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Diabetes Mellitus and HIV Study in Mwanza (CICADA)

28. juni 2021 oppdatert av: Dr George PrayGod, National Institute for Medical Research, Tanzania

Diabetes and Associated Complications in HIV Patients

Emerging evidence from high-income countries suggests that diabetes mellitus is become a major health problem among HIV-infected patients. However, due to differences in social, environmental, and genetic factors data from high-income countries can not be extrapolated directly to low-income countries. This study investigates HIV, ART, inflammation, and body composition changes as risk factors for diabetes mellitus among HIV-infected patients in Tanzania.

Studieoversikt

Status

Aktiv, ikke rekrutterende

Forhold

Detaljert beskrivelse

Access to antiretroviral therapy (ART) is increasing rapidly in low-income countries and HIV-infected patients initiate ART much earlier. As a result, these patients have prolonged life spans and, hence, longer HIV and ART exposure. Emerging data from developed countries suggest that HIV-infected patients have a higher risk than HIV-uninfected people of developing diabetes mellitus (DM) and other non-communicable diseases. The excess diabetes risk is probably related to multiple factors including HIV-associated inflammation, the use of some antiretroviral therapy (ART) regimens, and body composition changes associated with HIV and ART. As a result, HIV-infected populations may develop DM at a younger age and may have a higher mortality if management is not optimal as may be the case in resource-limited countries of Sub-Saharan Africa (SSA).

Most of the data to-date on HIV and DM are from high-income countries, and data in SSA are few and inconsistent. Because of differences in genetic composition as well as environmental factors including high burden of infectious diseases in resource-limited settings, data from high-income countries cannot be extrapolated and reliably used to improve quality of DM care among HIV patients in SSA. The objective of this study is to investigate if HIV, ART, and body composition changes occurring during ART use are associated with higher risk of DM as well as other risk factors for cardiovascular diseases in Tanzanian patients, and examine if HIV increases the risk of DM associated complications. This study is funded by the Danish Ministry of Foreign Affairs from 2016 to 2021.

Studietype

Observasjonsmessig

Registrering (Faktiske)

1947

Kontakter og plasseringer

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

Studiesteder

  • Tanzania
    • Mwanza Region
      • Mwanza, Mwanza Region, Tanzania
        • NIMR Research Clinic

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 og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

A prospective cohort study with two annual follow-ups will be conducted. This will be based on two existing HIV cohorts i.e. Nutrition, Diabetes and Pulmonary Tuberculosis (TB)/HIV (NUT-TB) (NCT00311298) conducted in Mwanza from 2006-2009 and Nutritional Support for African Adults Starting Antiretroviral Therapy (NUSTART) ( PACTR201106000300631) conducted in Mwanza during 2011-2013 and a new HIV cohort which will be recruited at study initiation. In the New HIV cohort, investigators will recruit both HIV patients and HIV negative participants who will act as controls. These 3 groups will provide about 1900 participants with and without HIV infection to address study objectives.

Beskrivelse

Inclusion Criteria:

  • For existing cohorts, patients should come from NUT-TB or NUSTART Cohorts
  • For New HIV cohort, patients should be HIV positive ART naive, HIV negative participants will be come from the same neighborhood as newly recruited HIV positive patients
  • Age will be 18 years and above
  • Mwanza region residency
  • Not planning to relocate outside Mwanza within the study period

Exclusion Criteria:

  • Very severe illness

Studieplan

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

Hvordan er studiet utformet?

Designdetaljer

Kohorter og intervensjoner

Gruppe / Kohort
HIV and Diabetes Cohort
Participants recruited in the study will have diverse characteristics. Participants will either be HIV infected or HIV negative and among those HIV-infected there will be those on ART and those not on ART. In addition, participants will have other background characteristics like having history of tuberculosis treatment, being malnourished while starting ART, having diabetes at ART initiation etc. Investigators will also be able to examine the effect of immune activation, body composition changes, and other related factors on the risk of diabetes. This diversity of characteristics will help provide adequate data to address study outcomes.

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Combined prevalence of pre-diabetes and diabetes
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine the combined prevalence of pre-diabetes and diabetes according to World Health Organization (WHO) diagnosis guidelines and investigate if behavioural and socio-demographic factors, and HIV, Tuberculosis (TB), ART, dyslipidaemia,chronic immune activation, parasitic infections, and body composition changes increase the risk of the outcome measure
Baseline and follow-up (12 and 24 months)
Prevalence of hypertension
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine the prevalence of hypertension according to WHO diagnosis guidelines and investigate if behavioural and socio-demographic factors, and HIV, TB, ART, dyslipidaemia,chronic immune activation, parasitic infections, and body composition changes increase the risk of the outcome measure
Baseline and follow-up (12 and 24 months)

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Combined incidence of pre-diabetes and diabetes
Tidsramme: Follow-up (12 and 24 months)
The investigators will determine the combined incidence of pre-diabetes and diabetes. The number of patients meeting WHO diagnostic criteria of pre-diabetes and those meeting WHO diagnostic criteria for diabetes will added together and become the numerator whereas participants who are not pre-diabetic or diabetic at the beginning of the observation period will constitute the denominator. Investigators will determine if behavioural and socio-demographic factors, and HIV, TB, ART, dyslipidaemia,chronic immune activation, parasitic infections, and body composition changes increase the risk of the outcome measure
Follow-up (12 and 24 months)
Prevalence of dyslipidaemia
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine prevalence of dyslipidaemia based on WHO diagnosis guidelines and investigate if HIV and ART increase the risk of the outcome measure
Baseline and follow-up (12 and 24 months)
Prevalence of diabetes clinical complications
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine prevalence of diabetes clinical complications and investigate if HIV and ART increase or modify the risk of the outcome measure
Baseline and follow-up (12 and 24 months)
Level of insulin resistance
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine level of insulin resistance and investigate if HIV and ART are associated with the outcome measure
Baseline and follow-up (12 and 24 months)
Level of beta-cell function
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine level of beta-cell function and investigate if HIV and ART are associated with the outcome measure
Baseline and follow-up (12 and 24 months)
Prevalence of diabetes by Fasting Blood Glucose (FBG), Oral Glucose Tolerance Test (OGTT) and Hba1c
Tidsramme: Baseline
By determining the prevalence of diabetes among HIV patients by 3 tests (FBG, OGTT and Hba1c), investigators will be able to judge the test which is best at diagnosing diabetes in HIV-infected populations.
Baseline
Prevalence of sub-clinical atherosclerosis
Tidsramme: Baseline and follow-up (12 and 24 months)
The investigators will determine the prevalence of sub-clinical atherosclerosis and investigate if behavioural and socio-demographic factors, and HIV, TB, ART, dyslipidaemia,chronic immune activation, parasitic infections, and body composition changes increase the risk of the outcome measure
Baseline and follow-up (12 and 24 months)

Samarbeidspartnere og etterforskere

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

Sponsor

National Institute for Medical Research, Tanzania

Samarbeidspartnere

London School of Hygiene and Tropical Medicine
Rigshospitalet, Denmark
University of Copenhagen
University of Bergen
Vanderbilt University
Tanzania Commission for AIDS, Tanzania
Hindu Mandal Hospital,Tanzania

Etterforskere

  • Hovedetterforsker: Henrik Friis, MD, PhD, University of Copenhagen
  • Hovedetterforsker: George PrayGod, MD, PhD, National Institute for Medical Research (NIMR), Tanzania
  • Hovedetterforsker: Nyagosya Range, MSc, PhD, NIMR, Tanzania
  • Hovedetterforsker: Mette F Olsen, MSc, PhD, University of Copenhagen
  • Hovedetterforsker: Daniel Faurholt-Jepsen, MD, PhD, University of Copenhagen

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

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 (Faktiske)

6. oktober 2016

Primær fullføring (Faktiske)

30. desember 2019

Studiet fullført (Forventet)

31. mars 2022

Datoer for studieregistrering

Først innsendt

15. februar 2017

Først innsendt som oppfylte QC-kriteriene

3. april 2017

Først lagt ut (Faktiske)

10. april 2017

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

29. juni 2021

Siste oppdatering sendt inn som oppfylte QC-kriteriene

28. juni 2021

Sist bekreftet

1. juni 2021

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • 16-P01-TAN

Plan for individuelle deltakerdata (IPD)

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Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

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