Effect of Insulin Detemir on Use of Energy in Type 1 Diabetes

January 30, 2017 updated by: Novo Nordisk A/S

A 32-week National, Single-centre, Open-labelled, Randomised, Crossover Trial Comparing Energy Expenditure With Insulin Detemir Versus NPH Insulin Using a Basal-Bolus Regimen With Insulin Aspart as Mealtime Insulin in Subjects With Type 1 Diabetes

This trial is conducted in Europe. The purpose of this trial is to investigate if there is any change in the mechanism of energy expenditure (i.e. the way in which energy is used) in patients with type 1 diabetes, whilst taking two different, commercially available insulins for the treatment of their diabetes.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Detailed Description

The study had been temporarily halted due to an unplanned interim analysis. The Sponsor is now aware that a further interim analysis has been performed by the site and therefore a decision has been made not to recommence the study

Study Type

Interventional

Enrollment (Actual)

23

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United Kingdom
      • Guildford, United Kingdom, GU2 7XX
        • Novo Nordisk Investigational Site

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Type 1 diabetes for more than 12 months
  • Current treatment: Basal-bolus insulin regimen for more than three months (i.e. at least one daily injection of long-acting insulin (including insulin glargine) and fast-acting insulin with each main meal)
  • HbA1c (glycosylated haemoglobin A1c) between 7.0 and 11.0%
  • Able and willing to maintain consistent physical activity level throughout the entire study period
  • Able and willing to maintain consistent eating habits throughout the entire study period

Exclusion Criteria:

  • Proliferative retinopathy that has required acute treatment within the last six months
  • Recurrent major hypoglycaemia or hypoglycaemic unawareness as judged by the Investigator
  • Liver, kidney or heart problems as judged by the Investigator
  • Pregnancy, breast-feeding, the intention of becoming pregnant or not using adequate contraceptive measures
  • Known or suspected allergy to trial products or related products
  • Receipt of any investigational drug within one month prior to this trial

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Treatment period 1
Insulin detemir for 16 weeks (treatment period 1) followed by insulin NPH treatment for 16 weeks (treatment period 2) in addition to meal-time insulin aspart
Drug: insulin detemir
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection
Drug: insulin NPH
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection
Drug: insulin aspart
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection
Experimental: Treatment period 2
Insulin NPH for 16 weeks (treatment period 1) followed by insulin detemir treatment for 16 weeks (treatment period 2) in addition to meal-time insulin aspart
Drug: insulin detemir
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection
Drug: insulin NPH
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection
Drug: insulin aspart
Treat-to-target dose tritation (dose adjusted individually), s.c. (under the skin) injection

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Total Energy Expenditure, Double-labelled Water Method
Time Frame: Weeks 14-16, weeks 30-32
Total energy expenditure (TEE) measured after each treatment period by the double-labelled water (DLW) method. This technique required subjects to label their body water using oral administration of water labelled with 2 stable isotopes (2H218O). The clearance of 2H and 18O was measured over a two week period with daily collections of urine. The difference between the clearance of 2H and 18O is a measure of CO2 production rate. This can be converted to provide a measure of energy expenditure.
Weeks 14-16, weeks 30-32
Total Energy Expenditure, Dietary Record Method
Time Frame: Weeks 14-16, weeks 30-32
The total energy expenditure (TEE) measured after each treatment period by the dietary record method. The calculation of energy balance is accomplished by compiling an accurate record of food intake over a period of time and measuring any changes in body weight that occur during that time. Data from the 7-day food diary was used to calculate TEE.
Weeks 14-16, weeks 30-32

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Component of Total Energy Expenditure: Resting Energy Expenditure (REE)
Time Frame: Week 14, week 30
Resting energy expenditure (REE) is a component of TEE (total energy expenditure). It was measured at 2 different timepoints during the trial using indirect calorimetry (measurement of O2 consumption/CO2 production) after an overnight fast when subjects would be metabolising a mixture of carbohydrate and free fatty acid. This technique allowed the calculation of the rate of carbohydrate and lipid oxidation.
Week 14, week 30
Component of Total Energy Expenditure: Diet Induced Thermogenesis (DIT)
Time Frame: Week 14, week 30
Diet induced thermogenesis (DIT) is a component of TEE (total energy expenditure) and is the energy expenditure following feeding for anabolic processes. Subjects fasted overnight and rested for 1 hour. Multiple measurements of REE (resting energy expenditure) were taken. A fixed 600 kcal liquid meal was given and REE was measured over the next 3 hours. DIT was calculated as area under the curve of total REE-resting REE for the 3-hour period and was then converted to a per day measurement by taking into account each individual's average daily food intake.
Week 14, week 30
Component of Total Energy Expenditure: Physical Activity Thermogenesis
Time Frame: Week 16, week 32
Physical activity thermogenesis is a component of TEE (total energy expenditure). Subjects were asked not to change their physical activity levels. Physical activity thermogenesis can be calculated as the difference between TEE minus (REE + DIT), as long as volitional exercise is unchanged. Volitional exercise was assessed using Actiheart 3-D monitor readings. Subjects were asked to measure their normal activity for between 1 and 5 days prior to their visits at week 16 and week 32).
Week 16, week 32
Component of Total Energy Expenditure: Non-exercise Activity Thermogenesis (NEAT)
Time Frame: Week 16, week 32
Non-exercise activity thermogenesis is a component of TEE (total energy expenditure). Thermic efficiency was assessed by measuring O2 consumption/CO2 production while the subject exercised on a bike for 20 minutes while hooked up to a device that recorded their respiration (visit in week 14 and week 30). If thermic efficiency was unchanged and volitional exercise was unchanged, then any change in physical activity thermogenesis was due to changes in NEAT.
Week 16, week 32
Body Weight
Time Frame: Week 16, week 32
Body weight after each treatment period.
Week 16, week 32
Lean Body Mass
Time Frame: Week 16, week 32
Lean body mass was measured using Bioelectrical Impedance Analysis (BIA), a method used for estimating body composition.
Week 16, week 32
Fat Mass
Time Frame: Week 16, week 32
Fat mass was measured using Bioelectrical Impedance Analysis (BIA), a method used for estimating body composition.
Week 16, week 32
Waist:Hip Ratio
Time Frame: Week 16, week 32
At each time-point, 3 measurements each of waist and hip circumference were taken, then an average across the three measurements was calculated for both and the ratio was calculated as the waist average in cm divided by hip average in cm, and multiplied by 100.
Week 16, week 32
Hormonal Assessment: Adiponectin
Time Frame: Week 14, week 30
Adiponectin levels after each treatment period.
Week 14, week 30
Hormonal Assessment: Insulin-like Growth Factor-1
Time Frame: Week 14, week 30
Insulin-like growth factor-1 (IGF-1) levels after each treatment period.
Week 14, week 30
Hormonal Assessment: Resistin
Time Frame: Week 14, week 30
Resistin levels after each treatment period.
Week 14, week 30
Hormonal Assessment: Leptin
Time Frame: Week 14, week 30
Leptin levels after each treatment period.
Week 14, week 30
Glycosylated Haemoglobin A1c (HbA1c)
Time Frame: Week 16, week 32
Glycosylated haemoglobin A1c (HbA1c) after each treatment period.
Week 16, week 32
Fasting Plasma Glucose
Time Frame: Week 16, week 32
Fasting plasma glucose (FPG) after each treatment period.
Week 16, week 32
Hypoglycaemic Episodes
Time Frame: Weeks 0-32
Total number of hypoglycaemic episodes experienced in the study.
Weeks 0-32
Hypoglycaemic Episodes, Diurnal/Nocturnal
Time Frame: Weeks 0-32
Total number of hypoglycaemic episodes during the day (diurnal) and the night (nocturnal) experienced in the study.
Weeks 0-32

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Novo Nordisk A/S

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

July 1, 2007

Primary Completion (Actual)

July 1, 2008

Study Completion (Actual)

July 1, 2008

Study Registration Dates

First Submitted

July 31, 2007

First Submitted That Met QC Criteria

July 31, 2007

First Posted (Estimate)

August 1, 2007

Study Record Updates

Last Update Posted (Actual)

March 10, 2017

Last Update Submitted That Met QC Criteria

January 30, 2017

Last Verified

January 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • NN304-1761
  • 2006-003060-59 (EudraCT Number)

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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