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Use of Terbutaline or a Reduction in Basal Insulin in the Prevention of Nocturnal Hypoglycemia

Primary Purpose

Type 1 Diabetes

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Terbutaline
20% basal insulin reduction
Control
Sponsored by
University of Colorado, Denver
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 1 Diabetes focused on measuring Children, Exercise, Hypoglycemia

Eligibility Criteria

10 Years - 17 Years (Child)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Clinical diagnosis of Type 1 Diabetes and using daily insulin therapy for at least one year.
  • Age 10 to 17 years, inclusive.
  • HbA1c < 10.0%.
  • BMI 5-95th % for age and gender.
  • Stable Continuous Subcutaneous Insulin Infusion regimen for at least 1 month and not anticipating a change prior to the subject's completion of the study.
  • Subject uses a downloadable insulin pump.
  • Normal thyroid function (measured within the previous year).
  • For females, subject not intending to become pregnant during the study.
  • No expectation that subject will be moving out of the area for the duration of the study.
  • Informed consent form signed and understood by the parent/guardian and Child Assent form signed/understood by subjects.

Exclusion Criteria:

  • The presence of a significant medical disorder (including epilepsy, or any cause of seizures other than hypoglycemia) that in the judgment of the investigator will affect the wearing of the sensors or the completion of any aspect of the protocol.
  • A recent injury to body or limb, Addison's disease, muscular disorder or disease in the judgment of the investigator that will affect the completion of the exercise protocol.
  • Asthma which has been medically treated within the last year.
  • Medically diagnosed cardiac disease, hypertension, or autonomic dysfunction.
  • Use of pseudoephedrine 48 hours prior to the visit (if used in the 48 hours prior to the scheduled visit, the visit will be deferred)
  • Severe hypoglycemia resulting in seizure of loss of consciousness in the 3 months prior to a visit.
  • Active infection (if at the time of the scheduled visit and infection is present, the visit will be deferred).
  • Anticipating a significant change in exercise regimen between visits (i.e. starting or stopping an organized sport).
  • Treatment with systemic or inhaled corticosteroids in the last 6 months.
  • Current treatment with B-blockers or presenting with high blood pressure.
  • Inpatient psychiatric treatment in the past 6 months for either the subject or the subject's primary care giver.
  • Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study
  • Known allergy to Terbutaline
  • Treatment with atenolol (Tenormin), carteolol (Cartrol), labetalol (Normodyne, Trandate), metoprolol (Lopressor), nadolol (Corgard), phenelzine (Nardil), propranolol (Inderal), sotalol (Betapace), theophylline (Theo-Dur), timolol (Blocadren), tranylcypromine (Parnate), other medications for asthma, heart disease or depression.
  • Treatment with ephedrine, phenylephrine, phenylpropanolamine, or pseudoephedrine.
  • The presence of an irregular heart beat, increased heart rate glaucoma or an overactive thyroid gland.

Sites / Locations

  • Barbara Davis Center

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Control

Terbutaline

20% Basal Insulin Reduction

Arm Description

Subjects complete the same exercise routine, however no treatment is given at 9:00pm.

Subjects complete same exercise routine. At 9:00pm, an oral dose of 2.5 mg of Terbutaline is administered.

All subjects complete the same exercise session. At 9:00pm, subject's basal rate is decreased by 20% for six hours.

Outcomes

Primary Outcome Measures

Blood Glucose Nadir
BG nadir overnight after intervention

Secondary Outcome Measures

Percent of Nighttime Glucose Levels <80
Percent of Nighttime Glucose Levels <70
Percent of Nighttime Glucose Levels >250 mg/dl

Full Information

First Posted
September 9, 2009
Last Updated
August 2, 2013
Sponsor
University of Colorado, Denver
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1. Study Identification

Unique Protocol Identification Number
NCT00974051
Brief Title
Use of Terbutaline or a Reduction in Basal Insulin in the Prevention of Nocturnal Hypoglycemia
Official Title
The Effect of Using Terbutaline or a Reduction in Basal Insulin Infusion as a Therapeutic Agent to Prevent Delayed Nocturnal Hypoglycemia in Children and Adolescents With Type 1 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
August 2013
Overall Recruitment Status
Completed
Study Start Date
March 2008 (undefined)
Primary Completion Date
December 2008 (Actual)
Study Completion Date
December 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Colorado, Denver

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The investigators hypothesize that the use of an oral dose of Terbutaline or a 20% basal reduction will be able to prevent nocturnal hypoglycemia after an afternoon exercise session. This is a randomized three period cross-over study including treatment with Terbutaline, a 20% basal reduction for six hours, or no treatment (control).
Detailed Description
In this study, a minimum of 16 youth with type 1 diabetes will be recruited. All subjects must have been diagnosed with type 1 diabetes for at least one year and on an insulin pump for at least one month. Subjects are between the ages of 10 and 17 years, inclusive, have an HbA1c less than 10.0% and normal thyroid function. Subjects can not have had a severe hypoglycemic episode in the last three months, any other illness or treatment that may affect the wearing of a continuous glucose monitor or the completion of the study as determined by the investigator. Subjects may not use drugs containing pseudoephedrine within 48 hours of the study visits. This study consists of three overnight visits at the Clinical Translational Research Center. Meals eaten during the study will be consistent for each of the three visits. Subjects will participate in a standardized afternoon exercise session on a treadmill as has been done in previous Diabetes Research in Children Network studies. Exercise will begin at 4pm and must be completed by 6pm. Dinner will be eaten at the end of the exercise. At 9pm, treatment will be given as determined by the randomization group the subject is assigned to. The treatment includes either an oral dose of 2.5mg Terbutaline, a 20% basal reduction for six hours or no treatment as the control. Blood glucose levels will be measured every 30 minutes until 6am.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type 1 Diabetes
Keywords
Children, Exercise, Hypoglycemia

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Control
Arm Type
Active Comparator
Arm Description
Subjects complete the same exercise routine, however no treatment is given at 9:00pm.
Arm Title
Terbutaline
Arm Type
Experimental
Arm Description
Subjects complete same exercise routine. At 9:00pm, an oral dose of 2.5 mg of Terbutaline is administered.
Arm Title
20% Basal Insulin Reduction
Arm Type
Experimental
Arm Description
All subjects complete the same exercise session. At 9:00pm, subject's basal rate is decreased by 20% for six hours.
Intervention Type
Drug
Intervention Name(s)
Terbutaline
Other Intervention Name(s)
β2-adrenergic agonist
Intervention Description
Oral (2.5mg) one time administration at 9:00pm
Intervention Type
Other
Intervention Name(s)
20% basal insulin reduction
Other Intervention Name(s)
80% basal insulin
Intervention Description
Basal insulin rate is reduced by 20% the normal (home dose) for six hours.
Intervention Type
Other
Intervention Name(s)
Control
Other Intervention Name(s)
No intervention
Intervention Description
No treatment is given for the study. This arm is for comparison with the two intervention arms.
Primary Outcome Measure Information:
Title
Blood Glucose Nadir
Description
BG nadir overnight after intervention
Time Frame
overnight hours
Secondary Outcome Measure Information:
Title
Percent of Nighttime Glucose Levels <80
Time Frame
9:00pm to 6:00am
Title
Percent of Nighttime Glucose Levels <70
Time Frame
10:00pm to 6:00am
Title
Percent of Nighttime Glucose Levels >250 mg/dl
Time Frame
10:00pm to 6:00am

10. Eligibility

Sex
All
Minimum Age & Unit of Time
10 Years
Maximum Age & Unit of Time
17 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Clinical diagnosis of Type 1 Diabetes and using daily insulin therapy for at least one year. Age 10 to 17 years, inclusive. HbA1c < 10.0%. BMI 5-95th % for age and gender. Stable Continuous Subcutaneous Insulin Infusion regimen for at least 1 month and not anticipating a change prior to the subject's completion of the study. Subject uses a downloadable insulin pump. Normal thyroid function (measured within the previous year). For females, subject not intending to become pregnant during the study. No expectation that subject will be moving out of the area for the duration of the study. Informed consent form signed and understood by the parent/guardian and Child Assent form signed/understood by subjects. Exclusion Criteria: The presence of a significant medical disorder (including epilepsy, or any cause of seizures other than hypoglycemia) that in the judgment of the investigator will affect the wearing of the sensors or the completion of any aspect of the protocol. A recent injury to body or limb, Addison's disease, muscular disorder or disease in the judgment of the investigator that will affect the completion of the exercise protocol. Asthma which has been medically treated within the last year. Medically diagnosed cardiac disease, hypertension, or autonomic dysfunction. Use of pseudoephedrine 48 hours prior to the visit (if used in the 48 hours prior to the scheduled visit, the visit will be deferred) Severe hypoglycemia resulting in seizure of loss of consciousness in the 3 months prior to a visit. Active infection (if at the time of the scheduled visit and infection is present, the visit will be deferred). Anticipating a significant change in exercise regimen between visits (i.e. starting or stopping an organized sport). Treatment with systemic or inhaled corticosteroids in the last 6 months. Current treatment with B-blockers or presenting with high blood pressure. Inpatient psychiatric treatment in the past 6 months for either the subject or the subject's primary care giver. Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study Known allergy to Terbutaline Treatment with atenolol (Tenormin), carteolol (Cartrol), labetalol (Normodyne, Trandate), metoprolol (Lopressor), nadolol (Corgard), phenelzine (Nardil), propranolol (Inderal), sotalol (Betapace), theophylline (Theo-Dur), timolol (Blocadren), tranylcypromine (Parnate), other medications for asthma, heart disease or depression. Treatment with ephedrine, phenylephrine, phenylpropanolamine, or pseudoephedrine. The presence of an irregular heart beat, increased heart rate glaucoma or an overactive thyroid gland.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rosanna Fiallo-Scharer, MD
Organizational Affiliation
University of Colorado, Denver
Official's Role
Principal Investigator
Facility Information:
Facility Name
Barbara Davis Center
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
20650471
Citation
Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr. 2010 Nov;157(5):784-8.e1. doi: 10.1016/j.jpeds.2010.06.004. Epub 2010 Jul 21.
Results Reference
derived

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Use of Terbutaline or a Reduction in Basal Insulin in the Prevention of Nocturnal Hypoglycemia

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