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Randomized Controlled Trial of Insulin Versus Tablets for Latent Autoimmune Diabetes in Adults (LADA) (LIT)

Primary Purpose

Latent Autoimmune Diabetes in Adults LADA

Status
Unknown status
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
NovoMix 30
Tablet treatment
Sponsored by
Abertawe Bro Morgannwg University NHS Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Latent Autoimmune Diabetes in Adults LADA focused on measuring LADA, Latent autoimmune diabetes in adults, Type 1.5, Slowly progressive type 1 diabetes

Eligibility Criteria

18 Years - 90 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Male, non-fertile female (i.e., post menopausal, post hysterectomy, or sterilized by tubal ligation) or female of childbearing potential using a medically approved birth control method.
  2. The patient has a diagnosis of diabetes mellitus according to WHO classification.
  3. The patient has a positive GAD antibody test of 101 WHO units or more on two separate occasions.
  4. Age 18 +
  5. The patient did not start on insulin within 1 month of diagnosis
  6. Written informed consent to participate in the study.
  7. Ability to comply with all study requirements.

Exclusion Criteria:

  1. Pregnant or breast-feeding females and females who plan pregnancy or breast-feeding during the course of the study.
  2. A history of:

    Diabetes that is a result of pancreatic injury, or secondary forms of diabetes, e.g., Cushing's syndrome and acromegaly.

    Acute metabolic diabetic complications such as ketoacidosis or hyperosmolar state (coma) within the past 6 months

  3. Acute infections, which may affect blood glucose control within 4 weeks prior to visit 1.
  4. Malignancy including leukaemia and lymphoma (not including basal cell skin cancer) within the last 5 years.
  5. The patient has a known immune deficiency from any disease, or a condition associated with an immune deficiency.
  6. The patient is receiving immunosuppressive or immunomodulating agents or cytotoxic therapy, or any medication that, in the opinion of the site investigator, might interfere with the study.
  7. Any of the following significant laboratory abnormalities:

    • Patients with severe renal failure as defined previous renal transplant or currently having renal dialysis or GFR <30.
    • Clinically significant laboratory abnormalities, confirmed by repeat measurement, that may interfere with the assessment of safety and/or efficacy of the study drug, other than hyperglycemia and glycosuria at visit 1.
    • Severe ketonuria (+++ on urine sticks testing; ++ on repeated urine sticks testing).
  8. The patient is a known or suspected drug abuser.
  9. The patient has chronic hepatitis or liver cirrhosis, or any other chronic liver disease.
  10. The patient is known to test positive for hepatitis B antigens or hepatitis C antibodies
  11. The patient is known to test positive for HIV antibodies.
  12. The patient has any significant diseases or conditions, including psychiatric disorders and substance abuse that, in the opinion of the site investigator, are likely to affect the patient's response to treatment or their ability to complete the study.
  13. The patient has chronic haematological disease.
  14. The patient has had a severe blood loss (>400 mL, e.g., blood donation) within 2 months before the first dosing of the study medication.
  15. The patient has known proliferative retinopathy.
  16. Patient has had stage 3-4 heart failure.
  17. The patient is participating in another research study which may affect the results of this trial.

Sites / Locations

  • Diabetes Unit
  • Clinical Research UnitRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Insulin

Tablet

Arm Description

Insulin: NovoMix 30. Patients will be given advice on diet and exercise and life style and will be started on NovoMix 30, one dose of 6 U at the evening/main meal.

Patients will progress from lifestyle modification to metformin, to metformin with Rosiglitazone and finally insulin depending on HbA1c levels.

Outcomes

Primary Outcome Measures

Change in fasting serum C-peptide level over 24 months and (2) change in HbA1c level over 24 months in patients with LADA.

Secondary Outcome Measures

Hypoglycaemic events

Full Information

First Posted
October 20, 2008
Last Updated
October 20, 2008
Sponsor
Abertawe Bro Morgannwg University NHS Trust
Collaborators
Novo Nordisk A/S
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1. Study Identification

Unique Protocol Identification Number
NCT00776607
Brief Title
Randomized Controlled Trial of Insulin Versus Tablets for Latent Autoimmune Diabetes in Adults (LADA)
Acronym
LIT
Official Title
Randomized, Controlled, Parallel-Group Prospective Study to Investigate the Clinical Effectiveness of Early Insulin Treatment in Patients With Latent Autoimmune Diabetes in Adults
Study Type
Interventional

2. Study Status

Record Verification Date
September 2008
Overall Recruitment Status
Unknown status
Study Start Date
April 2007 (undefined)
Primary Completion Date
April 2011 (Anticipated)
Study Completion Date
April 2011 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Abertawe Bro Morgannwg University NHS Trust
Collaborators
Novo Nordisk A/S

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Background: Latent autoimmune diabetes in adults [LADA] is a type 1 diabetes that is slowly developing. This means many people are treated as having type 2 diabetes at diagnosis as they are adults who are not immediately insulin dependent. LADA can be distinguished from type 2 diabetes by antibody tests. Patients who are antibody positive have an autoimmune reaction which is similar to that of type 1 diabetes and is not found in type 2 diabetes. We would like to examine the best way of treating LADA in the early phase of the conditions, with tablets (similar to type 2 diabetes) or with insulin (similar to type 1 diabetes). Methods/Design: This is an open parallel group prospective randomised trial. Participants need to have a GAD antibody test results of 101 WHO units or more and a diagnosis of diabetes not requiring insulin at diagnosis. Participants will need to have been diagnosed within 12 months and not treated with insulin at study entry. They will be randomised to receive either insulin (NovoMix 30) or tablets (diet treated followed by metformin followed by glitazone (with or without metformin) followed by insulin). Primary outcome assessment will be for change in HbA1c and change in fasting C-peptide over 24 months. Secondary outcome measures will include Quality of life, GAD antibody levels, adverse events, inflammatory markers, insulin resistance, and markers of the metabolic syndrome. Discussion: This study seeks the best treatment for early LADA in terms of maintaining glycaemic control and maintaining natural insulin production.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Latent Autoimmune Diabetes in Adults LADA
Keywords
LADA, Latent autoimmune diabetes in adults, Type 1.5, Slowly progressive type 1 diabetes

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
200 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Insulin
Arm Type
Experimental
Arm Description
Insulin: NovoMix 30. Patients will be given advice on diet and exercise and life style and will be started on NovoMix 30, one dose of 6 U at the evening/main meal.
Arm Title
Tablet
Arm Type
Active Comparator
Arm Description
Patients will progress from lifestyle modification to metformin, to metformin with Rosiglitazone and finally insulin depending on HbA1c levels.
Intervention Type
Drug
Intervention Name(s)
NovoMix 30
Intervention Description
Insulin arm: Patients will be given advice on diet and exercise and life style and will be started on NovoMix 30, one dose of 6 U at the evening/main meal. Dose will be adjusted in increments of 2-6U depending on fasting glucose level When total dose equals 16 U patient will be started on 4 units with breakfast and continue with 16 units with evening meal. Breakfast and/or evening meal dose will be adjusted where necessary at increments of 2-6 U depending on fasting and/or pre-evening meal glucose level. Patient needs to keep a daily diary of insulin doses taken.
Intervention Type
Drug
Intervention Name(s)
Tablet treatment
Intervention Description
Step 1: Lifestyle modification. If HbA1c at 7%+ or if on metformin/sulphonylurea go to step 2. Step 2: Glucophage. If HbA1c of 7%-7.5% give 500mg x 1 per day. If HbA1c 7.6%-8.0%, week 1 - 500mg x 1 day and then 500mg x 2 day. If HbA1c 8.0%+ then 500mg x 3 per day (Titrated). If HbA1c remains 7%+ give additional tablet until 2gms per day then progress to Step 3. Step 3: Rosiglitazone. HbA1c of 7%+ give 4 mg per day. If HbA1c remains 7%+ titrate to maximal dose 4 mg twice daily +/-Metformin. If HbA1c remains 7% + for an 3 months move to step 4. Before initiation of Rosiglitazone repeat medical history with special emphasis on cardiovascular disease, if patient has a history of CVD move to Step 4 (insulin). Any adverse events suggestive of heart disease move to step 4. Step 4: Insulin (oral agents will be stopped). Initiation of insulin will the same as for the insulin arm and will follow the protocol detailed in the Insulin arm.
Primary Outcome Measure Information:
Title
Change in fasting serum C-peptide level over 24 months and (2) change in HbA1c level over 24 months in patients with LADA.
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Hypoglycaemic events
Time Frame
24 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
90 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male, non-fertile female (i.e., post menopausal, post hysterectomy, or sterilized by tubal ligation) or female of childbearing potential using a medically approved birth control method. The patient has a diagnosis of diabetes mellitus according to WHO classification. The patient has a positive GAD antibody test of 101 WHO units or more on two separate occasions. Age 18 + The patient did not start on insulin within 1 month of diagnosis Written informed consent to participate in the study. Ability to comply with all study requirements. Exclusion Criteria: Pregnant or breast-feeding females and females who plan pregnancy or breast-feeding during the course of the study. A history of: Diabetes that is a result of pancreatic injury, or secondary forms of diabetes, e.g., Cushing's syndrome and acromegaly. Acute metabolic diabetic complications such as ketoacidosis or hyperosmolar state (coma) within the past 6 months Acute infections, which may affect blood glucose control within 4 weeks prior to visit 1. Malignancy including leukaemia and lymphoma (not including basal cell skin cancer) within the last 5 years. The patient has a known immune deficiency from any disease, or a condition associated with an immune deficiency. The patient is receiving immunosuppressive or immunomodulating agents or cytotoxic therapy, or any medication that, in the opinion of the site investigator, might interfere with the study. Any of the following significant laboratory abnormalities: Patients with severe renal failure as defined previous renal transplant or currently having renal dialysis or GFR <30. Clinically significant laboratory abnormalities, confirmed by repeat measurement, that may interfere with the assessment of safety and/or efficacy of the study drug, other than hyperglycemia and glycosuria at visit 1. Severe ketonuria (+++ on urine sticks testing; ++ on repeated urine sticks testing). The patient is a known or suspected drug abuser. The patient has chronic hepatitis or liver cirrhosis, or any other chronic liver disease. The patient is known to test positive for hepatitis B antigens or hepatitis C antibodies The patient is known to test positive for HIV antibodies. The patient has any significant diseases or conditions, including psychiatric disorders and substance abuse that, in the opinion of the site investigator, are likely to affect the patient's response to treatment or their ability to complete the study. The patient has chronic haematological disease. The patient has had a severe blood loss (>400 mL, e.g., blood donation) within 2 months before the first dosing of the study medication. The patient has known proliferative retinopathy. Patient has had stage 3-4 heart failure. The patient is participating in another research study which may affect the results of this trial.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Sinead Brophy
Phone
00 44 1792 602058
Ext
2058
Email
s.brophy@swansea.ac.uk
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sinead Brophy
Organizational Affiliation
Swansea University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Stephen Bain
Organizational Affiliation
Swansea University
Official's Role
Study Director
Facility Information:
Facility Name
Diabetes Unit
City
Cardiff
State/Province
Wales
ZIP/Postal Code
CF64 2XX
Country
United Kingdom
Individual Site Status
Not yet recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Julia Platts
Phone
02920 711 711
Ext
5149
Email
Julia.Platts@CardiffandVale.wales.nhs.uk
First Name & Middle Initial & Last Name & Degree
Julia Platts
Facility Name
Clinical Research Unit
City
Swansea
State/Province
Wales
ZIP/Postal Code
SA6 6NL
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Lucy Barlow
Phone
+44 (0) 1792 703722
Ext
3722
Email
Lucy.Barlow@swansea-tr.wales.nhs.uk
First Name & Middle Initial & Last Name & Degree
Jeffrey Stephens

12. IPD Sharing Statement

Citations:
PubMed Identifier
18652676
Citation
Brophy S, Davies H, Bain S, Stephens JW, Cheung WY, Richards K, Wareham K, Beaverstock C, Lloyd J, Page D, Williams M, Russell I, Williams R. Randomized, controlled, parallel-group prospective study to investigate the clinical effectiveness of early insulin treatment in patients with latent autoimmune diabetes in adults. BMC Endocr Disord. 2008 Jul 24;8:8. doi: 10.1186/1472-6823-8-8.
Results Reference
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Randomized Controlled Trial of Insulin Versus Tablets for Latent Autoimmune Diabetes in Adults (LADA)

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