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Treatment of Diabetic Neuropathy With Liraglutide (TODINELI)

Primary Purpose

Diabetes Mellitus, Type 1, Type 1 Diabetes Mellitus

Status
Completed
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
Placebo treatment
Liraglutide treatment
Sponsored by
Aalborg University Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 1 focused on measuring Diabetes Mellitus, Type 1, Diabetic Neuropathy, Liraglutide

Eligibility Criteria

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

Inclusion Criteria:

  • Abile person of Northern European descent
  • Age between 18 to 65 years
  • A verified diagnosis of DM type 1 for minimum 2 years (HbA1C=7%)
  • Stable DM treatment (Treatment is considered stable when the patient has been treated with basal-bolus insulin, premixed insulin or continously infused insulin with an insulin dose considered stable by investigator for at least 3 months prior to screening.)
  • The participants must be able to read and understand Danish.
  • Peripheral diabetic neuropathy ensured by having abnormal nerve conduction velocity
  • BMI equal to or above 22
  • Personally signed and dated informed consent document indicating that the patient has been informed of all pertinent aspects of the trial.
  • Patients willing and able to comply with the scheduled visits, treatment plan, laboratory tests and other trial procedures.

Exclusion Criteria:

  • Diabetes mellitus type II
  • Estimated glomerular filtration rate (s-creatinin/eGRF) < 60 ml/min/1.37m2
  • Calcitonin > 25
  • HbA1c level < 7%
  • Patients with any clinically significant laboratory abnormalities, that in the opinion of the investigator may increase the risk associated with trial participation or may interfere with the interpretation of the trial results.
  • Patients on GLP-1 receptor agonist treatment (exenatide, liraglutide or others) or pramlintide or any DPP-4 inhibitor within 3 months prior to screening.
  • Other neurological and/or psychiatric disease
  • Treatment of other endocrinological disease except hypothyreosis
  • Malignant neoplasms requiring chemotherapy, surgery, radiation or palliative care in the previous 5 years.
  • Family or personal history of multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid carcinoma.
  • Personal history of non-familial medullary thyroid carcinoma
  • Known abuse or alcohol and/or medicine (Alcohol use in accordance with the recommendations by the Danish Health and Medicines Authority are allowed).
  • Known allergy to liraglutide.
  • Participation in other clinical trials less than 3 months prior to inclusion
  • Female patients who are pregnant or lactating, or intend to become pregnant and male patients who intend to father a child during course of the study.
  • In women, a serum pregnancy test will be conducted at baseline based on h-CG in the blood. The investigator will have to ensure that fertile female patients use a safe contraception method during the study and for at least 15 hours after termination of the study medication period.

Sites / Locations

  • Mech-Sense, Department of Medical Gastroenterology, Aalborg University Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Active Comparator

Arm Label

Placebo treatment

Liraglutide treatment

Arm Description

Placebo solution will be slowly titrated to maximum tolerable dose in order to minimize potential side-effects, hence treatment will follow: First and second week: 0.6 mg/day; Third and fourth week: 1.2 mg/day and Fifth and to sixth week: 1.8 mg/day.

Liraglutide will be slowly titrated to maximum tolerable dose in order to minimize potential side-effects, hence treatment will follow: First and second week: 0.6 mg/day; Third and fourth week: 1.2 mg/day and Fifth and to sixth week: 1.8 mg/day.

Outcomes

Primary Outcome Measures

RIII withdrawal reflex activity (using standard electromyography)
Evoked brain potentials (using standard electroencephalographic brain imaging).

Secondary Outcome Measures

Heart rate variability/ alterations in simpatico-vagal balance (24 h Holter monitoring)
Resting brain activity (spectral analysis of resting brain activity)
Microstructural brain neurodegeneration (assessed by diffuse tensor imaging)
Variety in day/night blood pressure
Gut transit assessed by SmartPill (pH, pressure and transit in stomach, small and large intestine)
Quantitive sensory testing of pressure algometry in muscle
Capacity of descending pain inhibition induced by a cold pressor test (2C in 120 sec)
Profile of inflammatory cytokines including IL-beta, TNF-alfa, IL6, MCP-1 and specific markers sCD163, sMR, neopterin and HO-1.
Metabolic risk factors expressed as adipokines (adiponectin, leptin, resistin) and inflammatory cell markers
Self assessed symptomatology (Michigan neuropathy screening tool, Quality of life (SF-36), Pain catastrophizing scale (PCS) and self-assessed gastro-intestinal symptoms (PAGI-SYM))
OCT

Full Information

First Posted
May 13, 2014
Last Updated
August 9, 2021
Sponsor
Aalborg University Hospital
Collaborators
Novo Nordisk A/S
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1. Study Identification

Unique Protocol Identification Number
NCT02138045
Brief Title
Treatment of Diabetic Neuropathy With Liraglutide
Acronym
TODINELI
Official Title
A Randomized, Double-blinded, Single-centre, Parallel-group, Placebo-controlled, Prospective Trial of Neuroprotective Effect of Liraglutide for Treatment of Diabetic Neuropathy.
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
May 2014 (undefined)
Primary Completion Date
February 2017 (Actual)
Study Completion Date
February 2017 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Aalborg University Hospital
Collaborators
Novo Nordisk A/S

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this trial is to explore whether liraglutide has a long term effect on clinical symptoms and biomarkers in patients with diabetic neuropathy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1, Type 1 Diabetes Mellitus
Keywords
Diabetes Mellitus, Type 1, Diabetic Neuropathy, Liraglutide

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
39 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo treatment
Arm Type
Placebo Comparator
Arm Description
Placebo solution will be slowly titrated to maximum tolerable dose in order to minimize potential side-effects, hence treatment will follow: First and second week: 0.6 mg/day; Third and fourth week: 1.2 mg/day and Fifth and to sixth week: 1.8 mg/day.
Arm Title
Liraglutide treatment
Arm Type
Active Comparator
Arm Description
Liraglutide will be slowly titrated to maximum tolerable dose in order to minimize potential side-effects, hence treatment will follow: First and second week: 0.6 mg/day; Third and fourth week: 1.2 mg/day and Fifth and to sixth week: 1.8 mg/day.
Intervention Type
Drug
Intervention Name(s)
Placebo treatment
Intervention Description
Treatment continues at highest tolereable dose (minimum 1.2 mg/day). Intervention time 26 weeks at target dose.
Intervention Type
Drug
Intervention Name(s)
Liraglutide treatment
Intervention Description
Treatment continues at highest tolereable dose (minimum 1.2 mg/day). Intervention time 26 weeks at target dose.
Primary Outcome Measure Information:
Title
RIII withdrawal reflex activity (using standard electromyography)
Time Frame
After 6 months of treatment with Liraglutide
Title
Evoked brain potentials (using standard electroencephalographic brain imaging).
Time Frame
After 6 months of treatment with Liraglutide
Secondary Outcome Measure Information:
Title
Heart rate variability/ alterations in simpatico-vagal balance (24 h Holter monitoring)
Time Frame
After 6 months of treatment with Liraglutide
Title
Resting brain activity (spectral analysis of resting brain activity)
Time Frame
After 6 months of treatment with Liraglutide
Title
Microstructural brain neurodegeneration (assessed by diffuse tensor imaging)
Time Frame
After 6 months of treatment with Liraglutide
Title
Variety in day/night blood pressure
Time Frame
After 6 months of treatment with Liraglutide
Title
Gut transit assessed by SmartPill (pH, pressure and transit in stomach, small and large intestine)
Time Frame
After 6 months of treatment with Liraglutide
Title
Quantitive sensory testing of pressure algometry in muscle
Time Frame
After 6 months of treatment with Liraglutide
Title
Capacity of descending pain inhibition induced by a cold pressor test (2C in 120 sec)
Time Frame
After 6 months of treatment with Liraglutide
Title
Profile of inflammatory cytokines including IL-beta, TNF-alfa, IL6, MCP-1 and specific markers sCD163, sMR, neopterin and HO-1.
Time Frame
After 6 months of treatment with Liraglutide
Title
Metabolic risk factors expressed as adipokines (adiponectin, leptin, resistin) and inflammatory cell markers
Time Frame
After 6 months of treatment with Liraglutide
Title
Self assessed symptomatology (Michigan neuropathy screening tool, Quality of life (SF-36), Pain catastrophizing scale (PCS) and self-assessed gastro-intestinal symptoms (PAGI-SYM))
Time Frame
After 6 months of treatment with Liraglutide
Title
OCT
Time Frame
After 6 months of treatment with Liraglutide
Other Pre-specified Outcome Measures:
Title
HbA1C
Time Frame
After 6 months of treatment with Liraglutide
Title
Biochemical lipid profile
Time Frame
After 6 months of treatment with Liraglutide
Title
Heart rate and blood pressure
Time Frame
After 6 months of treatment with Liraglutide
Title
Weight/body mass index
Time Frame
After 6 months of treatment with Liraglutide

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Abile person of Northern European descent Age between 18 to 65 years A verified diagnosis of DM type 1 for minimum 2 years (HbA1C=7%) Stable DM treatment (Treatment is considered stable when the patient has been treated with basal-bolus insulin, premixed insulin or continously infused insulin with an insulin dose considered stable by investigator for at least 3 months prior to screening.) The participants must be able to read and understand Danish. Peripheral diabetic neuropathy ensured by having abnormal nerve conduction velocity BMI equal to or above 22 Personally signed and dated informed consent document indicating that the patient has been informed of all pertinent aspects of the trial. Patients willing and able to comply with the scheduled visits, treatment plan, laboratory tests and other trial procedures. Exclusion Criteria: Diabetes mellitus type II Estimated glomerular filtration rate (s-creatinin/eGRF) < 60 ml/min/1.37m2 Calcitonin > 25 HbA1c level < 7% Patients with any clinically significant laboratory abnormalities, that in the opinion of the investigator may increase the risk associated with trial participation or may interfere with the interpretation of the trial results. Patients on GLP-1 receptor agonist treatment (exenatide, liraglutide or others) or pramlintide or any DPP-4 inhibitor within 3 months prior to screening. Other neurological and/or psychiatric disease Treatment of other endocrinological disease except hypothyreosis Malignant neoplasms requiring chemotherapy, surgery, radiation or palliative care in the previous 5 years. Family or personal history of multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid carcinoma. Personal history of non-familial medullary thyroid carcinoma Known abuse or alcohol and/or medicine (Alcohol use in accordance with the recommendations by the Danish Health and Medicines Authority are allowed). Known allergy to liraglutide. Participation in other clinical trials less than 3 months prior to inclusion Female patients who are pregnant or lactating, or intend to become pregnant and male patients who intend to father a child during course of the study. In women, a serum pregnancy test will be conducted at baseline based on h-CG in the blood. The investigator will have to ensure that fertile female patients use a safe contraception method during the study and for at least 15 hours after termination of the study medication period.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Asbjørn M. Drewes, Professor
Organizational Affiliation
Mech-Sense, Department of Medical Gastroenterology, Aalborg Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mech-Sense, Department of Medical Gastroenterology, Aalborg University Hospital
City
Aalborg
State/Province
Jutland
ZIP/Postal Code
9000
Country
Denmark

12. IPD Sharing Statement

Citations:
PubMed Identifier
34918951
Citation
Arendt Nielsen T, Sega R, Uggerhoj Andersen C, Vorum H, Drewes AM, Jakobsen PE, Brock B, Brock C. Liraglutide Treatment Does Not Induce Changes in the Peripapillary Retinal Nerve Fiber Layer Thickness in Patients with Diabetic Retinopathy. J Ocul Pharmacol Ther. 2022 Jan-Feb;38(1):114-121. doi: 10.1089/jop.2021.0055. Epub 2021 Dec 16.
Results Reference
derived
PubMed Identifier
32571684
Citation
Nissen TD, Meldgaard T, Nedergaard RW, Juhl AH, Jakobsen PE, Karmisholt J, Drewes AM, Brock B, Brock C. Peripheral, synaptic and central neuronal transmission is affected in type 1 diabetes. J Diabetes Complications. 2020 Sep;34(9):107614. doi: 10.1016/j.jdiacomp.2020.107614. Epub 2020 May 8.
Results Reference
derived
PubMed Identifier
32501945
Citation
Nedergaard RB, Nissen TD, Morch CD, Meldgaard T, Juhl AH, Jakobsen PE, Karmisholt J, Brock B, Drewes AM, Brock C. Diabetic Neuropathy Influences Control of Spinal Mechanisms. J Clin Neurophysiol. 2021 Jul 1;38(4):299-305. doi: 10.1097/WNP.0000000000000691.
Results Reference
derived
PubMed Identifier
31338868
Citation
Brock C, Hansen CS, Karmisholt J, Moller HJ, Juhl A, Farmer AD, Drewes AM, Riahi S, Lervang HH, Jakobsen PE, Brock B. Liraglutide treatment reduced interleukin-6 in adults with type 1 diabetes but did not improve established autonomic or polyneuropathy. Br J Clin Pharmacol. 2019 Nov;85(11):2512-2523. doi: 10.1111/bcp.14063. Epub 2019 Aug 30.
Results Reference
derived

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Treatment of Diabetic Neuropathy With Liraglutide

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