- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02980276
A Randomized Placebo Controlled Trial of the Effectiveness of Metformin in Addition to Usual Care in the Reduction of Gestational Diabetes Mellitus Effects (EMERGE)
August 11, 2023 updated by: Fidelma Dunne, National University of Ireland, Galway, Ireland
A Randomised Placebo Controlled Trial of the Effectiveness of Early MEtformin in Addition to Usual Care in the Reduction of Gestational Diabetes Mellitus Effects (EMERGE)
The overall objective of the EMERGE trial is to determine whether metformin + usual care, compared to placebo + usual care (introduced at the time of initial diagnosis of GDM), reduces a) the need for insulin use, or hyperglycemia (primary outcome measure); b) excessive maternal weight gain; c) maternal and neonatal morbidities and, d) cost of treatment for women with Gestational Diabetes Mellitus.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
535
Phase
- Phase 3
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
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Galway, Ireland
- University Hospital Galway
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Galway
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Ballinasloe, Galway, Ireland
- Portiuncula University Hospital
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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 to 50 years (Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Willing and able to provide written informed consent
- Participants aged 18-50
- Pregnancy gestation up to 28 weeks (+ 6 days) confirmed by positive pregnancy test
- Singleton pregnancy as determined by scan
- Positive diagnosis of Gestational Diabetes Mellitus on a Oral Glucose Tolerance Test (OGTT) according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria if any one of the following are achieved: i) Fasting glucose >/= 5.1mmol/l and <7mmol/l, or ii) 1 hour post glucose load of >/=10mmol/l, or iii) 2 hour post glucose load of >/=8.5 mmol/l and <11.1mmo/l
- Resident in the locality and intending to deliver within the trial site
Exclusion Criteria:
- Participants who have an established diagnosis of diabetes (Type 1, Type 2, Monogenic or secondary)
- Participants with a fasting glucose > 7mmol/l or a 2h value > 11.1 mmol/l
- Multiple pregnancies (twins, triplets etc.) as determined by scan
- Known intolerance to metformin
- Known contraindication to the use of metformin which include: i) renal insufficiency (defined as serum creatinine of greater than 130 µmol/L or creatinine clearance <60 ml/min), ii) moderate to severe liver dysfunction (aspartate aminotransferase (AST) and alanine aminotransferase (ALT) greater than 3 times the upper limit of normal, iii) shock or sepsis, and iv) previous hypersensitivity to metformin
- Major congenital malformations or an abnormally deemed unsuitable for metformin by the site PI or attending consultant
- Known small for gestational age (Small for gestational age (SGA) refers to foetal growth less than the 10th percentile (RCOG, 2014), or if foetal growth is deemed unsatisfactory by the treating obstetrician)
- Known gestational hypertension or pre-eclampsia or ruptured membranes
- Participants who have a history of drug or alcohol use that, in the opinion of the investigator, would interfere with adherence to study requirements
- Participants with significant gastrointestinal problems such as severe vomiting, Crohn's disease or colitis which will inadvertently affect absorption of the study drug
- Participants with congestive heart failure or history of congestive heart failure
- Participants with serious mental illness which would affect adherence to study medication or compliance with study protocol in the opinion of the investigator
- Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption
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: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Active Comparator: Treatment
Participants randomised to the treatment arm will receive active metformin in addition to standard care.
Metformin tablets will be titrated according to a dosing schedule to achieve the pre-specified glucose targets.
Tablets will be in 500mg doses and will commence at 1 tablet per day (500mg) increasing to a maximum of 5 tablets per day (2500mg).
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Women randomised to the metformin group will receive metformin 500mg once daily, with the dose titrated upwards every 2 days over 10 days increasing to a maximum of 2500mg Metformin daily (5 tablets) or maximum tolerated dose, in addition to usual care (exercise and MNT), and taken until delivery.
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Placebo Comparator: Control
Participants randomised to the placebo arm will receive placebo in addition to standard care.
Placebo will be titrated according to the dosing schedule to achieve the pre-specified glucose targets.
Placebo tablets will commence at 1 tablet per day and will be increased to a maximum of 5 tablets per day over 10 days as with the treatment group.
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Women randomised to the placebo group will receive 1 placebo tablet once daily, with the dose titrated upwards every 2 days over 10 days increasing to a maximum of five placebo tablets daily, in addition to usual care (exercise and MNT), and taken until delivery.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Insulin Initiation/Fasting Glucose
Time Frame: Change from Gestational Weeks 32 and 38
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The primary efficacy outcome is a composite of:
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Change from Gestational Weeks 32 and 38
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to Insulin Initiation and Insulin Dose Required
Time Frame: Time to Insulin Initiation, from date of randomization until the date delivery, assessed up to 40 weeks
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Time to Insulin Initiation, from date of randomization until the date delivery, assessed up to 40 weeks
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Time to Insulin Initiation, from date of randomization until the date delivery, assessed up to 40 weeks
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Maternal Morbidity at Delivery
Time Frame: Delivery
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Number of women with maternal morbidity at delivery that is related to treatment (e.g.
hypertensive disorders, antepartum/postpartum haemorrhage, polyhydramnios)
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Delivery
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Mode of Delivery
Time Frame: Delivery
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Mode of delivery (e.g.
vaginal, cesarean)
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Delivery
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Time of Delivery
Time Frame: Delivery
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Gestational weeks at delivery
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Delivery
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Postpartum glucose status, insulin resistance, and metabolic syndrome
Time Frame: 12 weeks post-partum
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Number of women with abnormal glucose values/insulin resistance/metabolic syndrome
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12 weeks post-partum
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Post-partum BMI
Time Frame: 12 weeks post-partum
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Post-partum BMI in kg/m2 in participants between groups
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12 weeks post-partum
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Infant Birth Weight
Time Frame: Delivery
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Weight in kg at birth
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Delivery
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Neonatal height and head circumference at delivery
Time Frame: Delivery
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Height in cm Head circumference in cm
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Delivery
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Neonatal morbidities
Time Frame: Delivery
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Number of neonates with respiratory distress, jaundice, congenital anomalies, Apgar score, need for neonatal care unit
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Delivery
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Neonatal hypoglycaemia
Time Frame: Delivery
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Number of neonates with glucose <2.6mmol/l
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Delivery
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Neonatal hypoglycaemia
Time Frame: 12 weeks post-partum
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Number of neonates with glucose <2.6mmol/l
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12 weeks post-partum
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Treatment Acceptability
Time Frame: 4 weeks post-partum
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Treatment acceptability determined by Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Rowan Questionnaire
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4 weeks post-partum
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Quality of Life (EQ5D-5L)
Time Frame: Treatment week 12
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Quality of Life determined by EQ5D-5L Questionnaire
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Treatment week 12
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Post partum waist circumference
Time Frame: 12 weeks post partum
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waist circumference in cm in participants between groups
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12 weeks post partum
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Gestational weight gain
Time Frame: Change in weight from 24 weeks gestation until last visit before delivery
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Change in weight (kg) from 24 weeks gestation until last visit before delivery
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Change in weight from 24 weeks gestation until last visit before delivery
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Other Outcome Measures
Outcome Measure |
Time Frame |
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Cost effectiveness and budget impact of metformin treatment in addition to standard care
Time Frame: 24 weeks gestation to 12 weeks post-partum
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24 weeks gestation to 12 weeks post-partum
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Prof. Fidelma Dunne, National University of Ireland, Galway, Ireland
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.
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 (Actual)
June 6, 2017
Primary Completion (Actual)
January 12, 2023
Study Completion (Actual)
April 13, 2023
Study Registration Dates
First Submitted
November 9, 2016
First Submitted That Met QC Criteria
November 29, 2016
First Posted (Estimated)
December 2, 2016
Study Record Updates
Last Update Posted (Actual)
August 14, 2023
Last Update Submitted That Met QC Criteria
August 11, 2023
Last Verified
August 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- NUIG-2016-01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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