Pilot - Resistance Exercise for Inpatient Treatment in T2D (P-REFIT-T2D)
Exercise Training During Hospitalization in Patients With Type 2 Diabetes - A Phase 1 Trial
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Patients will be invited to participate, preferably within the first 24 hours of admission, and randomized to either resistance-based bodyweight exercise or a control group. In total, 24 patients will be recruited, and distributed between the groups stratified for biological sex. At baseline, participants will have their medical history, social anamnesis, height, and weight assessed. At baseline a continuous glucose monitor will and accelerometer will be applied, to be worn until discharge and end of the intervention, respectively. Furthermore at baseline a multitude of questionnaires will be performed: International Physical Activity Questionnaire (IPAQ), Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F), Brief Illness Perception Questionnaire (BIPQ), 5-level EQ-5D version (EQ-5D-5L), WHO-5 Well-Being Index (WHO-5).
Intervention session A body-weight based resistance exercise program will be performed based on a booklet "Syg men sund og aktiv" Sick but healthy and active for 30 minutes per day. Described in more detail below.
Control session The control group will be placed in a seated position for 30 minutes corresponding to the time the intervention group is active.
Assessments before and after intervention/control sessions Before the sessions the EQ-5D-5L, the WHO-5 modified to a daily version, and an acute assessment of malaise, tiredness, nausea, dizziness, pain and breathlessness will be performed using numerical rating scales (NRS). After the session the NRS will be performed again.
Follow-up visit Two days after completion of the intervention, the participants will be invited for a follow-up visit at the Centre for Physical Activity Research, Rigshospitalet. This visit includes a qualitative interview, assessment of body composition, assessment of physical capabilities, ultrasound of the thigh, and blood samples. In case the patient is unable to attend the follow-up visit at the center, the daily operating manager will visit the patient at home. In this case, Ultrasound and muscle biopsy will not be performed. If the patient lives more than one hour away by car, the assessment will be performed online and will not include ultrasound, body composition and blood tests.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 1
Contacts and Locations
Study Contact
Study Contact
- Name: Erik Niklasson PhD-student, MD
- Phone Number: 4550262014
- Email: erik.karl.anders.niklasson@regionh.dk
Study Locations
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Capitol Region of Denmark
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Copenhagen, Capitol Region of Denmark, Denmark, 2100
- Copenhagen University Hospital
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Copenhagen, Capitol Region of Denmark, Denmark, 2650
- Departement of Infectious Diseases - Hvidovre Hospital
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
T2D or prediabetes defined as at least one of the following
- ICD-10 diagnosis of T2D (DE11.x)
- HbA1c > 48 at time of admission
- Use of type 2 antidiabetic medicine (excluding SGLT2 inhibitors)
- HbA1c ≥ 42 within 3 months of admission (prediabetes) (from 18 of September, 2024)
- Hospitalized with an infection
- Expected residual hospitalization time of at least three days
- At least 18 years of age
- Able to perform exercises in the booklet "Syg men sun dog aktiv"
Exclusion Criteria:
- Admitted to the hospital more than 5 days ago
- Unable to give written consent to participate
- Terminal illness
- Unstable or new onset angina
- Ventricular arrhythmia
- Aortic stenosis
- Sternotomy in conjunction with the current hospitalization
- Blood pressure greater than 180/120 mmHg
- Kidney failure requiring dialysis
- Unable to follow the 3-stage command of the Mini-Mental State Examination
- Known allergy or contact dermatitis to tape, and CGMs
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
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Experimental: Exercise
The exercise intervention is a four-week intervention and will consist of body weight strength training.
All training sessions during hospitalization will be supervised and will be performed individually for 30 min/day.
If the patient is discharged within the four-week training period, the training will continue from home and will be online-based with a live video connection to an instructor.
The training program will be the same.
The intervention group will ideally exercise post-prandially (within 60 min following the meal) following either breakfast or lunch.
Exercise intensity will be monitored throughout the training (with a heart rate monitor) and patients will estimate the rigorousness of the training using the rate of perceived exertion (RPE)-scale.
If possible, the goal is for the patients to reach a minimum of 5, corresponding to moderate intensity, but preferably 7+ on the 0-10 RPE scale in each set.
The aim is to complete the training sessions five out of seven days/week.
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A body weight based resistance training.
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No Intervention: Control
The Control group will be placed in a chair for 30 minutes, within 60 minutes following either breakfast or lunch daily during admission, depending on other workflows in the ward.
This corresponds to the time spent on exercise by the intervention group.
The control group will also be in daily contact with the instructor following discharge and will be asked the same daily questions and will be seated in a chair for 30 minutes as during hospitalization.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Feasibility of exercise in hospitalized patients with type 2 diabetes
Time Frame: Baseline to follow-up visit (4 weeks).
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• Recruitment: Include 24 patients in five months. Failure to achieve this goal will indicate challenges in the recruitment process. The recruitment will be continuously evaluated. o Failure to recruit 5 participants within the 1st month of recruitment will lead to patients with prediabetes (HbA1c ≥ 42 mmol/mol) being eligible for inclusion. This criterion will be assessed monthly and if the projected recruitment of 4-5 patients/month is not met, the inclusion criteria will be expanded to include prediabetes. If so, an amendment will be submitted to change the title of the project to include prediabetes. An intermediate state of diabetes also has a higher frequency of critical outcomes during hospitalization, and is inversely related to skeletal muscle mass. |
Baseline to follow-up visit (4 weeks).
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Glycemic variability
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Coefficient of variance (%CV) during hospitalization evaluated using a continuous glucose monitor. Defined as the oscillations in blood glucose occurring throughout the day. High glycemic variability is associated with an increased risk of cardiovascular events, mortality, and impaired quality of life. Glycemic variability adds considerable nuance to blood glucose control and allows for short-term assessments compared to glycated hemoglobin. If the participant is not discharged after 4 weeks the data collection will stop. |
Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Short physical performance battery
Time Frame: Baseline to follow-up visit (4 weeks).
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The Short Physical performance battery (SPPB) will be assessed at baseline, discharge and 30-day follow-up.
The SPPB consists of a combined score of a balance test (with the feet together, in a semitandem and tandem position), a walking test measuring the average speed over a three-meter distance, and a chair raise test that evaluates the time it takes for the participant to stand up and sit down five times.
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Baseline to follow-up visit (4 weeks).
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Sit-down stand-up test
Time Frame: Baseline to follow-up visit (4 weeks).
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A sit down stand-up test will be performed at baseline, discharge and 30-day follow-up to assess the number of times the participant can stand up and sit down from a chair within 60 seconds.
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Baseline to follow-up visit (4 weeks).
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Grip strength
Time Frame: Baseline to follow-up visit (4 weeks).
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Grip strength will be assessed at baseline, discharge and 30-day follow-up.
Measurements will be taken three times per hand, with the participant in a seated position.
The upper arm will be parallel to the torso, the elbow flexed at 90 degrees, and the wrist in a neutral position.
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Baseline to follow-up visit (4 weeks).
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Duration of hospitalization
Time Frame: Baseline until discharge, with a maximum of 1 year post intervention.
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Number of days in hospital, from baseline until a maximum of 1 year post intervention.
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Baseline until discharge, with a maximum of 1 year post intervention.
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Insulin use during hospitalization
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Number of daily units during hospitalization, from baseline until a maximum of 4 weeks.
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Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Mean glucose levels
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Mean glucose levels during hospitalization assessed using a continuous glucose monitor. If the participant is not discharged after 4 weeks the data collection will stop. |
Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in hyperglycemia
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in hyperglycemia (blood glucose > 10 mmol/l) during hospitalization assessed using a continuous glucose monitor. If the participant is not discharged after 4 weeks the data collection will stop. |
Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in hypoglycemia
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in hypoglycemia (blood glucose < 4 mmol/l) during hospitalization assessed using a continuous glucose monitor. If the participant is not discharged after 4 weeks the data collection will stop. |
Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in normal glucose range
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Time in normal range (6-10 mmol/l in accordance with Danish guidelines), during hospitalization assessed using a continuous glucose monitor. If the participant is not discharged after 4 weeks the data collection will stop. |
Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Mean amplitude of glucose excursions
Time Frame: Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Mean amplitude of glucose excursions from peaks to nadirs that are > 1 SD of mean glucose, assessed during hospitalization assessed using a continuous glucose monitor.
If the participant is not discharged after 4 weeks the data collection will stop.
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Baseline until discharge, with a maximum of 4 weeks post-inclusion.
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Cognitive function
Time Frame: Baseline to follow-up visit (4 weeks).
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Assessed using the Mini-mental state examination at baseline, discharge and follow-up visit.
If the participant is not discharged after 4 weeks the follow-up will be examined at the hospital.
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Baseline to follow-up visit (4 weeks).
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Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire.
Time Frame: Baseline to follow-up visit (4 weeks).
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Assessed at baseline, discharge and follow-up visit using the questionnaire Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F).
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Baseline to follow-up visit (4 weeks).
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Perceived health - Health-related Quality of Life questionnaire (Euroqol EQ-5D-5L)
Time Frame: Baseline to follow-up visit (4 weeks).
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Assessed at baseline, discharge and follow-up visit using the questionnaire Health-related Quality of Life questionnaire (Euroqol EQ-5D-5L).
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Baseline to follow-up visit (4 weeks).
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Perceived health - Brief Illness Perception Questionnaire (BIPQ)
Time Frame: Baseline to follow-up visit (4 weeks).
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Assessed at baseline, discharge and follow-up visit using the questionnaire Brief Illness Perception Questionnaire (BIPQ).
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Baseline to follow-up visit (4 weeks).
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Dual Energy X-Ray Absorptiometry - Appendicular lean mass
Time Frame: Follow-up visit (4 weeks).
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Difference between exercise and control group in appendicular lean mass assessed at the 4-week follow-up using dual energy x-ray absorptiometry.
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Follow-up visit (4 weeks).
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Dual Energy X-Ray Absorptiometry - Percentage of body fat
Time Frame: Follow-up visit (4 weeks).
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Difference between exercise and control group in percentage of body fat assessed at the 4-week follow-up using dual energy x-ray absorptiometry.
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Follow-up visit (4 weeks).
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Dual Energy X-Ray Absorptiometry - Android fat
Time Frame: Follow-up visit (4 weeks).
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Difference between exercise and control group in android fat assessed at the 4-week follow-up using dual energy x-ray absorptiometry.
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Follow-up visit (4 weeks).
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Dual Energy X-Ray Absorptiometry- Gynoid fat
Time Frame: Follow-up visit (4 weeks).
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Difference between exercise and control group in gynoid fat assessed at the 4-week follow-up using dual energy x-ray absorptiometry.
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Follow-up visit (4 weeks).
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Rectus femoris cross-sectional area
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in cross-sectional area assessed at baseline, discharge and 4-week follow-up using an ultrasound of rectus femoris in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Rectus femoris echo intensity
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in echo intensity of rectus femoris assessed at baseline, discharge and 4-week follow-up using skeletal muscle ultrasound in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Rectus femoris echo variation
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in echo variation of rectus femoris assessed at baseline, discharge and 4-week follow-up using skeletal muscle ultrasound in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Rectus femoris pennation angle
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in pennation angle of rectus femoris assessed at baseline, discharge and 4-week follow-up using skeletal muscle ultrasound in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Thickness of the anterior thigh muscles
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in anterior thigh muscle thickness assessed at baseline, discharge and 4-week follow-up, measured from the mid-anterior point rectus femoris to the mid posterior point of vastus intermedius of the femoral quadriceps in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Thickness of rectus femoris
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in rectus femoris muscle thickness assessed at baseline, discharge and 4-week follow-up, measured from the mid-anterior point rectus femoris to the mid posterior point in the dominant leg.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
It will be measured at the distal third and midpoint between the anterior superior iliac spine and the proximal point of the patella.
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Baseline to follow-up visit (4 weeks).
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Bioelectrical Impedance - Appendicular lean body mass
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in estimated appendicular lean body mass using bioelectrical impedance assessed at baseline, discharge and 4-week follow-up.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
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Baseline to follow-up visit (4 weeks).
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Bioelectrical Impedance - Total lean body mass
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in estimated total lean body mass using bioelectrical impedance assessed at baseline, discharge and 4-week follow-up.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
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Baseline to follow-up visit (4 weeks).
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Bioelectrical Impedance - Percentage of body fat
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in estimated percentage of body fat using bioelectrical impedance assessed at baseline, discharge and 4-week follow-up.
If the participant is not discharged after 4 weeks, only baseline and follow-up will be assessed.
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Baseline to follow-up visit (4 weeks).
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Readmission rates.
Time Frame: Baseline until 1 year follow-up.
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Time-to-event, number of events and number of days and reason for event will be assessed.
The event will be assessed at 30 days post-discharge, 90 days post-discharge, and 1 year post intervention.
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Baseline until 1 year follow-up.
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Sick leave rates.
Time Frame: Baseline until 1 year follow-up.
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Time-to-event, number of events and number of days and reason for event will be assessed.
The event will be assessed at 30 days post-discharge, 90 days post-discharge, and 1 year post intervention
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Baseline until 1 year follow-up.
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All cause mortality
Time Frame: Baseline until 1 year follow-up.
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Time-to-event, number of events and number of days and reason for event will be assessed.
The event will be assessed during hospitalization, 30 days post-discharge, 90 days post-discharge, and 1 year post intervention.
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Baseline until 1 year follow-up.
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Use of antidiabetic medication 1-year post inclusion
Time Frame: Baseline until 1 year follow-up.
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The use of which types of antidiabetic medication will be assessed at baseline, discharge, and 1-year follow up.
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Baseline until 1 year follow-up.
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Circulatory factors in plasma - Interferon-γ
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma Interferon-γ assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-1β
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-1β assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-2
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-2 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-4
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-4 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-6
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-6 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-8
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-8 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-10
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-8 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-12p70
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-12p70 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Interleukin-13
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma interleukin-13 assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Tumor Necrosis Factor-α
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma tumor necrosis factor-α assessed using the Meso Scale Discovery's V-PLEX Proinflammatory Panel 1 Human Kit.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Myostatin
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma myostatin assessed using a Meso Scale custom plate.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Circulatory factors in plasma - Follistatin
Time Frame: Baseline to follow-up visit (4 weeks).
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Change in plasma follistatin assessed using a Meso Scale custom plate.
These samples will be conducted at baseline, discharge, and follow-up visit.
If the participant is not discharged within 4 weeks, samples will only be collected at baseline and follow-up.
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Baseline to follow-up visit (4 weeks).
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
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
- Endocrine System Diseases
- Metabolic Diseases
- Glucose Metabolism Disorders
- Behavior
- Nutritional and Metabolic Diseases
- Diabetes Mellitus, Type 2
- Diabetes Mellitus
- Prediabetic State
- Motor Activity
- Motor Activity
- Movement
- Musculoskeletal Physiological Phenomena
- Musculoskeletal and Neural Physiological Phenomena
- Exercise
Other Study ID Numbers
Other Study ID Numbers
- H-24002354
- PREFIT-T2D (Other Identifier: Centre for Physical Activity Research)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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