- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02051504
Muscle Oxygenation, Type 1 Diabetes, and Glycated Hemoglobin (OXYDIAB)
Impact of Type 1 Diabetes and Glycated Haemoglobin Levels on Oxygen Delivery and Release to Active Muscle During Exercise and on Muscle Oxidation Capacity - Possible Impact on Aerobic Fitness
Study Overview
Status
Conditions
Detailed Description
The current study aims at assessing the impact of Type 1 diabetes and HbA1c on muscle oxygen delivery and on muscle mitochondrial capacity. Our hypothesis is that these both steps of the oxygen cascade might be involved in the aerobic fitness impairment usually observed in poor-controlled patients.
Adults with Type 1 diabetes, aged 18-40 years, without microvascular and macrovascular diabetic complications, will be recruited among patients that regularly attend the unit of diabetology of the University Hospital of Lille and the regional hospital of Roubaix. They will be separated into 2 groups according to their glycaemic control at entrance in the study (HbA1c < 7%, HbA1c > 8%). Subsequently, two healthy control groups (checked by an OGTT) will be selected to strictly match the patients with Type 1 diabetes (age, sex, BMI, number of hours of physical activity per week, tobacco smoking). This is a cross-sectional study including 4 groups.
On their first visit, after the determination of HbA1c, all the subjects will perform at rest a DLCO/DLNO. Then they will realise an incremental exercise test to exhaustion on an electromagnetic cycle ergometer. Non-invasive measures will be performed throughout the exercise test, including gas exchange parameters (and maximal oxygen uptake), muscular and brain oxygenation (Near Infra Red Spectroscopy at vastus lateralis muscle and at prefrontal cortex). A blood sample from an arterialised ear-lobe will be taken at rest and exhaustion to determine O2 haemoglobin saturation, arterial partial pressure in O2 and CO2, haemoglobin concentration, hematocrit, and bicarbonates. Blood, from a catheter in a superficial cubital vein, will also be taken at rest, at a precise time during the exercise and immediately after the exercise to measure potential of hydrogen, bicarbonates, haemoglobin concentration, hematocrit, erythrocyte 2,3-diphosphoglycerate, and other blood markers of metabolic and hormonal adaptations to exercise. The subjects will also fill in questionnaires.
On a second visit, in a fasting state, the subjects will have a muscle biopsy at vastus lateralis using a specific needle (less than 150mg) in order to assess mitochondrial respiration capacity and endocannabinoid system activity. A venous blood sampling will allow analysing other health markers (lipid profile, insulin resistance...).
On another visit, the subjects will have a measure of body composition by Dual energy X-ray Absorptiometry and skinfold thickness.
They will also wear an accelerometer over one week and fill in a diet questionnaire over 3 days.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Lille, France, 59037
- CHRU Lille
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
The two groups of patients with Type 1 diabetes are recruited from primary care clinics (university hospital of Lille and hospital of Roubaix, France) among patients with Type 1 diabetes for more than 1 year and free from micro and macrovascular complications.
Healthy participants are selected from a list (n=250) drawn up from patients' friends and contacts. Each healthy control is chosen to strictly match a patient with type 1 diabetes according to gender, age, physical activity levels, and tobacco status.
Description
Inclusion Criteria:
- Patients with Type 1 diabetes (duration of Type 1 diabetes > 1 year and < 20 years)
- Healthy subjects
Exclusion Criteria:
Exclusion Criteria for patients with Type 1 diabetes:
- Maturity onset diabetes of the young, mitochondrial diabetes, Type 2 diabetes
- Macro or microvascular complications of diabetes
Exclusion Criteria for healthy controls :
• Diabetes (Glycaemia > 11 mmol/L two hours after the OGTT)
Exclusion Criteria for all subjects :
- Obesity (Body Mass Index > 30 kg/m2)
- Contra-indication to maximal exercise
- Pregnant or breast-feeding women
- Other chronic disease than diabetes
- Muscle or articular problems
Study Plan
How is the study designed?
Design Details
- Observational Models: Case-Control
- Time Perspectives: Cross-Sectional
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Type 1 diabetes, HbA1c <7%
Patients with Type 1 diabetes and adequate glycemic control: HbA1c <7% at the entrance in the study. Intervention: Incremental maximal exercise Near-Infra Red-Spectroscopy at vastus lateralis and pre-frontal cortex (during exercise) Gas exchanges (VO2, VCO2) during exercise Combined DLCO/DLNO (at rest) Venous and arterialised blood sampling (rest and exercise) Muscle biopsy at the vastus lateralis (rest) Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires Accelerometry over one week Dual energy X-ray Absorptiometry |
The exercise test starts 2-4h after a standardised breakfast.
After a 2-min resting period sitting on the cycle ergometer (Excalibur Sport, Lode B.V, Medical Technology, Groningen, Netherlands), the test starts at 30 watts with a 20 watts increment every 2min until exhaustion.
A sample of vastus lateralis (less than 150mg) is taken with a specific needle under local anesthesia.
Lung carbon monoxide and nitric oxide diffusion capacities are assessed at rest in a sitting position.
Body composition is measured using dual energy X-ray absorptiometry at rest.
The subjects wear an uniaxial accelerometer over one week to assess their usual physical activity level
Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires
|
Type 1 diabetes, HbA1c >8%
Patients with Type 1 diabetes and inadequate glycemic control: HbA1c >8% at the entrance in the study. Intervention: Incremental maximal exercise Near-Infra Red-Spectroscopy at vastus lateralis and pre-frontal cortex (during exercise) Gas exchanges (VO2, VCO2) during exercise Combined DLCO/DLNO (at rest) Venous and arterialised blood sampling (rest and exercise) Muscle biopsy at the vastus lateralis (rest) Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires Accelerometry over one week Dual energy X-ray Absorptiometry |
The exercise test starts 2-4h after a standardised breakfast.
After a 2-min resting period sitting on the cycle ergometer (Excalibur Sport, Lode B.V, Medical Technology, Groningen, Netherlands), the test starts at 30 watts with a 20 watts increment every 2min until exhaustion.
A sample of vastus lateralis (less than 150mg) is taken with a specific needle under local anesthesia.
Lung carbon monoxide and nitric oxide diffusion capacities are assessed at rest in a sitting position.
Body composition is measured using dual energy X-ray absorptiometry at rest.
The subjects wear an uniaxial accelerometer over one week to assess their usual physical activity level
Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires
|
Healthy controls, Groupe 1
Healthy controls for patients with Type 1 diabetes and adequate glycemic control matched on age, sex, body composition and physical activity level. Intervention: Oral Glucose Tolerance Test Incremental maximal exercise Near-Infra Red-Spectroscopy at vastus lateralis and pre-frontal cortex (during exercise) Gas exchanges (VO2, VCO2) during exercise Combined DLCO/DLNO (at rest) Venous and arterialised blood sampling (rest and exercise) Muscle biopsy at the vastus lateralis (rest) Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires Accelerometry over one week Dual energy X-ray Absorptiometry |
The exercise test starts 2-4h after a standardised breakfast.
After a 2-min resting period sitting on the cycle ergometer (Excalibur Sport, Lode B.V, Medical Technology, Groningen, Netherlands), the test starts at 30 watts with a 20 watts increment every 2min until exhaustion.
A sample of vastus lateralis (less than 150mg) is taken with a specific needle under local anesthesia.
Lung carbon monoxide and nitric oxide diffusion capacities are assessed at rest in a sitting position.
Body composition is measured using dual energy X-ray absorptiometry at rest.
The subjects wear an uniaxial accelerometer over one week to assess their usual physical activity level
Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires
The subjects arrive after an overnight fast and have a 75g Glucose Oral Charge.
|
Healthy controls, Group 2
Healthy controls for patients with Type 1 diabetes and inadequate glycemic control matched on age, sex, body composition and physical activity level. Intervention: Oral Glucose Tolerance Test Incremental maximal exercise Near-Infra Red-Spectroscopy at vastus lateralis and pre-frontal cortex (during exercise) Gas exchanges (VO2, VCO2) during exercise Combined DLCO/DLNO (at rest) Venous and arterialised blood sampling (rest and exercise) Muscle biopsy at the vastus lateralis (rest) Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires Accelerometry over one week Dual energy X-ray Absorptiometry |
The exercise test starts 2-4h after a standardised breakfast.
After a 2-min resting period sitting on the cycle ergometer (Excalibur Sport, Lode B.V, Medical Technology, Groningen, Netherlands), the test starts at 30 watts with a 20 watts increment every 2min until exhaustion.
A sample of vastus lateralis (less than 150mg) is taken with a specific needle under local anesthesia.
Lung carbon monoxide and nitric oxide diffusion capacities are assessed at rest in a sitting position.
Body composition is measured using dual energy X-ray absorptiometry at rest.
The subjects wear an uniaxial accelerometer over one week to assess their usual physical activity level
Diet questionnaire, quality-of-life questionnaires, physical activity questionnaires
The subjects arrive after an overnight fast and have a 75g Glucose Oral Charge.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Maximal oxygen uptake
Time Frame: Participants will perform the incremental maximal exercise on visit 1, one week minimum and 8 weeks maximum after their inclusion in the protocol
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Incremental maximal exercise with gas exchange measure
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Participants will perform the incremental maximal exercise on visit 1, one week minimum and 8 weeks maximum after their inclusion in the protocol
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Arterial oxygen content during maximal exercise
Time Frame: Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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measured in ear-lobe arterialised capillary samples
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Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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Oxyhemoglobin dissociation at active muscle during maximal exercise
Time Frame: On visit 1, continuously during the incremental maximal exercise
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Deoxyhemoglobin and total hemoglobin assessed at vastus lateralis by Near Infrared Spectroscopy
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On visit 1, continuously during the incremental maximal exercise
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Mitochondrial respiration capacity of vastus lateralis muscle
Time Frame: Participants will have a muscle biopsy on visit 2, performed 3 days minimum and 32 weeks maximum after their visit 1.
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Vastus lateralis muscle sample is obtained by the percutaneous technique after local anesthesia.
The mitochondrial respiration is then studied in situ in saponin-skinned fibers.
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Participants will have a muscle biopsy on visit 2, performed 3 days minimum and 32 weeks maximum after their visit 1.
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Prefrontal cortex oxygenation during exercise
Time Frame: On visit 1, continuously during the incremental maximal exercise
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Total hemoglobin and oxyhemoglobin are assessed at the left prefrontal cortex using Near-Infrared Spectroscopy.
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On visit 1, continuously during the incremental maximal exercise
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Other factors than hemoglobin glycation that could influence arterial oxygen content
Time Frame: Prior to the incremental maximal exercise on visit 1
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Lung capillary carbon monoxide and nitric oxide diffusion capacities (DLCO, DLNO)
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Prior to the incremental maximal exercise on visit 1
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Other factors able to modify the oxyhemoglobin dissociation curve
Time Frame: Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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venous erythrocyte 2,3-diphosphoglycerate, arterialised capillary potential of hydrogen oxygen partial pressure, carbon dioxide partial pressure
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Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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Mechanisms possibly involved in muscle mitochondrial dysfunctions
Time Frame: Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1. Prior to the muscle biopsy on visit 2.
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oxidative stress (blood oxidative and antioxidant markers at rest and in response to maximal exercise), endocannabinoid system activity
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Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1. Prior to the muscle biopsy on visit 2.
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Other health markers in link with physical activity levels and aerobic fitness
Time Frame: Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1. Prior to the muscle biopsy on visit 2.
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Lipid profile (HDL-C, LDL-C, apolipoprotein A1, apolipoprotein B, lipoprotein a, ...) Insulin resistance markers (blood ghrelin, adiponectin, leptin...)
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Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1. Prior to the muscle biopsy on visit 2.
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Blood metabolic and hormonal responses to exercise
Time Frame: Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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Free fatty acids, glycerol, glucose, insulin, catecholamines, glucagon, cortisol, insulin-like growth factor 1, brain-derived neurotrophic factor...
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Prior to the incremental maximal exercise on visit 1, and immediately after the incremental maximal exercise on visit 1.
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Body composition
Time Frame: Prior to incremental maximal exercise on visit 1
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Dual energy X-ray Absorptiometry, skinfold thickness, waist and hip circumferences
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Prior to incremental maximal exercise on visit 1
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Collaborators and Investigators
Sponsor
Investigators
- Study Director: Elsa HEYMAN, PHD, EA4488 'Physical activity, Muscle, Health
- Principal Investigator: Pierre FONTAINE, MD-PHD, CHRU Lille
Publications and helpful links
General Publications
- Lespagnol E, Tagougui S, Fernandez BO, Zerimech F, Matran R, Maboudou P, Berthoin S, Descat A, Kim I, Pawlak-Chaouch M, Boissière J, Boulanger E, Feelisch M, Fontaine P, Heyman E. Circulating biomarkers of nitric oxide bioactivity and impaired muscle vasoreactivity to exercise in adults with uncomplicated type 1 diabetes. Diabetologia. 2021 Feb;64(2):325-338. doi: 10.1007/s00125-020-05329-8. Epub 2020 Nov 21.
- Heyman E, Daussin F, Wieczorek V, Caiazzo R, Matran R, Berthon P, Aucouturier J, Berthoin S, Descatoire A, Leclair E, Marais G, Combes A, Fontaine P, Tagougui S. Muscle Oxygen Supply and Use in Type 1 Diabetes, From Ambient Air to the Mitochondrial Respiratory Chain: Is There a Limiting Step? Diabetes Care. 2020 Jan;43(1):209-218. doi: 10.2337/dc19-1125. Epub 2019 Oct 21.
- Tagougui S, Fontaine P, Leclair E, Aucouturier J, Matran R, Oussaidene K, Descatoire A, Prieur F, Mucci P, Vambergue A, Baquet G, Heyman E. Regional cerebral hemodynamic response to incremental exercise is blunted in poorly controlled patients with uncomplicated type 1 diabetes. Diabetes Care. 2015 May;38(5):858-67. doi: 10.2337/dc14-1792. Epub 2015 Feb 9.
- Tagougui S, Leclair E, Fontaine P, Matran R, Marais G, Aucouturier J, Descatoire A, Vambergue A, Oussaidene K, Baquet G, Heyman E. Muscle oxygen supply impairment during exercise in poorly controlled type 1 diabetes. Med Sci Sports Exerc. 2015 Feb;47(2):231-9. doi: 10.1249/MSS.0000000000000424.
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
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2009_12
- 2009-A00746-51. (Other Identifier: ID-RCB number, AFSSAPS)
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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