Intranasal Insulin: A Novel Treatment for Gulf War Multisymptom Illness
Recruitment status was: Recruiting
Following their deployment to the 1991 Gulf War, many veterans (GWV) reported a constellation of unexplained health symptoms; common among them were attention and memory difficulties, fatigue, joint pain, headaches, gastrointestinal complaints, and mood and sleep problems. Despite the passage of time, the symptom complex persists for many veterans. Indeed, it is estimated that at least 25 percent of GWV (nearly 170,000 veterans) have a persistent form of chronic multisymptom illness (CMI). GW deployed veterans are also developing significantly more chronic diseases such as diabetes, hypertension, arthritis, and coronary heart disease than their non-deployed veteran peers putting these individuals at risk for accelerated aging-related diseases of the peripheral and central nervous system (CNS). Recent studies have shown a slowing of response speed that affects mental flexibility across multiple cognitive domains (memory, attention, visuospatial functions) especially on tests that were timed and computerized and where small differences in cognitive reaction times could be measured. Recent studies also have suggested that the response inhibition deficits shown in GWV may reflect executive system dysfunction as reflected by slower motor responses across multiple cognitive domains.
To date, there are no treatments that have been shown to improve the health or cognitive difficulties of GW veterans; thus there is an urgent need to establish effective, safe, and tolerable treatments for GW CMI. Previous studies in other cognitive disorders have found that intranasal insulin improves memory, attention, and mood, reduces neuroinflammation, and modulates cortisol levels; it has also been identified as a treatment that has the capacity to alter many of the leading problems of GW CMI.
During this study there are 2 treatment groups and a placebo group that will last for 8 weeks. The treatment groups will self-administer their designated dosage of insulin through a nasal pump twice a day, while the placebo group will administer saline through a nasal pump twice a day. These doses have been shown to be effective and safe. The primary outcome measure will assess improvements in verbal delayed memory using a specific list learning task and on a measure of selective attention. The study will assess improvements in overall physical health and mood by asking the participants to complete self report questionnaires. Neuroendocrine measures will also be obtained in order to evaluate changes in glucose, insulin, and cortisol levels and examine their impact on GW CMI.
Intranasal insulin has shown great promise in improving memory, attention, and mood in both older adults with cognitive impairment as well as normal subjects. Thus, this proposal could prove intranasal insulin to be an effective, safe, and affordable therapy for these ailing veterans.
|Chronic Multisymptom Illness in Gulf War Veterans||Device: Intranasal Insulin||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Official Title:||Intranasal Insulin: A Novel Treatment for Gulf War Multisymptom Illness|
- Memory Functioning [ Time Frame: Eight weeks ]To assess the efficacy of two different doses (10 IU BID and 20 IU BID) of daily intranasal insulin for eight weeks on memory functioning in Gulf War Veterans with Chronic Multisymptom Illness. The primary clinical outcome measure will be a change in the performance on the delayed verbal memory score on a list learning task (California Verbal Learning Test (CVLT). To determine the sustainability of change in cognitive status, the response from treatment endpoint (end of 8-week treatment period) to one month follow-up (post end of 8-week treatment period) will also be assessed for the primary outcome measure.
- Attention Functioning [ Time Frame: Eight Weeks ]To assess the efficacy of two different doses (10 IU BID and 20 IU BID) of daily intranasal insulin for eight weeks on attention functioning in Gulf War Veterans with Chronic Multisymptom Illness. The primary clinical outcome measure will be a change in performance on a selective attention task (Stroop Color-Word Interference Task) from treatment baseline to endpoint. To determine the sustainability of change in cognitive status, the response from treatment endpoint (end of 8-week treatment period) to one month follow-up (post end of 8-week treatment period) will also be assessed for the outcome measure.
- Physical Health [ Time Frame: Eight weeks ]An outcome measure will be the changes in physical health over the course of active treatment. The primary measure of physical health will be the Physical Components Score (PCS) from the Standard Form 12-veteran version (SF-12V). The clinical outcome measure will be the change in PCS score from treatment baseline to endpoint. To determine the sustainability of change in PCS scores, the response from treatment endpoint to one month follow-up will also be assessed.
- Mood [ Time Frame: Eight Weeks ]An outcome measure will be the changes in mood over the course of active treatment. The primary measure of mood will be obtained from the Profile of Mood States (POMS) vigor scale. The clinical outcome measure will be the change in POMS scores from treatment baseline to endpoint. To determine the sustainability of change in POMS scores, the response from treatment endpoint to one month follow-up will also be assessed.
|Study Start Date:||April 2014|
|Estimated Study Completion Date:||December 2016|
|Estimated Primary Completion Date:||December 2016 (Final data collection date for primary outcome measure)|
Experimental: 10 IU BID
10 IU BID
|Device: Intranasal Insulin|
Experimental: 20 IU BID
20 IU BID
|Device: Intranasal Insulin|
Please refer to this study by its ClinicalTrials.gov identifier: NCT01802944
|Contact: Emily K Chapman, BA||(718) 584-9000 ext 6587||Emily.Chapman@va.gov|
|United States, Massachusetts|
|VA Boston Healthcare System||Recruiting|
|Boston, Massachusetts, United States, 02130|
|Contact: Maxine Krengel, PhD 617-232-9500 Maxine.Krengel@va.gov|
|Principal Investigator: Maxine Krengel, PhD|
|United States, New York|
|James J. Peters VA Medical Center||Recruiting|
|Bronx, New York, United States, 10468|
|Contact: Julia A Golier, MD 718-584-9000 ext 5196 Julia.Golier@va.gov|
|Principal Investigator: Julia A Golier, MD|