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Study to Estimate the Effects of Inhaled Versus Intravenous (IV) Infusion of Human Insulin in Subjects With Type 1 Diabetes

15. februar 2008 oppdatert av: University of Pittsburgh

Open-Label Randomized Two-Way Crossover Pilot Study to Estimate the Effects of Inhaled vs. IV Infusion of Human Insulin With Regards to Glucose Disposal in Subjects With Type 1 Diabetes Mellitus

University of Pittsburgh Medical Center (UPMC) diabetes research physicians are studying the action in muscle tissue of "inhaled" insulin (Exubera®) and "infused" (intravenous or IV) insulin on blood sugar control in people with type 1 diabetes. Type 1 diabetics often take 2-4 shots of insulin every day. Exubera may offer an alternative to these insulin injections.

Studieoversikt

Status

Fullført

Forhold

Type 1 diabetes mellitus

Intervensjon / Behandling

Legemiddel: Exubera

Detaljert beskrivelse

A dry powder insulin formulation delivered by an aerosol inhaler has been in clinical development for use in types 1 and 2 diabetes mellitus (DM) and just recently (1-27-06) received approval from the U.S. Food and Drug Administration (FDA) for the clinical treatment of diabetes. Administration of insulin without the need for subcutaneous (SC) injection is an attractive alternative for patients with diabetes. There are preclinical and clinical data that indicate inhalation of insulin results in a more potent effect on glucose disposal and a lower fasting glucose than is attained with equivalent dosing of SC or intravenous (IV) insulin. The physiological mechanism(s) are unclear, but occur even when matched for pharmacokinetics.

The current proposal seeks primarily to more fully delineate whether there are physiological differences in the metabolic effects of inhaled compared to IV infused insulin, giving IV insulin to match the pharmacokinetics (PK) achieved with inhaled insulin.

There are 3 specific aims:

The first aim is to establish a protocol for matching the PK of inhaled insulin with the PK of intravenously infused insulin. An infusion algorithm has been developed and will be tested and refined in healthy volunteers (n = 3-5), and will be used for the physiological studies (aims) outlined below.
The second aim is to perform Positron Emission Tomography (PET) imaging of [18F]-FDG uptake by muscle, following administration of a single dose of inhaled compared to infused insulin. Volunteers with type 1 DM (n =12) will be studied, serving as his/her within-subject control, under each condition of insulin administration.
In these type 1 diabetes mellitus (type 1 DM) volunteers, we will test the hypothesis that a single dose of inhaled versus infused insulin, matched for arterial concentrations, causes greater stimulation of muscle glucose uptake.
The third aim is to determine overnight rates of glucose production and plasma glucose after a single pre-dinner dose of inhaled compared to IV infused insulin. The same 12 volunteers studied for Aim 2 will be studied the evening preceding the PET imaging studies and will serve as his/her within-subject control, under each condition of insulin administration.

Studietype

Intervensjonell

Registrering (Forventet)

Fase

Fase 4

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

Forente stater
- Pennsylvania
  - Pittsburgh, Pennsylvania, Forente stater, 15213
    - University of Pittsburgh

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år til 50 år (Voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

Ages 18 to 50 years old
Body mass index (BMI) 20 to 27 kg/m2 and a total body weight > 50 kg (110 lbs)
Blood pressure: systolic < 150; diastolic < 95.
Type 1 DM
Have diagnosed diabetes type 1 for a minimum of 12 months prior to study entry
In good general health with no evidence or history of clinically significant hematological, renal, endocrine (other than diabetes), pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, neurologic, or allergic disease (including drug allergies, but excluding untreated, asymptomatic, seasonal allergies at time of dosing)
Hematocrit (Hct) > 34%
ALT < 60; AST < 60
Alkaline phosphatase (Alk Phos) < 150
Sensitive thyroid-stimulating hormone (sTSH) < 6
Fasting (morning) glucose 100-160 mg/dl
Documented hemoglobin A1c (HbA1c) < 7.5% at time of entry
Triglycerides < 175
Cholesterol < 275

Exclusion Criteria:

Exclude if unable to master use of the inhalation device after 3 attempts
Exclude if positive urine drug screen
Exclude if any episodes of severe hypoglycemia in the past 3 months
Exclude if pregnant or breastfeeding or unwilling to use an acceptable method of non-hormonal contraception from at least 14 days prior to the first dose of Exubera® until study is completed.
Exclude if any history of (h/o) asthma or chronic obstructive pulmonary disease (COPD)
Exclude if forced expiratory volume in one second (FEV1) or forced vital capacity (FVC) < 70% predicted
Exclude if treatment with an investigational drug within 30 days preceding the first dose of trial medication.
Exclude if blood donation of approximately 1 pint (500 mL) within 56 days prior to dosing
Exclude if unable or unwilling to comply with the protocol as written
Exclude if any use of tobacco or nicotine containing products within the past 6 months
Exclude if history of regular alcohol consumption exceeding 7 drinks/week for females or 14 drinks/week for men (1 drink = 5 ounces of wine or 12 ounces [360 mL] of beer or 1.5 ounces [45 mL] of hard liquor) within 6 months of screening
Exclude if claustrophobic, any surgical or vascular implants or pacemakers, or any metal in the body

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Primært formål: Behandling
Tildeling: Randomisert
Intervensjonsmodell: Crossover-oppdrag
Masking: Ingen (Open Label)

Hva måler studien?

Primære resultatmål

Resultatmål
To perform positron emission tomography (PET) imaging of [18F]-fluoro-deoxy-glucose (FDG) uptake by muscle, following administration of a single dose of inhaled compared to infused insulin in volunteers with type 1 diabetes

Sekundære resultatmål

Resultatmål
To determine overnight rates of glucose production and plasma glucose after a single pre-dinner dose of inhaled compared to IV infused insulin in volunteers with type 1 diabetes

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University of Pittsburgh

Samarbeidspartnere

Pfizer

Etterforskere

Hovedetterforsker: David E. Kelley, MD, University of Pittsburgh

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. april 2006

Studiet fullført (Faktiske)

1. desember 2006

Datoer for studieregistrering

Først innsendt

17. april 2006

Først innsendt som oppfylte QC-kriteriene