Prevention of Clinical Onset of Type 1 Diabetes in High Risk First Degree Relatives

Prevention of Clinical Onset of Type 1 Diabetes by Daily Administration of Metabolically Active Insulin in High Risk First Degree Relatives.

Sponsors

Lead Sponsor: AZ-VUB

Collaborator: Novo Nordisk A/S

Source AZ-VUB
Brief Summary

Prophylactic administration of metabolically active insulin can prevent or delay clinical onset of diabetes in a high risk group of nondiabetic siblings as defined by positivity for autoantibodies against IA-2 (IA-2-A).

Detailed Description

Hypotheses:

Primary: Prophylactic administration of metabolically active insulin can prevent or delay clinical onset of diabetes in a high risk group of nondiabetic siblings as defined by positivity for autoantibodies against IA-2 (IA-2-A).

Secondary: 1) Untreated siblings with positivity for IA-2-A develop clinical diabetes significantly faster than untreated offspring with the same marker positivity. 2) Plasma proinsulin levels increase disproportionately before clinical onset of Type 1 diabetes both in siblings and offspring. 3) Prophylactic administration of metabolically active insulin reduces the plasma proinsulin/C-peptide ratio in non-diabetic antibody positive siblings and offspring. 4) Prophylactic administration of metabolically active insulin reduces the presence and/or levels of diabetes-associated autoantibodies directed against islet cell components.

Endpoints: Fasting glycemia; fasting and stimulated plasma C-peptide and proinsulin values; islet cell autoantibodies; incidence of hypoglycemia; body weight gain.

Overall Status Completed
Start Date February 2000
Completion Date November 2007
Primary Completion Date April 2004
Phase Phase 2
Study Type Interventional
Primary Outcome
Measure Time Frame
Fasting glycemia; 2004
fasting and stimulated plasma C-peptide and proinsulin values; 2004
islet cell autoantibodies; 2004
body weight gain. 2004
Enrollment 112
Condition
Intervention

Intervention Type: Drug

Intervention Name: Actrapid HM

Description: 56 subjects will receive metabolically active insulin by subcutaneous injections for 36 months (twice daily)

Arm Group Label: 1

Eligibility

Criteria:

Inclusion Criteria:

- Sibling/offspring of a Type 1 diabetic patient

- in good general condition

- age 5-39 years

- fasting plasma glucose <126 mg/dL AND an OGTT that is non-diabetic by 1997 ADA criteria (33):

1. Normal glycemia:

- fasting plasma glucose < 110 mg/dL and

- 2 hour plasma glucose < 140 mg/dL

2. Impaired Fasting Glucose (IFG):

- fasting plasma glucose 110-125 mg/dL and

- 2 hour plasma glucose < 140 mg/dL

3. Impaired Glucose Tolerance (IGT):

- fasting plasma glucose <110 mg/dL and

- 2 hour plasma glucose 140-199 mg/dL

- at least positive for IA-2-A

- absence of a protective DQ genotype: A4-B2/X or X/Y or X/X where X = A2-B3.3, A1-B1.9, A1-B1.2, A4-B3.1, A2-B2 or A4.23-B3.1 Y = A1-B1.1, A1-B2, A1-B1.AZH, A3-B2, A3-B3.1, A3-B3.3, A3-B4, A4-B4, A4.23-B4, A4-B3.2, A3-B1.1, A4-B3.3, A4-B1.1 or A4.23-B2 (32)

- cooperative and reliable subject (age ≥ 14 yrs) / parents (age < 14 yrs) giving informed consent by signature; the patient/parents should be informed in sufficient detail on the content and procedure of the protocol, indicating potential risks of insulin therapy; early intervention with metabolically active insulin treatment should be identified as a clinical trial. Both parents should sign and agree with the protocol procedure.

Exclusion Criteria:

- diabetes by 1997 ADA criteria (33):

- fasting plasma glucose ≥ 126 mg/dL, or

- 2 hour plasma glucose ≥ 200 mg/dL

- donation of blood during the study or within one month prior to screening

- pregnancy or lactation in women

- use of inadequate anticonception by female patients of childbearing potential

- use of illicit drugs or overconsumption of alcohol (> 3 beers/day) or history of drug or alcohol abuse

- being legally incapacitated, having significant emotional problems at the time of the study, or having a history of psychiatric disorders

- having received antidepressant medications during the last 6 months

- treatment with immune modulating or diabetogenic medication (such as corticosteroids)

- presently participating in another clinical study or having done so during the last 12 months

- history of any illness that, in the opinion of the investigator, might confound the results of the study or pose additional risks to the patient

Gender: All

Minimum Age: 5 Years

Maximum Age: 39 Years

Healthy Volunteers: Accepts Healthy Volunteers

Overall Official
Location
Facility:
Universitair Ziekenhuis Antwerpen | Antwerpen, Belgium
Academisch Ziekenhuis and Diabetes Research Center - Brussels Free University-VUB | Brussels, 1090, Belgium
Department of Endocrinology and Nephrology, UZ Gasthuisberg, Katholieke Universiteit Leuven -KUL | Leuven, 3000, Belgium
Location Countries

Belgium

Verification Date

April 2008

Responsible Party

Name Title: Prof. F Gorus

Organization: Free University Brussels

Keywords
Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Label: 1

Type: Active Comparator

Description: 56 subjects will receive metabolically active insulin by subcutaneous injections for 36 months (twice daily)

Label: 2

Type: No Intervention

Study Design Info

Intervention Model: Parallel Assignment

Primary Purpose: Prevention

Masking: None (Open Label)

Source: ClinicalTrials.gov