Semaglutid til behandling af glukoseintolerance hos kvinder med tidligere svangerskabsdiabetes (SERENA)
Semaglutid til behandling af glukoseintolerance hos kvinder med tidligere svangerskabsdiabetes: en dobbeltblind RCT
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
Patientpopulation: Kvinder med en nylig historie med svangerskabsdiabetes (GDM) og vedvarende glukoseintolerans i tidlig postpartum er en særlig højrisikogruppe, hvor omkring 50 % udvikler type 2-diabetes (T2DM) inden for 5 år efter fødslen. Semaglutid er en langtidsvirkende glukagon-lignende peptid-1 (GLP-1) agonist med flere gavnlige metaboliske effekter, herunder glukosesænkende effekt, vægttab og kardiovaskulære beskyttende effekter. Vi antager, at hos kvinder med tidligere GDM og glukoseintolerans i tidlig postpartum, vil behandling med semaglutid reducere risikoen for at udvikle T2DM på lang sigt sammenlignet med placebo.
Intervention og sammenligning: Belgisk multicentrisk dobbeltblind RCT med 12 centre til sammenligning af semaglutid (en gang om ugen) med placebo hos kvinder med en nylig historie med GDM og glukoseintolerance [svækket fastende glykæmi (IFG) og/eller nedsat glukosetolerance (IGT) ] 6-24 uger efter fødslen. Deltagerne vil blive 1/1 randomiseret til semaglutid eller placebo på baggrund af livsstilsforanstaltninger. Semaglutid vil blive optitreret til 1 mg/uge over en 8-ugers periode. Deltagerne vil blive fulgt op i 3 år. Deltagerne vil modtage en 75 g oral glukosetolerancetest (OGTT) 3 måneder efter stop af interventionen. Randomisering vil blive stratificeret efter BMI ved det tidlige postpartum besøg (
Resultater: Det primære endepunkt er udviklingen af T2DM defineret af OGTT og/eller HbA1c. Vigtige sekundære endepunkter omfatter behovet for redningsterapi til diabetes, regression til normoglykæmi, vægttab, beta-cellefunktion, insulinresistens og det metaboliske syndrom. For at opnå 80 % effekt planlægger vi en stikprøvestørrelse på 206 for at opdage en estimeret 50 % reduktion i risikoen for at udvikle T2DM mellem begge grupper, forudsat et tab på 30 % til opfølgning under undersøgelsen.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Fase 3
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Katrien Benhalima, MD PhD
- Telefonnummer: 32 16340614
- E-mail: katrien.benhalima@uzleuven.be
Studiesteder
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Aalst, Belgien
- Rekruttering
- AZORG
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Kontakt:
- Katrien Wierckx
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Antwerp, Belgien
- Rekruttering
- UZA
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Kontakt:
- Niels Bochanen
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Antwerp, Belgien
- Rekruttering
- ZAS
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Kontakt:
- Ann Verhaegen
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Bruges, Belgien
- Rekruttering
- AZ St Jan Brugge
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Kontakt:
- Sara Vandewalle, MD
- Telefonnummer: 003250 45 23 3
- E-mail: SARA.VANDEWALLE@azsintjan.be
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Brussels, Belgien
- Rekruttering
- UZ Brussel
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Kontakt:
- Nancy Van Wilder
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Brussels, Belgien
- Rekruttering
- Erasme
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Kontakt:
- Maria Lytrivi
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Ieper, Belgien
- Rekruttering
- Jan Yperman
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Kontakt:
- An Nollet, MD
- Telefonnummer: 003257 35 72 70
- E-mail: an.nollet@yperman.net
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Kortrijk, Belgien
- Rekruttering
- AZ Groeninge Kortrijk
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Kontakt:
- Gertjan Vereecke
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Leuven, Belgien
- Rekruttering
- UZ Leuven
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Kontakt:
- Katrien Benhalima
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Liège, Belgien
- Rekruttering
- CHU de Liege
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Kontakt:
- JC Philips
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Mouscron, Belgien
- Rekruttering
- Centre Hospitalier Mouscron
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Kontakt:
- Philippe Oriot
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Sint-Niklaas, Belgien
- Rekruttering
- Vitaz
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Kontakt:
- Peter Coremans
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Turnhout, Belgien
- Rekruttering
- AZ Turnhout
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Kontakt:
- Joke Cuypers, MD
- Telefonnummer: 003214 44 44 32
- E-mail: joke.cuypers@azturnhout.be
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Beskrivelse
Inklusionskriterier:
- Der er indhentet frivilligt skriftligt informeret samtykke fra deltageren forud for eventuelle screeningsprocedurer
- Brug af yderst effektive præventionsmetoder
- Anamnese med GDM (diagnosticeret med 2013 WHO-kriterier 24-32 ugers graviditet) og glukoseintolerans 6-24 uger efter fødslen (baseret på ADA-kriterierne)
- Skal kunne forstå og tale hollandsk, fransk eller engelsk
Ekskluderingskriterier:
- 1. Deltageren har en historie med enhver type diabetes eller autoantistoffer mod type 1 diabetes, historie med pancreatitis, familie eller personlig historie med medullært thyreoideacarcinom eller multipel endokrin neoplasi syndrom type 2, alvorlig psykiatrisk lidelse inden for det seneste år, hjertesvigt NYHA klasse 4, nyresygdom i slutstadiet (eGFR
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Forebyggelse
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Tredobbelt
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: semaglutid
semaglutid SC én gang ugentligt, optitrering over en 2-måneders periode til 1 mg/uge (0,25 mg én gang om ugen, efter 4 uger 0,5 mg én gang om ugen og efter 8 uger vedligeholdelsesdosis på 1 mg én gang om ugen), behandlingsvarighed på max. 3 år
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vedligeholdelsesdosis på 1 mg SC én gang om ugen
Andre navne:
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Placebo komparator: placebo
placebo SC én gang om ugen, samme dosis-eskaleringsregime, ved brug af matchende injektioner, behandlingsvarighed på max. 3 år
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vedligeholdelsesdosis på 1 mg SC én gang om ugen
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Development of T2DM
Tidsramme: by 160 weeks
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Defined by FPG, OGTT, and/or HbA1c according to the ADA criteria
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by 160 weeks
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Need for glucose-lowering (rescue) therapy
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage need for rescue therapy for diabetes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Frequency of prediabetes based on FPG, OGTT, and/or HbA1c
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage of prediabetes based on FPG, OGTT, and/or HbA1c
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Regression to normoglycaemia
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage regression to normoglycaemia, based on fasting glycaemia, oral glucose tolerance test and/or HbA1c (ADA criteria)
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Change in body weight
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Change in body weight (kg)
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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BMI
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Mean BMI (Kg/m2)
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Waist circumference
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Mean waist circumference (cm)
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
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Waist-to-hip ratio
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Waist/hip circumference ratio
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Proportion of participants achieving ≥5% weight loss
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage weight loss ≥5%
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
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Proportion of participants achieving ≥10% weight loss
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage weight loss ≥10%
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Proportion of participants achieving ≥15% weight loss
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage weight loss ≥15%
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Body fat percentage assessed by bioelectrical impedance analysis (Bodystat 1500®)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage body fat measured by bioelectrical impedance analysis
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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β-cell function, assessed by HOMA-B
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Beta-cell function measured by the HOMA-B index
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Insulinogenic index divided by HOMA-IR
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Beta-cell function measured by the by the insulinogenic index divided by HOMA-insulin resistance index
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Insulin secretion-sensitivity index-2
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Beta-cell function measured by theby the insulin-secretion sensitivity-2 index
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Stumvoll index
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Beta-cell function measured by the Stumvoll index
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Insulin sensitivity, assessed by the Matsuda index (reflecting whole body insulin sensitivity)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Whole body Insulin sensitivity measured by the insulin sensitivity index of Matsuda
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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1/HOMA-IR, reflecting primarily hepatic insulin sensitivity
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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The reciprocal of the homeostasis model assessment of insulin resistance (1/HOMA-IR)
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Prevalence of the metabolic syndrome
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage of the metabolic syndrome based on the WHO criteria
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Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
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Blood pressure (blood pressure ≥140/90 mmHg)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage blood pressure ≥140/90mmHg
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Heart rate
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Mean heart rate
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Lipid profile, including low density lipoprotein-cholesterol (LDL-cholesterol, ≥100 mg/dL or ≥2,6 mmol/L)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Percentage LDL cholesterol ≥100mg/dl or ≥2,6 mmol/L
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
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Lipid profile, including triglycerides (≥150 mg/dL or ≥1,7 mmol/L)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Percentage triglycerides ≥150mg/dl or ≥1,7 mmol/L
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Health-related quality of life assessed by SF-36
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Health-related quality of life assessed using the 36-Item Short Form Health Survey (SF-36).
Scores range from 0 to 100, with higher scores indicating better health-related quality of life
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Health-related quality of life assessed by EQ-5D-5L
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Health-related quality of life assessed using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) Visual Analogue Scale (EQ VAS).
Scores range from 0 to 100, with higher scores indicating better perceived health status
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Symptoms of depression (CES-D)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Depressive symptoms assessed using the 20-item Center for Epidemiologic Studies Depression Scale (CES-D).
Total scores range from 0 to 60, with higher scores indicating more depressive symptoms
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Symptoms of anxiety (short-form STAI)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Symptoms of anxiety assessed using the 6-item short-form State-Trait Anxiety Inventory (STAI).
Total scores range from 20 to 80 after score transformation, with higher scores indicating greater anxiety symptoms
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Treatment satisfaction assessed using a study-specific questionnaire based on the Diabetes Treatment Satisfaction Questionnaire
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Diabetes risk perception assessed using the Diabetes Risk Perception Questionnaire, a validated questionnaire that evaluates perceived risk of developing diabetes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Sleep quality (Pittsburgh Sleep Quality Index)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Sleep quality assessed using the validated Pittsburgh Sleep Quality Index (PSQI)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Food security (short-form HFSSM)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Food security assessed using the short-form Household Food Security Survey Module (HFSSM).
Scores indicate the level of food security, with higher scores reflecting greater food insecurity
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Plasma metabolite concentrations
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Changes in and associations of metabolomic profiles, with cardiometabolic risk and treatment response.
Assessed using metabolomic profiling.
Blood samples will be collected at baseline and every 6 months during a 3.5-year follow-up period (study visits).
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Quality-adjusted life years (QALYs)
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Quality-adjusted life years (QALYs), calculated as the area under the curve of health-related quality of life utility values over time, where higher values indicate better health outcomes
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Incremental costs and incremental cost-effectiveness ratio (ICER) of semaglutide compared with placebo
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Incremental costs and incremental cost-effectiveness ratio (ICER) of semaglutide versus placebo
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
|
Incremental healthcare costs
Tidsramme: Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
|
Incremental healthcare costs associated with the intervention compared with control, calculated from collected healthcare resource utilization and unit cost data.
Currency (e.g., EUR per participant)
|
Assessed at 160 weeks (end of treatment) and at 172-184 weeks (3-6 months after discontinuation of study medication)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Samarbejdspartnere
Samarbejdspartnere
Publikationer og nyttige links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Urogenitale sygdomme
- Sygdomme i det endokrine system
- Kvinders urogenitale sygdomme og graviditetskomplikationer
- Metaboliske sygdomme
- Graviditetskomplikationer
- Glukosemetabolismeforstyrrelser
- Diabetes mellitus
- Ernæringsmæssige og metaboliske sygdomme
- Diabetes, svangerskabssyge
- Diabetes mellitus, type 2
- Glukagon-lignende peptid-1-receptoragonister
- Lægemidlers fysiologiske virkninger
- Hypoglykæmiske midler
- Semaglutid
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- S66967
- 2022-502082-22-00 (Anden identifikator: EU CT number)
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
IPD-planbeskrivelse
Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter
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