Exploratory Study of the Efficacy of Standard of Care Revascularization of the Lower Extremity
Revascularization of the Lateral Plantar Artery and Anterior Pedal Loop of the Foot as Treatment for Diabetic Peripheral Neuropathy.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.
Participants who satisfy eligibility criteria may undergo standard of care revascularization of one lower extremity as required, with the addition of revascularization of the lateral plantar artery and anterior pedal loop followed by a 26-week follow-up phase. Standard of Care revascularization will be performed in any limb with ≥ 50% stenosis as determined by intra-vascular ultrasound (IVUS) at the time of planned study intervention.
Participants will be evaluated prior to intervention and at 2, 4, 14 and 26 weeks after the pedal loop intervention.
Study Type
Study Type
Enrollment (Anticipated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Terri L Ryan, RN
- Phone Number: 1630 210-614-8612
- Email: terri.ryan@dgdclinic.com
Study Contact Backup
- Name: Josette M Negrete, BAAS
- Phone Number: 1515 210-614-8612
- Email: josette.negrete@dgdclinic.com
Study Locations
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-
Texas
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San Antonio, Texas, United States, 78229
- Diabetes and Glandular Disease Clinic, P.A.
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-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Male or female age 30 to 80 years (inclusive at first screening visit)
- Clinical diagnosis of type 1 or type 2 diabetes as diagnosed by HbA1c ≥ 6.5% or current treatment
- Clinical signs and symptoms of diabetic peripheral neuropathy bilaterally affecting the lower extremities, in the investigator's opinion, which may include neuropathic symptoms (e.g., numbness, tingling, burning sensation, sharp pains, sensitivity to touch) and decreased distal sensation (e.g., decreased vibration, pinprick or pain sensation, monofilament)
- HbA1c ≤ 11% (historical results allowed if performed within the past 90 days)
- Females of child-bearing potential who are willing to use contraceptive measures to prevent pregnancy for the duration of the study
- Willing to attend all scheduled study visits and undergo all study procedures
- Clinical diagnosis of Peripheral Artery Disease (PAD)
- Be able to understand, speak, read and write English
- Have medical insurance or financial means to cover the cost of the revascularization procedure and follow-up visits with the Interventional Radiologist
Exclusion Criteria:
- Inability to undergo angiogram with revascularization
- Unilateral neuropathic findings or symptoms
- Vitamin B-12 level < 400 pg/ml (historical results allowed if performed within the past 30 days) *
- Known causes of peripheral neuropathy other than diabetes, e.g., Amyloidosis, Tangier disease, Fabry's disease, hereditary sensory autonomic neuropathy, alcohol-related neuropathy, drug-induced neuropathy (e.g., chemotherapy, antibiotics, anti-retroviral agents, other neurotoxic agents) hypothyroidism that is not well controlled, rheumatoid arthritis or autoimmune disorders requiring treatment with corticosteroids, anti-tumor necrosis factor or immune-modulating medicines
- Known history of Hepatitis B, C, or HIV
- Lower limb amputation, including toe
- Lower extremity inoperable occlusive vascular disease
- Inability to provide informed consent
- History of bleeding disorders
- History of diabetic ulcers to the lower extremities
- History of any surgical bypass of the lower extremities prior to randomization
- History of previous revascularization of the lower extremities prior to randomization
- End Stage Renal Disease (ESRD) requiring or on dialysis
- Thyroid Stimulating Hormone -TSH >10.0 uu/mL*
- Potassium > 5.5 mmol/L. *
- Calcium < 8.5 mg/dL or > 11mg/dL *
- Hemoglobin < 9.0 g/dL *
- Female that is pregnant, breastfeeding or intends to become pregnant during the study period
- Clinically significant abnormal ECG findings, in the opinion of the Investigator
- Participation in another clinical trial with investigational drug or device at time of screening
- Any other clinically significant disorders or prior therapy that, in the opinion of the Investigator, would make the participant unsuitable for the study or unable to comply with the protocol requirements
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: NA
- Interventional Model: SINGLE_GROUP
- Masking: NONE
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
OTHER: Single Arm
This is a 26 week, single arm, single-site, Investigator-initiated, exploratory trial evaluating the efficacy of the standard of care revascularization of the lower extremity with the addition of revascularization of the lateral plantar artery and anterior pedal loop of the foot as treatment for participants with PAD, diabetic neuropathy and have a clinical diagnosis of type 1 or type 2 diabetes whose main symptoms are numbness and/or tingling of the feet with or without pain.
|
Angiogram and IVUS with revascularization of the lateral plantar artery and pedal arch on target foot.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Intra-epidermal Nerve Fiber Density
Time Frame: 26 weeks
|
Change from baseline in intra-epidermal nerve fiber density (IENFD) via skin biopsy of the revascularized foot over the extensor digitorum brevis muscle (EDBM) at week 26.
|
26 weeks
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Intra-epidermal Nerve Fiber Density
Time Frame: 14 and 26 weeks
|
Number and percent of participants whose IENFD have increased by at least 20% from baseline
|
14 and 26 weeks
|
|
Utah Early Neuropathy Scale
Time Frame: 14 and 26 weeks
|
Number and percentage of participants with improvement on Utah Neuropathy Scale (UENS)
|
14 and 26 weeks
|
|
Sural Nerve Action Potential Amplitude
Time Frame: 14 and 26 weeks
|
Number and percentage of participants with improvement of sural nerve action potential amplitude
|
14 and 26 weeks
|
|
Sudoscan
Time Frame: 14 and 26 weeks
|
Number and percentage of participants with 20% improvement on Sudoscan
|
14 and 26 weeks
|
|
Intra-epidermal Nerve Fiber Density
Time Frame: 14 weeks
|
Number and percentage of participants with improvement of intra-epidermal nerve fiber density
|
14 weeks
|
|
Neuropathic Pain Syndrome Inventory
Time Frame: 14 and 26 weeks
|
Improvement in quality of life as measured by the Neuropathic Pain Syndrome Inventory
|
14 and 26 weeks
|
|
Patency of Lateral Plantar Artery
Time Frame: 14 and 26 weeks
|
Number and percentage of participants with patency of lateral plantar artery per ultrasound
|
14 and 26 weeks
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Medial Plantar Sural Nerve Action Potential Amplitude
Time Frame: 14 and 26 weeks
|
Number of participants with 20% change in medial plantar sural nerve action potential amplitude (SNAP) via nerve conduction study
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14 and 26 weeks
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Dallas Broadway, MD, Modern Vascular, LLC
- Principal Investigator: Mark S Kipnes, MD, Diabetes and Glandular Disease Clinic, P.A.
Publications and helpful links
General Publications
- Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004 Apr;108(3):248-257. doi: 10.1016/j.pain.2003.12.024.
- Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001 Nov;44(11):1973-88. doi: 10.1007/s001250100001.
- Ibrahim S, Harris ND, Radatz M, Selmi F, Rajbhandari S, Brady L, Jakubowski J, Ward JD. A new minimally invasive technique to show nerve ischaemia in diabetic neuropathy. Diabetologia. 1999 Jun;42(6):737-42. doi: 10.1007/s001250051222.
- Malik RA, Masson EA, Sharma AK, Lye RH, Ah-See AK, Compton AM, Tomlinson DR, Hanley SP, Boulton AJ. Hypoxic neuropathy: relevance to human diabetic neuropathy. Diabetologia. 1990 May;33(5):311-8. doi: 10.1007/BF00403326.
- Newrick PG, Wilson AJ, Jakubowski J, Boulton AJ, Ward JD. Sural nerve oxygen tension in diabetes. Br Med J (Clin Res Ed). 1986 Oct 25;293(6554):1053-4. doi: 10.1136/bmj.293.6554.1053.
- Ram Z, Sadeh M, Walden R, Adar R. Vascular insufficiency quantitatively aggravates diabetic neuropathy. Arch Neurol. 1991 Dec;48(12):1239-42. doi: 10.1001/archneur.1991.00530240043016.
- Singleton JR, Bixby B, Russell JW, Feldman EL, Peltier A, Goldstein J, Howard J, Smith AG. The Utah Early Neuropathy Scale: a sensitive clinical scale for early sensory predominant neuropathy. J Peripher Nerv Syst. 2008 Sep;13(3):218-27. doi: 10.1111/j.1529-8027.2008.00180.x.
- Tesfaye S, Harris N, Jakubowski JJ, Mody C, Wilson RM, Rennie IG, Ward JD. Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography. Diabetologia. 1993 Dec;36(12):1266-74. doi: 10.1007/BF00400804.
- Veves A, Donaghue VM, Sarnow MR, Giurini JM, Campbell DR, LoGerfo FW. The impact of reversal of hypoxia by revascularization on the peripheral nerve function of diabetic patients. Diabetologia. 1996 Mar;39(3):344-8. doi: 10.1007/BF00418351.
- Young MJ, Veves A, Walker MG, Boulton AJ. Correlations between nerve function and tissue oxygenation in diabetic patients: further clues to the aetiology of diabetic neuropathy? Diabetologia. 1992 Dec;35(12):1146-50. doi: 10.1007/BF00401368.
- Young MJ, Veves A, Smith JV, Walker MG, Boulton AJ. Restoring lower limb blood flow improves conduction velocity in diabetic patients. Diabetologia. 1995 Sep;38(9):1051-4. doi: 10.1007/BF00402174.
Study record dates
Study Major Dates
Study Start (ANTICIPATED)
Study Start
Primary Completion (ANTICIPATED)
Primary Completion
Study Completion (ANTICIPATED)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (ACTUAL)
First Posted
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- DBMK-001
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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