Incretin Effect and Use After Clinical Islet Transplantation

This study has been completed.
Sponsor:
Collaborator:
Juvenile Diabetes Research Foundation
Information provided by (Responsible Party):
University of Alberta
ClinicalTrials.gov Identifier:
NCT00768651
First received: October 7, 2008
Last updated: May 29, 2015
Last verified: May 2015

October 7, 2008
May 29, 2015
October 2008
July 2011   (final data collection date for primary outcome measure)
  • The Primary Endpoint Will be Insulin Independence After 6 Months of Therapy. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Insulin independence was defined as no insulin use for at least one week, HbA1c < 6.0%, fasting plasma glucose < 7.0 mmol/l, fasting or stimulated c-peptide ≥ 0.5 ng/ml. In addition capillary blood glucose levels could not be >7.8 mmol/l (fasting) or > 10 mmol/l (post-prandial) on more than three occasions in the preceding week. Mean daily insulin use was calculated from the three days prior to study visits. Blinded continuous glucose monitoring (CGM) was performed using the iPro device and Carelink software (Medtronic, Mississauga, ON, CA).
  • Number of Participants Not Using Insulin for at Least One Week After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Number of Participants With HbA1c < 6.0 % After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    HbA1c was measured using method (manufacturer) at baseline, 3, 6 and 9 months.
  • Number of Participants With Fasting Plasma Glucose (FPG) < 7 mmol/l After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Mean Daily Insulin Use (U/Day) After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Mean daily insulin use was calculated from the three days prior to study visits and performed at baseline, 3, 6, and 9 months.
  • Change From Baseline of GLP-1 Level After One Month of Therapy [ Time Frame: Baseline and One month ] [ Designated as safety issue: No ]
    Fasting Glucagon-Like Peptide (GLP-1) levels were measured at baseline and one month. Blood samples were collected in p700 vacutainers (Becton Dickinson, Franklin Lakes, NJ) containing a Dipeptidyl peptidase-4 (DPP4) protease inhibitor cocktail to measure total and active GLP-1 in duplicate using a commercially available ELISA (kit manufacturer) and expressed as the ratio of active:total GLP-1.
  • Change From Baseline on Gastrin Level After One Month of Therapy [ Time Frame: Baseline and One month ] [ Designated as safety issue: No ]
    Gastrin levels were measured at baseline and at one month by method (manufacturer).
  • HbA1c Plasma Laboratory Value for Participants After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    HbA1c was measured at baseline, 3, 6, and 9 months using method (manufacturer.
  • Acute Insulin Responses to Arginine After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    An intravenous arginine stimulation test (AST) [Ryan:2002cg] was performed at baseline, 6, and 9 months to assess Graft function.
  • C-peptide Laboratory Value at 90 Minutes After a Mixed Meal Tolerance Test (MMTT) After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Measuring of C-peptide before and 90 minutes after a mixed meal tolerance test (MMTT) [Ryan:2005ts] at baseline, 6 and 9 months to assess Graft function.
  • C-peptide Laboratory Value Before a Mixed Meal Tolerance Test (MMTT) After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Measuring of C-peptide before and 90 minutes after a mixed meal tolerance test (MMTT) [Ryan:2005ts] at baseline, 6 and 9 months to assess Graft function.
  • Glucose Laboratory Value at 90 Minutes After Mixed Meal Tolerance Test (MMTT) After 6 Months of Therapy. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Measuring Glucose before and 90 minutes after Mixed Meal Tolerance Test (MMTT) [Ryan: 2005ts] at baseline, 6 and 9 months to assess Graft function.
  • Blood Glucose Laboratory Value Before Mixed Meal Tolerance Test (MMTT) After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Weight Change From Baseline After 6 Months of Therapy [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    Measuring the weight change from baseline at months: 1, 3, 6 and 9.
The primary endpoint will be insulin independence after 6 months of therapy. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT00768651 on ClinicalTrials.gov Archive Site
  • Insulin Independence After the 3 Month Washout Period [ Time Frame: After the 3 month washout period ] [ Designated as safety issue: No ]
    Insulin independence was defined as no insulin use for at least one week, HbA1c < 6.0%, fasting plasma glucose < 7.0 mmol/l, fasting or stimulated c-peptide ≥ 0.5 ng/ml. In addition capillary blood glucose levels could not be >7.8 mmol/l (fasting) or > 10 mmol/l (post-prandial) on more than three occasions in the preceding week. Mean daily insulin use was calculated from the three days prior to study visits. Blinded continuous glucose monitoring (CGM) was performed using the iPro device and Carelink software (Medtronic, Mississauga, ON, CA).
  • Insulin Dose (U/Day) [ Time Frame: After the 3 month washout period ] [ Designated as safety issue: No ]
  • Acute Insulin Response to Arginine After the 3 Month Washout Period [ Time Frame: 3 months - washout period ] [ Designated as safety issue: No ]
    An intravenous Arginine stimulation test (AST) [Ryan:2002cg] was performed at baseline, 6, and 9 months to assess Graft function. The Arginine is a proxy for insulin secretory reserve (Robertson:2004br)(Rickels:2007cg) and correlates with islet mass in the context of islet allo-transplant (Ryan:2002cg), auto-transplant (Teuscher:1998eu) and hemipancreatectomy (Seaquist:1992iv). An increase in Arginine (AIRarg) would have suggested an increase in beta cell mass.
  • HbA1c Plasma Laboratory Value for Participants After the 3 Month Washout Period [ Time Frame: After the 3 month washout period ] [ Designated as safety issue: No ]
    Measuring of HbA1c using method (manufacturer) at baseline, and months: 1, 3, 6, 9.
  • C-peptide Plasma Laboratory Value at 90 Minutes After a Mixed Meal Tolerance Test (MMTT) at the End of the 3 Month Washout Period. [ Time Frame: After the 3 month washout period ] [ Designated as safety issue: No ]
    Measuring of C-peptide before and 90 minutes after a Mixed Meal Tolerance Test (MMTT) [Ryan:2005ts] at baseline, 6 and 9 months to assess Graft function. Ther
  • C-peptide Laboratory Value Before a Mixed Meal Tolerance Test (MMTT) After the 3 Month Washout Period. [ Time Frame: 3 months - washout period ] [ Designated as safety issue: No ]
    Measuring of C-peptide before and 90 minutes after a mixed meal tolerance test (MMTT) [Ryan:2005ts] at baseline, 6 and 9 months to assess Graft function.
  • Glucose Laboratory Value at 90 Minutes After Mixed Meal Tolerance Test (MMTT) After the 3 Month Washout Period. [ Time Frame: 3 months - washout period ] [ Designated as safety issue: No ]
    Measuring Blood Glucose before and 90 minutes after Mixed Meal Tolerance Test (MMTT) [Ryan: 2005ts] at baseline, 6 and 9 months to assess Graft function.
  • Blood Glucose Laboratory Value Before Mixed Meal Tolerance Test (MMTT) After the 3 Month Washout Period [ Time Frame: After the 3 month washout period ] [ Designated as safety issue: No ]
    Measuring Blood Glucose before and 90 minutes after Mixed Meal Tolerance Test (MMTT) [Ryan: 2005ts] at baseline, 6 and 9 months to assess Graft function.
Insulin independence after the 3 month washout period; insulin and C-peptide responses to the intravenous arginine and mixed meal tests; reduction in insulin use; and improvement in glycemic control as determined by HbA1c and CGMS. [ Time Frame: 3 months ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Incretin Effect and Use After Clinical Islet Transplantation
Pilot Study of Safety and Efficacy of Combined Use of Dipeptidyl-peptidase Inhibitor (Sitagliptin) and Proton Pump Inhibitor (Pantoprazole) to Prevent Beta-cell Apoptosis and Promote Islet Regeneration in Islet Transplant Recipients With Early Graft Dysfunction

We aim to study if the administration of medications to increase the secretion of hormones from the intestines can improve glycemic control, reduce insulin use and promote β-cell regeneration/expansion in subjects with type 1 diabetes following islet transplantation who are back using small doses of insulin because of early graft dysfunction. We believe that the results will enable us to understand whether these drugs could be useful in islet transplant recipients, particularly if glycemic control deteriorates.

This is a single centre non-randomized pilot study. Subjects will be recruited from the current cohort of islet transplant recipients at the University of Alberta.

The primary objective of the study is to evaluate whether the combination of sitagliptin and pantoprazole can restore insulin independence in previously insulin independent islet transplant recipients experiencing early graft dysfunction. The study will also evaluate the safety of the combination drug therapy.

Interventional
Phase 2
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Type 1 Diabetes
  • Drug: Pantoprazole
    Starting on Day 1, Pantoprazole 80 mg daily (40 mg every morning and 40 mg every evening) administered orally at the same time each day for a period of 6 months.
    Other Name: Pantoloc
  • Drug: Sitagliptin
    Starting on Day 1, Sitagliptin 100mg once daily administered orally at the same time each day for a period of 6 months.
    Other Name: Januvia
Experimental: One arm: Sitagliptin + Pantoprazole

Intervention Details:

Sitagliptin 100 mg daily and Pantoprazole 40 mg bid for 6 months, followed by a three-month washout.

Interventions:
  • Drug: Pantoprazole
  • Drug: Sitagliptin
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
8
December 2011
July 2011   (final data collection date for primary outcome measure)

Inclusion Criteria

Subjects must meet the following criteria to be enrolled in this study:

  1. Male or female, aged 18 to 70, inclusive, who is a previous islet transplant recipient (at least 3 months since last islet transplant) and who received their transplant at the University of Alberta.
  2. Insulin independent for 3 months or longer after islet transplant.
  3. Early graft dysfunction as defined by:

    1. HbA1c >6% (but less than 7.5%); or
    2. fasting glucose > 7 mmol/L (126 mg/dl); or
    3. random glucose > 10 mmol/L (180 mg/dl), and
    4. Total insulin use of < 10 units/day.
  4. C-peptide positive.
  5. Able to provide informed consent.

Exclusion Criteria:

Subjects who meet any of the following criteria will be excluded from the study:

  1. Unable to provide informed consent.
  2. Prior therapy with sitagliptin or a proton pump inhibitor in the preceding 2 months.
  3. Vulnerable populations (i.e. cognitively impaired, pregnant women, residing in institutions, University of Alberta students or employees under the supervision of any of the investigators).
  4. Children, adolescent or patients with a "contraindication" or "warning" listed in the package insert of any of the study drugs:

    1. Hypersensitivity to sitagliptin or pantoprazole for any component of the formulation.
    2. Renal disease or renal dysfunction (as suggested by serum creatinine levels ≥ 136 µmol/L (males), ≥ 124 µmol/L (females) or abnormal creatinine clearance; or estimated by Glomerular Filtration Rate (GFR) <50 ml/min/1.73m2).
    3. Acute or chronic metabolic acidosis with or without coma (including diabetic ketoacidosis).
  5. Uncontrolled hyperglycemia
  6. Any subject that in the opinion of the investigator would not be a good candidate for study participation.
Both
18 Years to 70 Years
No
Contact information is only displayed when the study is recruiting subjects
Canada
 
NCT00768651
7331
No
University of Alberta
University of Alberta
Juvenile Diabetes Research Foundation
Principal Investigator: Peter Senior, MD, PhD University of Alberta
University of Alberta
May 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP