Pancreatin Added to Standard Antihyperglycemic Therapy in Patients With Type 2 Diabetes
The Effect of Pancreatin Added to Standard Antihyperglycemic Therapy on Metabolic Control in Patients With Type 2 Diabetes
Medications that enhance the incretin effect (GLP-1 receptor agonists, tirzepatide (GIP/GLP-1 receptor agonist) and DPP-4 inhibitors) are used in treatment of patients with type 2 diabetes. GLP-1 agonists and tirzepatide not only effectively lower blood glucose levels but also promote weight loss-primarily by stimulating the satiety center in the central nervous system - and reduce cardiovascular risk. Evidence suggests that oral pancreatin supplementation also enhances the incretin effect by increasing GIP and GLP-1 concentrations, and consequently insulin levels, which translates into a reduction in postprandial glycemia in patients with cystic fibrosis or chronic pancreatitis. In our study we aim to evaluate the impact of pancreatin on the incretin effect and glycemic control in patients with type 2 diabetes without exocrine pancreatic insufficiency.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Detaillierte Beschreibung
Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the two primary incretin hormones secreted from the small intestine on ingestion of glucose or nutrients to stimulate insulin secretion from pancreatic β cells. They play a role in regulation of blood glucose levels, particularly postprandial glycemia. Lipids and carbohydrates are the most potent stimulators of incretin hormone secretion. Pancreatin is a mixture of digestive enzymes naturally produced by the pancreas, which is used as a medication supporting macronutrient digestion, especially in cases of exocrine pancreatic insufficiency. Evidence suggests that oral pancreatin supplementation enhances the incretin effect by increasing GIP and GLP-1 concentrations, and consequently insulin levels, which translates into a reduction in postprandial glycemia in patients with cystic fibrosis or chronic pancreatitis. Based on a randomized, placebo-controlled, double-blind study, we aim to evaluate the effect of pancreatin on the incretin effect and glycemic control in patients with type 2 diabetes without exocrine pancreatic insufficiency.
We plan to recruit a total of 100 patients with type 2 diabetes treated with oral antihyperglycemic drugs or insulin, either as monotherapy or in combination. Patients will be randomly divided into 2 groups:
- Group of 50 patients receiving pancreatin 25 000 U with up to 3 main meals daily for 3 months
- Group of 50 patients receiving placebo with up to 3 main meals daily for 3 months
Baseline assessment:
- Anthropometric parameters: body weight, height, waist-to-hip ratio, body composition (bioelectrical impedance analysis)
- Laboratory tests: aspartate aminotransferase, alanine aminotransferase, serum amylase, lipid profile, HbA1c, selected cytokines, average glucose concentration from the last 7 days before study start (glucometer - 4 measurements per day), data from the FreeStyle Libre2 continuous glucose monitoring system (2 weeks prior to study start): assessment of TIR (Time in Range 70-180 mg/dL), glycemic variability coefficient (CV), standard deviation (SD), mean glucose concentration, frequency and severity of hypoglycemia; daily insulin requirements from the last 7 days (for insulin-treated patients)
Assessment after study completion:
- Anthropometric parameters: body weight, height, waist-to-hip ratio, body composition (bioelectrical impedance analysis)
- Laboratory tests: aspartate aminotransferase, alanine aminotransferase, serum amylase, lipid profile, HbA1c, selected cytokines, average glucose concentration from the last 7 days before study end (glucometer - 4 measurements per day), data from the FreeStyle Libre 2 continuous glucose monitoring system (last 2 weeks of study): assessment of TIR, CV, SD, mean glucose concentration, frequency and severity of hypoglycemia; daily insulin requirements from the last 7 days (for insulin-treated patients).
Should pancreatin demonstrate a beneficial effect on glycemic homeostasis, these formulations could serve as a valuable adjunctive therapy for type 2 diabetes.
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 4
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Marta Wróbel, PhD
- Telefonnummer: 48606873060
- E-Mail: mwrobel@sum.edu.pl
Studieren Sie die Kontaktsicherung
- Name: Paulina Piekarz-Ząbek, MD
- Telefonnummer: +48 604 223 652
- E-Mail: k_bielawa@poczta.fm
Studienorte
-
-
Silesian Voivodeship
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Zabrze, Silesian Voivodeship, Polen, 41-800
- Rekrutierung
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze
-
Kontakt:
- Paulina Piekarz-Ząbek, MD
- Telefonnummer: +48 604 223 652
- E-Mail: k_bielawa@poczta.fm
-
Kontakt:
- Marta Wróbel, PhD
- Telefonnummer: +48606873060
- E-Mail: mwrobel@sum.edu.pl
-
-
Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
- Type 2 diabetes diagnosed for at least 12 months
- Patients treated with oral antihyperglycemic agents and/or insulin as monotherapy or combination therapy
- Age between 35 and 75 years
- HbA1c: 6.5% - 9.0%
Exclusion Criteria:
- Type 1 diabetes
- Use of incretin-based drugs (GLP-1 receptor agonists, dual GIP and GLP-1 receptor agonists, DPP-4 inhibitors) currently or within the last 3 months
- History of pancreatic surgery
- History of chronic pancreatitis
- History of acute pancreatitis
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Doppelt
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Pancreatin
Participants receiving pancreatin |
Pancreatin 25 000 U with each of the 3 main meals daily for 3 months
Andere Namen:
|
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Placebo-Komparator: Control
Participants receiving placebo |
Placebo capsule with each of the 3 main meals daily for 3 months
Andere Namen:
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Glycemic control
Zeitfenster: 3 months
|
HbA1c value |
3 months
|
|
Time in range
Zeitfenster: 3 months
|
Time in range (glucose 70-180 mg/dl) |
3 months
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Body weight
Zeitfenster: 3 months
|
Body weight measurement |
3 months
|
|
Lipid profile
Zeitfenster: 3 months
|
Total cholesterol, LDL-cholesterol, HDL-cholesterol, Triglicerides |
3 months
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Mitarbeiter
Mitarbeiter
Ermittler
Ermittler
- Hauptermittler: Marta Wróbel, PhD, Department of Internal Medicine, Diabetology and Cardiometabolic Disorders
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Perano SJ, Couper JJ, Horowitz M, Martin AJ, Kritas S, Sullivan T, Rayner CK. Pancreatic enzyme supplementation improves the incretin hormone response and attenuates postprandial glycemia in adolescents with cystic fibrosis: a randomized crossover trial. J Clin Endocrinol Metab. 2014 Jul;99(7):2486-93. doi: 10.1210/jc.2013-4417. Epub 2014 Mar 26.
- Knop FK, Vilsboll T, Larsen S, Hojberg PV, Volund A, Madsbad S, Holst JJ, Krarup T. Increased postprandial responses of GLP-1 and GIP in patients with chronic pancreatitis and steatorrhea following pancreatic enzyme substitution. Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E324-30. doi: 10.1152/ajpendo.00059.2006. Epub 2006 Sep 5.
- Ebert R, Creutzfeldt W. Reversal of impaired GIP and insulin secretion in patients with pancreatogenic steatorrhea following enzyme substitution. Diabetologia. 1980 Sep;19(3):198-204. doi: 10.1007/BF00275269.
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- Pancreatin - type 2 diabetes
- BNW-1-089/N/5/K (Andere Zuschuss-/Finanzierungsnummer: Medical University of Silesia, Katowice, Poland)
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Beschreibung des IPD-Plans
Deidentified individual participant data and the study protocol will be made available upon reasonable request.
IPD-Sharing-Zeitrahmen
after publication, till 5 yrs
IPD-Sharing-Zugriffskriterien
via email:mwrobel@sum.edu.pl
Art der unterstützenden IPD-Freigabeinformationen
- STUDIENPROTOKOLL
- SAFT
- ICF
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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