endocrine neoplasia type 2 (MEN 2), neurofibromatosis, or Von Hippel-Lindau disease). History of insulinoma. History of allergies to glucagon or glucagon-like products, or any history of significant hypersensitivity to glucagon or any related products or to any of the excipients (DMSO and trehalose) in the investigational formulation. History of glycogen storage disease. Subject tests positive for human immunodeficiency virus (HIV), hepatitis C virus (HCV), or hepatitis B virus (HBV) infection (hepatitis B surface antigen positive [HBsAg+]) at Screening. Active substance other than tetrahydrocannabinol (THC) or alcohol abuse (more than 21 drinks per week for male subjects or 14 drinks per week for female subject). Administration of glucagon within 7 days of Screening. Participation in other studies involving administration of an investigational drug or device within 30 days or 5 half-lives, whichever is longer, before Screening for the current study and during participation in the current study. Any other reason the Investigator deems exclusionary.
Facility Information:
Facility Name
Diablo Clinical Research
City
Walnut Creek
State/Province
California
ZIP/Postal Code
94598
Country
United States
Facility Name
Atlanta Diabetes Associates
City
Atlanta
State/Province
Georgia
ZIP/Postal Code
30318
Country
United States
Facility Name
PPD-Las Vegas Clinical Research Unit
City
Las Vegas
State/Province
Nevada
ZIP/Postal Code
89113
Country
United States
Facility Name
Rainier Research Center
City
Renton
State/Province
Washington
ZIP/Postal Code
98057
Country
United States
Facility Name
Medizinische Universität Graz-Center for Medical Research
City
Graz
ZIP/Postal Code
8010
Country
Austria
Facility Name
LMC Diabetes & Endocrinology
City
Toronto
State/Province
Ontario
ZIP/Postal Code
M4G 3E8
Country
Canada
Facility Name
AltaSciences
City
Montréal
State/Province
Quebec
ZIP/Postal Code
H3P 3P1
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35322535
Citation
Pieber TR, Aronson R, Christiansen MP, Bode B, Junaidi K, Conoscenti V. Efficacy, safety, tolerability, and noninferiority phase 3 study of glucagon as a ready-to-use room temperature liquid stable formulation versus a lyophilised formulation for the biochemical recovery and symptomatic relief of insulin-induced severe hypoglycaemia in adults with type 1 diabetes. Diabetes Obes Metab. 2022 Jul;24(7):1394-1397. doi: 10.1111/dom.14699. Epub 2022 Apr 28. No abstract available.
Results Reference
derived

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G-Pen Compared to Glucagen Hypokit for Severe Hypoglycemia Rescue in Adults With Type 1 Diabetes

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