Study of the Pharmacologic Action of a GPR119 Agonist on Glucagon Counter-regulation During Insulin-induced Hypoglycemia in Type 1 Diabetes Mellitus (PHROG)

This is an interventional basic science trial for Diabetes Mellitus, Type 1 Read More

Inclusion Criteria:

Type 1 diabetes cohort

1. Age >20 years
2. Diagnosis of T1DM according to American Diabetes Association (ADA) criteria continuously requiring insulin for survival
3. Diabetes diagnosis performed more than 5 years before enrollment
4. Fasting C-peptide levels < 0.7 ng/mL with a concurrent plasma glucose concentration > 90 mg/dL
5. For female participants: agrees not to become pregnant during the study and for at least 2 weeks after the last dose of the study medication. For male participants: agrees not to donate sperm or not to get a woman pregnant during the study and for at least 2 weeks after the last dose of the study medication.

Healthy subject cohort

1. Age >20 years
2. General good health
3. Creatinine clearance >80 mL/min based on MDRD equation
4. Fasting blood glucose (FBG) >70 mg/dL and <100 mg/dL
5. No history of diabetes

Exclusion Criteria:

1. BMI >30 kg/m2 and <18.5 kg/m2
2. No evidence by history, EKG or exams of symptomatic cardiovascular disease (unstable angina, myocardial infarction or coronary revascularization within 6 months, clinically significant abnormalities on EKG, presence of cardiac pacemaker, implanted cardiac defibrillator)
3. Evidence of autonomic neuropathy
4. Liver disease (AST or ALT >2.5 times the upper limit of normal)
5. Kidney disease (creatinine >1.6 mg/dl or estimated GFR <60 ml/min).
6. Dyslipidemia, including triglycerides >500 mg/dl, LDL >200 mg/dl or unstable hyperlipidemia. Treatment with a single lipid lowering agents is allowed if stable within the previous 3 months.
7. Anemia (hemoglobin <12 g/dl in men, <11 g/dl in women)
8. Thyroid dysfunction (suppressed thyroid stimulating hormone (TSH), elevated TSH <10 µIU/ml if symptomatic or elevated TSH >10 µIU/ml if asymptomatic)
9. Uncontrolled hypertension (BP >160 mmHg systolic or >100 mmHg diastolic) or treatment with more than 2 antihypertensive medications
10. History of cancer within the last 5 years (skin cancers, with the exception of melanoma, may be acceptable).
11. History of organ transplant
12. History of HIV, active Hepatitis B or C, or Tuberculosis
13. Pregnancy, lactation or 6 months postpartum from the scheduled date of collection
14. Females of childbearing potential (any female except those with tubal ligation, hysterectomy, or absence of menses >2 years) unwilling to use an approved method of contraception (one medically accepted method of contraception with ≥99% effectiveness when used consistently and correctly: implantable uterine device (IUD), hormonal contraception). Male participants: unwilling to use appropriate contraception (e.g. condoms) and/or their partner uses a medically accepted form of contraception during the study.
15. History of Major Depression in the last 5 years
16. History of an eating disorder
17. History of bariatric surgery
18. History of drug or alcohol abuse (> 3 drinks per day) within the last 5 years
19. Psychiatric disease prohibiting adherence to study protocol
20. Use of oral or injectable anti-hyperglycemic agents: metformin, sulfonylureas, DPP IV inhibitors, SGLT-2 inhibitors, thiazolidinediones, acarbose, GLP-1 analogs
21. Current use of beta-adrenergic blocking agents or their use was stopped less than one month before recruitment
22. Initiation or change in hormone replacement therapy within the past 3 months (including, but not limited to thyroid hormone or estrogen replacement therapy)
23. Use of any medications known to influence glucose, fat and/or energy metabolism within the last 3 months (e.g., growth hormone therapy, glucocorticoids [steroids], prescribed medications for weight loss, etc.)
24. Current night shift worker
25. Presence of any condition that, in the opinion of the Investigator, compromises participant safety or data integrity or the participant's ability to complete study visits Additional exclusion Criteria for type 1 diabetes cohort
26. History of T2DM or any form of diabetes other than T1DM
27. Hypoglycemia unawareness as assessed using the GOLD score
28. Using a predictive low blood glucose suspend mode on an insulin pump or a hybrid closed loop algorithm for insulin delivery. For those applying these strategies for everyday management of blood glucose and willing to participate, the algorithm will be stopped at enrollment where possible.
29. Two or more episode of severe hypoglycemia per month in the past six months.
30. QTcF >450 ms for males and >470 ms for females
31. Using non-insulin agents to control blood glucose levels.

32. No evidence of moderate or severe end-organ diabetic complications of retinopathy, nephropathy or neuropathy. Non-proliferative retinopathy and microalbuminura will be allowed.

    Additional exclusion Criteria for the healthy cohort

33. Insulin treatment