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The Effects of Hypoglycaemia in People With Type 2 Diabetes

31. juli 2014 opdateret af: Thozhukat Sathyapalan, University of Hull

The Effects of Hypoglycaemia on Platelets Function and Inflammatory Markers in People With Type 2 Diabetes and Normal Controls.

Strict glycaemic control has been associated with increased hypoglycaemia and mortality rate, the cause of which was unclear, in subjects with type 2 diabetes. In this study, we hypothesised that acute hypoglycaemia will result in platelet activation in people with type 2 diabetes to a higher degree than controls.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Type 2 diabetes is associated with increased risk of cardiovascular disease. Although the United Kingdom Prospective Diabetes Study (UKPDS) follow-up data suggested reduced macrovascular complications with tight glycaemic control, recent studies in people with type 2 diabetes failed to replicate these findings. Furthermore, all-cause mortality was found to be increased with strict glycaemic control in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study. The cause of the increased deaths remains unclear.

Strict glycaemic control is associated with increased risk of hypoglycaemia. Although, hypoglycaemia has traditionally been considered a complication of the treatment for type 1 diabetes, it has recently been recognised as a problem in people with type 2 diabetes particularly those on insulin therapy. In the ACCORD study, the risk of death was significantly increased in those with one or more episode of severe hypoglycaemia in both the strict and standard study treatment arms. As plasma glucose falls to below 4.0 mmol/L, a series of defence mechanisms occur, at an individualised glycaemic thresholds, to reverse hypoglycaemia including a rise in catecholamine levels. This may lead to hypokalaemia, prolonged QT interval, and cardiac arrhythmias. It may also lead to impaired cardiovascular autonomic function for up to 16 hours afterwards; increased inflammatory markers; platelet activation and promote vascular damage. As the majority of studies assessing the effects of hypoglycaemia on cardiovascular risk markers are conducted in people with type 1 diabetes and healthy controls, their findings may not necessarily be applicable to people with type 2 diabetes. In particular, the effects of hypoglycaemia on platelet function and thrombotic risk in people with type 2 diabetes require further clarification. In this study, we hypothesised that acute hypoglycaemia will result in platelet activation in people with type 2 diabetes to a higher degree than controls.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

18

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

40 år til 60 år (Voksen)

Tager imod sunde frivillige

Ja

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. Healthy volunteers:

    • Males or females
    • On no medications except for the contraceptive pill and without medical illnesses in the last three months.
    • Non-smokers
    • 40 - 60 years of age.

  2. T2DM subjects:

    • Males or females
    • Diagnosis of T2DM
    • 40 - 60 years of age
    • HbA1C: 6.5 - 9.5%
    • Duration of diabetes 1 - 10 years
    • Diabetes treated with diet, or tablets only.

Exclusion Criteria:

  1. Healthy volunteers:

    • Pregnancy
    • Lack of contraception in women of child bearing age
    • Chronic medical conditions
    • Current smokers
    • Evidence of ischaemia on ECG
    • Drop attacks
    • Alcohol or drug abuse
    • Psychiatric illness
    • Previous history of seizure
    • Alcohol or drug abuse

  2. Type 2 diabetes subjects:

    • Pregnancy
    • Current smokers
    • Recurrent episodes of hypoglycaemia
    • Treatment with anti-platelet or anti-coagulation therapy
    • History of ischaemic heart disease, stroke or peripheral vascular disease
    • Epilepsy
    • Drop attacks
    • Evidence of ischaemia on ECG
    • Insulin treated T2DM
    • History of microvascular disease (retinopathy, nephropathy or neuropathy).
    • Alcohol or drug abuse
    • Psychiatric illness

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Diagnostisk
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Controls
Weight-matched healthy controls. Euglycaemic Hypoglycaemic insulin clamp. Using hyperinsulinaemic clamps, blood glucose levels were stabilised over 1 hour to reach 5 mmol/L and maintained at that level for 1 hour, then gradually reduced over 1 hour to 2.8 mmol/L and maintained at that level for 1 hour. Blood samples were collected at times 0 (baseline), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and at 24 hours after the clamp studies.
Medicin: Insulin (Humulin S)
Using insulin and glucose infusions (hyperinsulinaemic clamps), blood glucose levels were stabilised over 1 hour to reach 5 mmol/L and maintained at that level for 1 hour, then gradually reduced over 1 hour to 2.8 mmol/L and maintained at that level for 1 hour. Blood samples were collected at times 0 (baseline), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and at 24 hours after the clamp studies.
Andre navne:
  • Glucose (20% Dextrose).
Enhed: Euglycaemic Hypoglycaemic Insulin clamp
Aktiv komparator: Type 2 diabetes
People with a known diagnosis of type 2 diabetes. Euglycaemic Hypoglycaemic Insulin clamp. Using hyperinsulinaemic clamps, blood glucose levels were stabilised over 1 hour to reach 5 mmol/L and maintained at that level for 1 hour, then gradually reduced over 1 hour to 2.8 mmol/L and maintained at that level for 1 hour. Blood samples were collected at times 0 (baseline), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and at 24 hours after the clamp studies.
Medicin: Insulin (Humulin S)
Using insulin and glucose infusions (hyperinsulinaemic clamps), blood glucose levels were stabilised over 1 hour to reach 5 mmol/L and maintained at that level for 1 hour, then gradually reduced over 1 hour to 2.8 mmol/L and maintained at that level for 1 hour. Blood samples were collected at times 0 (baseline), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and at 24 hours after the clamp studies.
Andre navne:
  • Glucose (20% Dextrose).
Enhed: Euglycaemic Hypoglycaemic Insulin clamp

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
To examine the effect of hypoglycaemia on platelet surface expression of platelet activation markers P-selectin and fibrinogen binding.
Tidsramme: Up to 24 hours after euglycaemic hypoglycaemic clamp

Platelet surface expression of activation markers, P-selectin and fibrinogen binding, were measured in the resting state (unstimulated samples) and in response to stimulation with platelet agonist adenosine diphosphate, and platelet inhibitor prostacyclin.

A change in platelet function from times 0 (baseline), to 2 hours (euglycaemia), 4 hours (hypoglycaemia) and 24 hours after the clamp studies was measured and compared between the two groups.
Up to 24 hours after euglycaemic hypoglycaemic clamp

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
To measure changes in markers of inflammation (high sensitivity C-reactive protein) and endothelial function using EndoPat 2000
Tidsramme: Up to 24h after euglycaemic hypoglycaemic clamp

High sensitivity C-reactive protein was measured at baseline (time 0), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and 24 hours after clamp studies. Changes from baseline were compared between the groups.

EndoPat was measured before the insulin clamp and 24 hours afterwards and changes were compared between the two groups.
Up to 24h after euglycaemic hypoglycaemic clamp

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
To assess the effects of hypoglycaemia on participants scores on cognitive function tests
Tidsramme: Up to 24h after euglycaemic hypoglycaemic clamp
Three cognitive function tests (Tower of Hanoi; Dual Task test and The Digit symbol-coding) were measured at baseline (time 0), 2 hours (euglycaemia), 4 hours (hypoglycaemia) and 24 hours after insulin clamp studies. Changes from baseline in each of these tests in response to the insulin clamp were compared between the two groups.
Up to 24h after euglycaemic hypoglycaemic clamp

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

University of Hull

Samarbejdspartnere

Hull University Teaching Hospitals NHS Trust

Efterforskere

  • Ledende efterforsker: Stephen L Atkin, PhD, Hull York Medical School

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. november 2011

Primær færdiggørelse (Faktiske)

1. maj 2013

Studieafslutning (Faktiske)

1. maj 2013

Datoer for studieregistrering

Først indsendt

28. juli 2014

Først indsendt, der opfyldte QC-kriterier

31. juli 2014

Først opslået (Skøn)

1. august 2014

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Skøn)

1. august 2014

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

31. juli 2014

Sidst verificeret

1. juli 2014

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 11/YH/0161

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Kliniske forsøg med Type 2 diabetes mellitus

Kliniske forsøg med Insulin (Humulin S)

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