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The Effect of Saxagliptin on Glucose Fluctuation and Immune Regulation in Patients With Type 1 Diabetes

Primary Purpose

Type 1 Diabetes

Status
Unknown status
Phase
Phase 4
Locations
China
Study Type
Interventional
Intervention
Saxagliptin
Insulin
Sponsored by
Nanjing Medical University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring Saxagliptin, Type 1 Diabetes, Glycemic variability, C-Peptide

Eligibility Criteria

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

Inclusion Criteria:

  1. Provision of informed consent prior to any study specific procedures;
  2. Diagnosed with type 1 diabetes;
  3. Men or women who are 12 to 65 years of age at time of consenting upon Visit 1.;
  4. Positivity for at least one of the four islet autoantibodies(IA-2A、IAA、GADA、ZnT8A);
  5. 6.5% ≤ HbA1c ≤10.0%.

Exclusion Criteria:

  1. type 2 diabetes;
  2. Evidence of chronic or acute complications of diabetes which is unstable and requires hospitalization;
  3. Evidence of disease stress;
  4. History of administration of any antihyperglycemic therapy (other than insulin) during the 12 weeks prior to Visit 1;
  5. Have a history of, or currently have, acute or chronic pancreatitis;
  6. Immunocompromised individuals such as patients that have undergone organ transplantation or patients diagnosed with HIV or patients with agranulocytosis;
  7. Evidence of chronic or acute infection;
  8. Active liver disease and/or significant abnormal liver function defined as Aspartate transaminase(AST) ≥3x Upper Limit of Normal(ULN) and/or Alanine aminotransferase (ALT) ≥3x Upper Limit of Normal(ULN);
  9. History of unstable or rapidly progressing renal disease, creatinine clearance(CrCl) ≤50ml/min;
  10. Congestive heart failure defined as New York Heart Association (NYHA) class III or IV and/or left ventricular ejection fraction of ≤ 40%;
  11. Rheumatoid arthritis or other autoimmune disease(except AITD);
  12. Hypersensitivity to saxagliptin;
  13. History of drug allergy or allergic disease
  14. History of alcohol abuse, illegal drug abuse, mental disease or other disease which is not eligible for the study
  15. Pregnant or breastfeeding patients;
  16. Patients with any diseases which in the judgement of the investigator would compromise the patient's safety or successful participation in the clinical study
  17. Any condition where, in the opinion of the investigator, participation in this study may pose a significant risk to the patient or could render the patient unable to successfully complete the study
  18. Any disease or condition which the investigator feels would interfere with the trial;
  19. Treatment with other immunosuppressive agent such as systemic glucocorticoids other than replacement therapy. Inhaled, local injected and topical use of glucocorticoids is allowed during the last 90 days prior to Visit 1;
  20. Participation in a clinical study during the last 90 days prior to Visit 1;
  21. Patients who are participating in other clinical study;
  22. Treatment with strong cytochrome P450 3A4/5 (CYP3A4/5) inhibitors or other contraindications to therapy as outlined in the saxagliptin package insert;
  23. History of haemoglobinopathies (sickle cell anaemia or thalassemias, sideroblastic anaemia).

Sites / Locations

  • First Affiliated Hospital, Nanjing Medical UniversityRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

insulin+Saxagliptin

insulin

Arm Description

Patients who have diagnosed type 1 diabetes are assigned to receive Saxagliptin tablets 5 mg and insulin for 24-week.

Patients who have diagnosed type 1 diabetes only use insulin.

Outcomes

Primary Outcome Measures

Change of Mean amplitude of glycemic excursions (MAGE) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone by continuous glucose monitoring system (CGMS)

Secondary Outcome Measures

Change of C-peptide area under the curve (AUC C-peptide) or fasting C-peptide from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone by 3-hour mixed meal tolerance test(MMTT)
Change of Haemoglobin A1c (HbA1c) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone
Change of insulin dosage (U/kg/d) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone

Full Information

First Posted
November 12, 2014
Last Updated
July 5, 2016
Sponsor
Nanjing Medical University
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1. Study Identification

Unique Protocol Identification Number
NCT02307695
Brief Title
The Effect of Saxagliptin on Glucose Fluctuation and Immune Regulation in Patients With Type 1 Diabetes
Official Title
The Effect of Saxagliptin on Glucose Fluctuation and Immune Regulation in Patients With Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
July 2016
Overall Recruitment Status
Unknown status
Study Start Date
November 2014 (undefined)
Primary Completion Date
March 2017 (Anticipated)
Study Completion Date
March 2017 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Nanjing Medical University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
To investigate whether saxagliptin could reduce the fluctuation of glycemia and improve the glycemic control in those type 1 diabetes through mechanisms of suppressing glucagon secretion, improving beta cell function, and re-regulating of the T cell immune system.
Detailed Description
Type 1 diabetes mellitus (T1DM) is characterized by immune mediated beta-cell destruction. Due to the imbalance between glucagon and insulin, long-term T1DM patients experience frequent hypoglycaemia and high glucose variability despite of multiple daily injections of insulin. Dipeptidyl peptidase 4 (DPP-4) inhibitors are a new class of anti-diabetic agents and are widely used in clinical practice to improve glycemic control and protect β-cell function in patients with type 2 diabetes mellitus(T2DM). Saxagliptin, a DPP-4 inhibitor, improves glycemic control in patients with T2DM by increasing endogenous active, intact glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide in response to food, which augments insulin secretion and decreases glucagon release. This mechanism can lead to the reduction of glucose variation. In some pilot studies, incretin-based therapy in patients with T1DM can improve glucose control and reduce hypoglycemia, the mechanism probably is that it regulates glucagon level. In type 1 diabetic mouse models, DPP-4 inhibitors preserves beta-cell mass and stimulating beta-cell replication. Interestingly, DPP-4 is also known as cluster of differentiation antigen 26(CD26).It is expressed on the membrane of many types of lymphocyte, e.g. T, B and natural killer(NK)cells, and is involved in their cellular functions. CD26 plays a key role in many aspects in lymphocyte function beyond its DPP-4 enzymatic activity.These observations make it a promising therapeutic target. Recently, the attention of saxagliptin has been mainly focused on type 2 diabetes, data in type 1 diabetes is rare. We are going to carry out this phase 4 study to testify our hypothesis that saxagliptin could reduce the fluctuation of glycemia and improve the glycemic control in those type 1 diabetes through mechanisms of suppressing glucagon secretion, improving beta cell function, and re-regulating of the T cell immune system.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
Saxagliptin, Type 1 Diabetes, Glycemic variability, C-Peptide

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
184 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
insulin+Saxagliptin
Arm Type
Experimental
Arm Description
Patients who have diagnosed type 1 diabetes are assigned to receive Saxagliptin tablets 5 mg and insulin for 24-week.
Arm Title
insulin
Arm Type
Active Comparator
Arm Description
Patients who have diagnosed type 1 diabetes only use insulin.
Intervention Type
Drug
Intervention Name(s)
Saxagliptin
Other Intervention Name(s)
Onglyza, DPP-IV inhibitor
Intervention Description
saxagliptin 5 mg p.o. qd, 24 week
Intervention Type
Drug
Intervention Name(s)
Insulin
Intervention Description
Patients will be treated according to routine clinical practice at the discretion of the treating physician.
Primary Outcome Measure Information:
Title
Change of Mean amplitude of glycemic excursions (MAGE) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone by continuous glucose monitoring system (CGMS)
Time Frame
24 week
Secondary Outcome Measure Information:
Title
Change of C-peptide area under the curve (AUC C-peptide) or fasting C-peptide from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone by 3-hour mixed meal tolerance test(MMTT)
Time Frame
24 week
Title
Change of Haemoglobin A1c (HbA1c) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone
Time Frame
24 week
Title
Change of insulin dosage (U/kg/d) from baseline in patients with type 1 diabetes treated with saxagliptin plus insulin or insulin alone
Time Frame
24 week

10. Eligibility

Sex
All
Minimum Age & Unit of Time
12 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Provision of informed consent prior to any study specific procedures; Diagnosed with type 1 diabetes; Men or women who are 12 to 65 years of age at time of consenting upon Visit 1.; Positivity for at least one of the four islet autoantibodies(IA-2A、IAA、GADA、ZnT8A); 6.5% ≤ HbA1c ≤10.0%. Exclusion Criteria: type 2 diabetes; Evidence of chronic or acute complications of diabetes which is unstable and requires hospitalization; Evidence of disease stress; History of administration of any antihyperglycemic therapy (other than insulin) during the 12 weeks prior to Visit 1; Have a history of, or currently have, acute or chronic pancreatitis; Immunocompromised individuals such as patients that have undergone organ transplantation or patients diagnosed with HIV or patients with agranulocytosis; Evidence of chronic or acute infection; Active liver disease and/or significant abnormal liver function defined as Aspartate transaminase(AST) ≥3x Upper Limit of Normal(ULN) and/or Alanine aminotransferase (ALT) ≥3x Upper Limit of Normal(ULN); History of unstable or rapidly progressing renal disease, creatinine clearance(CrCl) ≤50ml/min; Congestive heart failure defined as New York Heart Association (NYHA) class III or IV and/or left ventricular ejection fraction of ≤ 40%; Rheumatoid arthritis or other autoimmune disease(except AITD); Hypersensitivity to saxagliptin; History of drug allergy or allergic disease History of alcohol abuse, illegal drug abuse, mental disease or other disease which is not eligible for the study Pregnant or breastfeeding patients; Patients with any diseases which in the judgement of the investigator would compromise the patient's safety or successful participation in the clinical study Any condition where, in the opinion of the investigator, participation in this study may pose a significant risk to the patient or could render the patient unable to successfully complete the study Any disease or condition which the investigator feels would interfere with the trial; Treatment with other immunosuppressive agent such as systemic glucocorticoids other than replacement therapy. Inhaled, local injected and topical use of glucocorticoids is allowed during the last 90 days prior to Visit 1; Participation in a clinical study during the last 90 days prior to Visit 1; Patients who are participating in other clinical study; Treatment with strong cytochrome P450 3A4/5 (CYP3A4/5) inhibitors or other contraindications to therapy as outlined in the saxagliptin package insert; History of haemoglobinopathies (sickle cell anaemia or thalassemias, sideroblastic anaemia).
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Tao Yang, MD/PhD
Phone
86-25-83718836
Ext
6466
Email
yangt@njmu.edu.cn
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tao Yang, MD/PhD
Organizational Affiliation
First Affiliated Hospital, Nanjing Medical University, China
Official's Role
Principal Investigator
Facility Information:
Facility Name
First Affiliated Hospital, Nanjing Medical University
City
Nanjing
State/Province
Jiangsu
ZIP/Postal Code
210029
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Tao Yang, PhD
Phone
86-25-83718836
Ext
6466
Email
yangt@njmu.edu.cn
First Name & Middle Initial & Last Name & Degree
Tao Yang, PhD

12. IPD Sharing Statement

Learn more about this trial

The Effect of Saxagliptin on Glucose Fluctuation and Immune Regulation in Patients With Type 1 Diabetes

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