- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01363609
Effects of Glucagon Like Peptide-1(GLP-1) and Liraglutide on Brain Satiety and Reward Circuits and Feeding Behavior in Diabetes (LIBRA)
Central Effects of Endogenous Glucagon Like Peptide-1 (GLP-1) and the GLP-1 Analog Liraglutide on Brain Satiety and Reward Circuits and Feeding Behavior in Diabetes
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
First aim will be addressed in a cross-sectional randomized study. 20 healthy, lean and 20 obese individuals with type 2 diabetes (T2DM) will be exposed to food cues and with concomitant infusion of glucagon Like peptide-1 (GLP-1) receptor antagonist or saline, to assess the involvement of endogenous GLP-1, secreted in response to a meal. Measurements activation of CNS circuits involved in satiety and reward will be performed using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI).
The second aim will be addressed in cross-over randomized-controlled trial (RCT) in the T2DM patients only. Patients will be randomly assigned liraglutide vs insulin glargine treatment, during a treatment period of 12 weeks each with a 12-week washout period in between. The investigators will perform the same fMRI protocol.
The third aim will be addressed in a study with obese individuals who are scheduled for a gastric bypass surgery. The same protocol as for the first aim will be performed and this will be before and after the surgery in the same individuals.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Amsterdam, Netherlands, 1081 HV
- VU University Medical Center
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- For the healthy, lean individuals:
- Age 18-65 years
- Women: post menopausal (excluding possible menstruation cycle effects)
- Body-mass index (BMI) of <25 kg/m2,
- Stable bodyweight (<5% reported change during the previous 3 months).
- Normal fasting and 2h post load glucose as ascertained during a 75-g oral glucose tolerance test (OGTT) (34)
- Right handed
For the obese T2DM individuals:
- Age 18-65 years
- Women: post menopausal (excluding possible menstruation cycle effects)
- BMI 25-40 kg/m2
- Stable bodyweight (<5% reported change during the previous 3 months).
- Diagnosed with T2DM > 3 months prior to screening
- HbA1C 6.5-8.5%
- Treatment with metformin at a stable dose for at least 3 months.
- Right handed
For the obese individuals scheduled for gastric bypass surgery:
- Age 18-65 years
- Women: preferably post menopausal (excluding possible menstruation cycle effects)
- Body-mass index (BMI) of >30 kg/m2,
- Stable bodyweight (<5% reported change during the previous 1 months).
- Normal or impaired fasting and 2h post load glucose as ascertained during a 75-g oral glucose tolerance test (OGTT) (defined as glucose fasting < 7.1 mmol/l and after OGTT t=120min < 11.0 mmol/l) (39)
- Right handed
Exclusion Criteria:
- GLP-1 based therapies, thiazolidinediones, sulphonylurea or insulin within 3 months before screening
- Weight-lowering agents within 3 months before screening.
- Congestive heart failure (NYHA II-IV)
- Chronic renal failure (glomerular filtration rate < 60 mL/min/1.73m2 per Modification of Diet in Renal Disease (MDRD))
- Liver disease
- History of gastrointestinal disorders (including gastropareses, pancreatitis and cholelithiasis)
- Neurological illness
- Malignancy
- Other type of bariatric surgery (Redo-GBP, sleeve, distal GBP, adj banding, Scopinaro)
- History of major heart disease
- History of major renal disease
- Pregnancy or breast feeding
- Implantable devices
- Substance abuse
- Addiction
- Contra-indication for MRI, such as claustrophobia or pacemaker
- Any psychiatric illness; including eating disorders and depression
- Chronic use of centrally acting agents or glucocorticoids within 2 weeks immediately prior to screening.
- Use of cytostatic or immune modulatory agents
- History or known allergy for acetaminophen.
- History of allergy for insulin analog
- History of allergy for liraglutide
- Participation in other studies
- Individuals who have received treatment within the last 30 days with a drug that has not received regulatory approval for any indication at the time of study entry
- Individuals who are investigator site personnel, directly affiliated with the study, or are immediate family
Study Plan
How is the study designed?
Design Details
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Liraglutide
12 week treatment with liraglutide in fixed dosage
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liraglutide will be started with a titration period of 2 weeks: week 1 0.6mg once daily, week 2 1.2mg once daily.
If well tolerated, treatment will be continued for 10 more weeks in dosage of 1.8mg once daily
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Active Comparator: Insulin glargine
12 week treatment, once daily, with insulin glargine.
Dosage based on fasting blood glucose measurements
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Insulin glargine treatment consist a treatment period of 12 weeks.
Treatment will start with a dosage of 10 IU once daily.
Patient will self-titrate the insulin glargine dosage based on self-monitored fasting blood glucose (FBG) concentrations for the previous 3 days using the following guideline: If FBG levels are above 5.6 mmol/L (100-153 mg/dL) on 3 consecutive mornings, the daily dose is to be increased by 2 IU/day.
If hypoglycemia documented by glucose concentration < 3.3 mmol/L (60 mg/dL) or requiring assistance occurs without an easily identifiable reason (skipped meal, excessive physical activity), the daily dose is to be downregulated, with -2 IU/day
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Other: before start of treatment period
before start of the treatment period, one day with tests will be performed.
During this test a GLP-1 receptor antagonist will be administered In the group with obesity and planned gastric bypass surgery, the GLP-1 receptor agonist will be administered during 1 test before and 1 test after the surgery
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Exendin 9-39 will be infused intravenously at doses of 600 pM/kg • min.
This will only be during one of the visit for the healthy lean controls and the T2DM group, and during two visits in the group with obesity planned for gastric bypass surgery
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
food-stimuli related neuronal activity in reward and satiety circuits as represented by BOLD fMRI signal change from baseline (%)
Time Frame: approximately 3 years
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approximately 3 years
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
GLP-1 analog treatment related changes in obese patients with type 2 diabetes in self-reported hunger, satiety, fullness
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in basal metabolic rate and post-prandial energy expenditure
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in microvascular function and vasomotion
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in cardiovascular autonomic nervous balance
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in concomitant changes in metabolic and humoral markers
Time Frame: approximately 3 years
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approximately 3 years
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Alterations in resting state brain activity networks in obese patients with type 2 diabetes compared to lean, healthy individuals and the involvement of endogenous GLP-1
Time Frame: approximately 3 years
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approximately 3 years
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Alterations in brain arterial blood flow in obese patients with type 2 diabetes compared to lean, healthy individuals and the involvement of endogenous GLP-1
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in resting state brain activity networks.
Time Frame: approximately 3 years
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approximately 3 years
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GLP-1 analog treatment related changes in obese patients with type 2 diabetes in brain arterial blood flow.
Time Frame: approximately 3 years
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approximately 3 years
|
Collaborators and Investigators
Sponsor
Publications and helpful links
General Publications
- Ten Kulve JS, Veltman DJ, Gerdes VEA, van Bloemendaal L, Barkhof F, Deacon CF, Holst JJ, Drent ML, Diamant M, IJzerman RG. Elevated Postoperative Endogenous GLP-1 Levels Mediate Effects of Roux-en-Y Gastric Bypass on Neural Responsivity to Food Cues. Diabetes Care. 2017 Nov;40(11):1522-1529. doi: 10.2337/dc16-2113.
- ten Kulve JS, Veltman DJ, van Bloemendaal L, Barkhof F, Deacon CF, Holst JJ, Konrad RJ, Sloan JH, Drent ML, Diamant M, IJzerman RG. Endogenous GLP-1 mediates postprandial reductions in activation in central reward and satiety areas in patients with type 2 diabetes. Diabetologia. 2015 Dec;58(12):2688-98. doi: 10.1007/s00125-015-3754-x. Epub 2015 Sep 18.
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- DC2011LiBrain001
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