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Saxenda in Obesity Services (STRIVE Study) (STRIVE)

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ClinicalTrials.gov Identifier: NCT03036800
Recruitment Status : Recruiting
First Posted : January 30, 2017
Last Update Posted : June 18, 2018
Sponsor:
Collaborator:
Novo Nordisk A/S
Information provided by (Responsible Party):
University of Leicester

Tracking Information
First Submitted Date  ICMJE December 20, 2016
First Posted Date  ICMJE January 30, 2017
Last Update Posted Date June 18, 2018
Actual Study Start Date  ICMJE November 28, 2017
Estimated Primary Completion Date September 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: January 25, 2017)
Weight loss of ≥15% at 52 weeks [ Time Frame: 52 weeks ]
The primary outcome of the study will be the proportion of participants with severe and complicated obesity achieving weight loss of ≥15% at 52 weeks with the use of LIRA 3mg according to the outlined protocol in combination with standard care versus standard care alone in a Tier 3 service.
Original Primary Outcome Measures  ICMJE Same as current
Change History Complete list of historical versions of study NCT03036800 on ClinicalTrials.gov Archive Site
Current Secondary Outcome Measures  ICMJE
 (submitted: January 25, 2017)
  • budget impact of a Tier 3 weight management service [ Time Frame: 52 & 104 weeks ]
    budget impact of a Tier 3 weight management service
  • cost-effectiveness [ Time Frame: 52 & 104 weeks ]
    long-term cost-effectiveness when used as part of the proposed combination strategy
  • improving obesity-related co-morbidities [ Time Frame: 52 & 104 weeks ]
    improving obesity-related co-morbidities (obstructive sleep apnoea , prediabetes, diabetes, hypertension)
  • Maintenance of ≥15% weight loss until 104 weeks (an additional 52 weeks) [ Time Frame: 104 weeks ]
    proportion of patients who will achieve ≥15% weight loss at 52 weeks after randomisation and will be able to maintain ≥15% weight loss for another 52 weeks
  • patient compliance [ Time Frame: 16, 32, 52 and 104 weeks ]
  • referral rates to other obesity interventions [ Time Frame: 52 and 104 weeks ]
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures
 (submitted: July 25, 2017)
  • Liver function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Alkaline Transaminase (i u/L), Alkaline Phosphatase (i u/L), Total Bilirubin (umol/L), Albumin (g/L)
  • Thyroid function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Thyroid Stimulating Hormone (miu/L), Free Thyroxine (pmol/L)
  • Renal function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Urea (mmol/L), Creatinine (umol/L), eGFR (mL/min)
  • Haematology profile [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: White Blood Cell Count (x10^9/L), Red blood cell count (x10^12/L), Haemoglobin (g/L), Haematocrit (L/L), Mean Cell Volume (fL), Mean Cell Haemoglobin (pg), Platelet Count (x10^9/L)
  • Lipids [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Cholesterol (mmol/L), Triglycerides (mmol/L), HDL Cholesterol (mmol/L), LDL Cholesterol calc (mmol/L), HDL Ratio
  • HbA1c [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: DCCT (%), IFCC (mmol/mol)
  • Amylase [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: (U/L)
  • Lipase [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: (U/L)
  • Height [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (cm)
  • Weight [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (kg)
  • BMI [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (kg/m2)
  • Waist Circumference [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (cm)
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    King's Obesity Staging System
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Epworth score
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Apnoea Hypopnoea Index
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Oxygen Desaturation Index
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    CPAP Pressures
  • Medical History [ Time Frame: Screening - 104 weeks ]
    including surgical history
  • Demographics [ Time Frame: Screening - 104 weeks ]
  • Concomitant medication [ Time Frame: Screening - 104 weeks ]
  • HSRUQ (Health service and resource uses questionnaire) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • TSQM (Treatment Satisfaction Questionnaire for Medication) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • EQ5D-5L (Quality of Life) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • IWQOL-Lite (Impact of Weight on Quality of Life) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • Change in concomitant medications [ Time Frame: Baseline-104 weeks ]
  • Blood Pressure [ Time Frame: Screening-104 weeks ]
    mmHg
  • Pulse Rate [ Time Frame: Screening-104 weeks ]
    PBM
  • Adverse Events [ Time Frame: Baseline - 104 weeks ]
    including Serious Adverse Events
  • Adherence with injections [ Time Frame: Baseline-104 weeks ]
    LIRA 3mg arm only
  • Adherence with other anti-obesity medications [ Time Frame: Baseline - 104 weeks ]
  • Adherence to Tier 3 (or equivalent) Service [ Time Frame: Baseline - 104 weeks ]
Original Other Pre-specified Outcome Measures
 (submitted: January 25, 2017)
  • Liver function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Alkaline Transaminase (i u/L), Alkaline Phosphatase (i u/L), Total Bilirubin (umol/L), Albumin (g/L)
  • Thyroid function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Thyroid Stimulating Hormone (miu/L), Free Thyroxine (pmol/L)
  • Renal function tests [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Urea (mmol/L), Creatinine (umol/L), eGFR (mL/min)
  • Haematology profile [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: White Blood Cell Count (x10^9/L), Red blood cell count (x10^12/L), Haemoglobin (g/L), Haematocrit (L/L), Mean Cell Volume (fL), Mean Cell Haemoglobin (pg), Platelet Count (x10^9/L)
  • Lipids [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: Cholesterol (mmol/L), Triglycerides (mmol/L), HDL Cholesterol (mmol/L), LDL Cholesterol calc (mmol/L), HDL Ratio
  • HbA1c [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: DCCT (%), IFCC (mmol/mol)
  • Amylase [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: (U/L)
  • Lipase [ Time Frame: Screening, 32, 52 and 104 weeks ]
    Biochemistry: (U/L)
  • Height [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (cm)
  • Weight [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (kg)
  • BMI [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (kg/m2)
  • Waist Circumference [ Time Frame: Screening-104 weeks ]
    Anthropometric Measures: (cm)
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    King's Obesity Staging System
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Epworth score
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Apnoea Hypopnoea Index
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    Oxygen Desaturation Index
  • Scoring System [ Time Frame: Screening, 52 and 104 weeks ]
    CPAP Pressures
  • Medical History [ Time Frame: Sceening - 104 weeks ]
    including surgical history
  • Demographics [ Time Frame: Sceening - 104 weeks ]
  • Concomitant medication [ Time Frame: Sceening - 104 weeks ]
  • HSRUQ (Health service and resource uses questionnaire) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • TSQM (Treatment Satisfaction Questionnaire for Medication) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • EQ5D-5L (Quality of Life) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • IWQOL-Lite (Impact of Weight on Quality of Life) [ Time Frame: Baseline, 52 and 104 weeks ]
    Questionnaire
  • Columbia Suicide Severity Rating Scale (C-SSRS) [ Time Frame: Screening, 52 and 104 weeks ]
    Questionnaire
  • Change in concomitant medications [ Time Frame: Baseline-104 weeks ]
  • Blood Pressure [ Time Frame: Screening-104 weeks ]
    mmHg
  • Pulse Rate [ Time Frame: Screening-104 weeks ]
    PBM
  • Adverse Events [ Time Frame: Baseline - 104 weeks ]
    including Serious Adverse Events
  • Adherence with injections [ Time Frame: Baseline-104 weeks ]
    LIRA 3mg arm only
  • Adherence with other anti-obesity medications [ Time Frame: Baseline - 104 weeks ]
  • Adherence to Tier 3 (or equivalent) Service [ Time Frame: Baseline - 104 weeks ]
 
Descriptive Information
Brief Title  ICMJE Saxenda in Obesity Services (STRIVE Study)
Official Title  ICMJE EFFECTIVENESS AND COST OF INTEGRATING A PROTOCOL WITH USE OF LIRAGLUTIDE 3.0 MG INTO AN OBESITY SERVICE: (STRIVE Study)
Brief Summary A two year, parallel, two group, open-label, real-world randomised controlled trial (RCT) design for subjects with severe and complex obesity who are referred to a Tier 3 or equivalent specialist weight management/obesity service. Participants will be randomised to receive 1) standard care (obesity-specialist care), or 2) targeted prescribing pathway (obesity-specialist care plus targeted use of Liraglutide 3.0mg [LIRA 3mg] with pre-specified stopping rules for the medication). The aim of the study is to compare the effectiveness, budget impact, and cost-effectiveness between the two groups in a real-world setting among otherwise largely unselected patients.
Detailed Description

Summary of Trial Design A two year, parallel, two group, open-label, real-world, RCT design for patients with severe and complex obesity who are referred to a Tier 3 obesity service (including patients who are referred to a Tier 3 service as part of the bariatric surgery pathway). The total duration of participation will be 104 weeks (+/-2 weeks).

The first 52 weeks of the study (after randomisation) will determine whether using the targeted prescribing pathway in a Tier 3 setting will result in more participants attaining ≥15% weight loss compared with standard care. The second 52 weeks of the study will assess whether patients who lose ≥15% of their baseline weight by the first 52 weeks are more likely to maintain ≥15% weight loss for another 52 weeks in the targeted prescribing pathway compared with standard care. Further, budget impact, cost-effectiveness, improvement in obesity-related co-morbidities, complementary aspects of safety, effectiveness, adherence, and treatment satisfaction of both treatment groups will be assessed and compared.

Participants will be randomised in a 2:1 fashion to either the intervention (targeted prescribing pathway + standard care) or control (standard care) group (2 intervention: 1 control). The control group will receive standard care in a specialist obesity service (Tier 3 or equivalent), according to the best practice in each site and can include total or partial meal replacement strategies. The intervention group will receive the same standard care as the control group (i.e. according to the best practice in each site) plus all participants will initially receive LIRA with pre-specified stopping rules. The targeted prescribing pathway: participants who do not meet the definition of a 'early and good responder' (defined as achieving ≥5% weight loss at 16 weeks, ≥10% weight loss at 32 weeks and ≥15% weight loss at 52 weeks) will have their LIRA 3mg treatment stopped. It is important to note that all participants will be analysed in the group to which they are randomised; in particular, participants in the intervention group who stop receiving LIRA 3mg will remain in the intervention group and will continue to receive standard care for the remainder of the study as per the targeted prescribing pathway (albeit, the part of the pathway where LIRA 3mg is not prescribed; see Figure 1).

The study is intentionally designed to reflect a pragmatic "real-world" scenario and each Tier 3 provider may require a different number of visits for their programme. However, study appointments for data collection, titration reviews, application of the stopping rules of LIRA 3mg, and dispensing will be standardised for all of the five sites.

Intervention (Targeted Prescribing Pathway)

The NHS Weight Management pathway is divided into four distinct tiers:

Tier 1: health promotion Tier 2: lifestyle interventions Tier 3: specialist multidisciplinary weight management services Tier 4: bariatric surgery

Across the UK, each region has a specialist Tier 3 obesity and/or weight management service or equivalent, usually referred to as Tier 3. This includes a clinician led multidisciplinary team approach, potentially including a specialist physician, nurse, dietician, psychologist, physiotherapist, etc. From this point forwards, Tier 3 specialist weight management and/or equivalent services will be referred to as 'Tier 3' throughout the remainder of this protocol.

Participants in the intervention group will receive the same standard care as those in the control group, i.e. the best medical practice delivered by the Tier 3 service at each site. Additionally, at baseline, LIRA 3mg will be prescribed to all of the participants in the intervention group at a starting dose of 0.6mg daily. Dose escalation of Liraglutide will occur according to a pre-specified titration protocol, from 0.6mg to a maximum of 3.0mg daily. Liraglutide dose will be initiated at 0.6mg and then increased to 1.2mg in Week 2, 1.8mg in Week 3, 2.4mg in Week 4, and 3.0mg in Week 5. Participants in the intervention group will be aware that the LIRA 3mg treatment may be stopped at various time points throughout the duration of the study and that continued use of LIRA 3mg is based upon their response to the treatment in terms of them achieving pre-defined weight loss targets at 16, 32 and 52 weeks.. Specifically, participants in the intervention group will continue to be prescribed LIRA 3mg for the 104 week duration of the study, unless one of the following stopping rules applies:

  1. st stopping rule: After 16 weeks (± 14 days) on the medication, only those participants who have lost ≥5% of their baseline weight will be offered further treatment with LIRA 3mg for another 16 weeks. Participants who have not met this weight loss target will have their LIRA 3mg treatment stopped but will still continue in the targeted prescribing pathway but will receive standard care only during the remainder of the study.
  2. nd stopping rule: After 32 weeks (± 14 days) on the medication, only those participants who have lost ≥10% of their baseline weight and are still on treatment with LIRA 3mg will be offered another 20 weeks on LIRA 3mg. Participants who have not met this weight loss target will have their LIRA 3mg treatment stopped but will still continue in the targeted prescribing pathway but will receive standard care only during the remainder of the study.
  3. rd stopping rule: After the first year of treatment (week 52; ± 14 days), only those participants who have lost ≥15% of their baseline weight and are still on treatment with LIRA 3mg will be offered another 52 weeks on LIRA 3mg. Participants who have not met this weight loss target will have their LIRA 3mg treatment stopped but will still continue in the targeted prescribing pathway but will receive standard care only during the remainder of the study.

Participants who fail to reach the pre-defined weight-loss targets to continue LIRA 3mg treatment, or who choose to stop receiving LIRA 3mg, will continue to be offered the standard care provided by the Tier 3 service. These participants will still attend the Clinical Review Visits but not the additional visits for participants who are still on LIRA 3mg (e.g. Weeks 65 & 91) because these visits will not be relevant to them; visits at Weeks 65 and 91 are intended to provide a new prescription of LIRA 3mg and to discuss adherence and any side effects;; see Appendices 2 & 3).

Participants will remain routinely in the Tier 3 service in-line with NICE guidance throughout the duration of the research study. Participants may be offered treatment options within the duration of the study, including bariatric surgery, as per NICE guidance and according to the decision of the local Tier 3 Multidisciplinary Team. Participants who have undergone bariatric surgery after randomisation will only be included in the intention to treat (ITT) analysis. This decision was made because the proportion of participants undergoing bariatric surgery is likely to be unbalanced between the treatment groups (i.e. more participants in the control group are expected to have bariatric surgery than in the targeted prescribing pathway treatment group), and thus weight loss in these individuals could unduly influence the study results. Participants who have been prescribed and start anti-obesity medication (such as Orlistat) will be ineligible for LIRA 3mg treatment.

Control (Standard Care) Participants in the control group will follow the best medical care provided by the Tier 3 service at the relevant site. This typically involves dietary advice to reduce energy intake (and may include a period of partial or total meal replacement), accompanied - if available - by a physical activity programme, both supported by behavioural change techniques with regular professional contacts. The nature of the standard care will vary between the different Tier 3 services at each site, as this is a pragmatic 'real-world' study. Clinician input will include the medical assessment of participants for severe and complicated obesity and the prescription of anti-obesity drugs (such as Orlistat) as per local Tier 3 service policy. As with the LIRA 3mg group those patients taking antihypertensive or antidepressant medication will be assessed and it will be at the clinician's discretion as to whether these medications are changed. Participants will remain routinely in the Tier 3 service in-line with NICE guidance throughout the duration of the research study. Participants may be offered treatment options within the duration of the study, including bariatric surgery, as per NICE guidance and according to the decision of the local Tier 3 Multidisciplinary Team.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE
  • Obesity
  • Weight Loss
  • Diabetes Mellitus
Intervention  ICMJE
  • Drug: Saxenda
    standard care plus targeted use of Liraglutide (LIRA) 3mg when pre-specified stopping rules for the medication apply. Liraglutide (Saxenda) 6 mg/mL solution for injection in pre-filled pen, administered by subcutaneous injection. Dose escalation to 3.0 mg daily (or maximum tolerated dose)
    Other Name: Liraglutide 3mg
  • Other: Specialist Obesity Management Services
    Specialist Obesity Management Services standard of care
Study Arms  ICMJE
  • Experimental: Targeted Prescribing Pathway (LIRA 3mg + Standard Care)
    Standard care plus targeted use of the intervention Liraglutide (LIRA) 3mg when pre-specified stopping rules for the medication apply
    Interventions:
    • Drug: Saxenda
    • Other: Specialist Obesity Management Services
  • Active Comparator: Standard Care
    standard Tier 3 obesity specialist service care
    Intervention: Other: Specialist Obesity Management Services
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: June 14, 2018)
375
Original Estimated Enrollment  ICMJE
 (submitted: January 25, 2017)
400
Estimated Study Completion Date  ICMJE January 2021
Estimated Primary Completion Date September 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • be aged between 18-75 years old (inclusive)
  • be able to give in informed consent
  • a body mass index ≥35 kg/m2,
  • have been referred to Tier 3 weight management or equivalent service in one of the five participating sites,
  • have a stable body weight (less than 5kg self-reported change during the previous 12 weeks),
  • Participant must be able to meet at least one of the inclusion criteria listed below:

    1. prediabetes (defined as established diagnosis of impaired fasting glycaemia (IFG) from GP and/or established diagnosis of impaired glucose tolerance (IGT) from GP and/or HbA1C 42-47 mmol/mol (6-6.4%) without glucose lowering medications, at a blood test during the last 6 months) and/or
    2. diabetes [defined as established diagnosis of Type II diabetes from GP and/or HbA1C ≥48 mmol/mol (>6.5%) at a blood test during the last 6 months] being treated with any combination of lifestyle, metformin, sulphonylureas or SGLT-2, and/or
    3. hypertension treated (defined as being on antihypertensive treatment with or without a diagnosis of hypertension from GP) or untreated (defined as Systolic Blood Pressure (SBP) ≥140 mmHg at two consecutive visits at the Tier 3 clinic), and/or
    4. obstructive sleep apnoea (on CPAP or established diagnosis of Apnoea Hypopnoea Index ≥15 at sleep studies during the last 12 months)

Exclusion Criteria:

  • Diagnosis of Type 1 diabetes
  • Type 2 diabetes with treatment on DPP-IV or insulin
  • Treatment with GLP-1 receptor agonists at the past
  • Treatment with anti-obesity drugs within the last 12 weeks prior to randomisation
  • eGFR ≤30ml/min/1.73m2 on serum testing over the last 26 weeks
  • Females referred to the clinic because of fertility problem
  • Females of child bearing potential who are pregnant, breast-feeding or intend to become pregnant or are not using or willing to use adequate contraceptive methods
  • Have terminal illness
  • Are not primarily responsible for their own care
  • Not willing or able to give informed consent
  • Unable to understand English
  • Any other significant disease or disorder which in the opinion of the investigator, may either put the participants at risk or may influence the result of the study or the participant's ability to participate
  • Untreated or uncontrolled hypothyroidism/hyperthyroidism defined as thyroid- stimulating hormone >6 mIU/liter or <0.4 mIU/liter
  • Family or personal history of multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid carcinoma (FMTC)
  • Personal history of non-familial medullary thyroid carcinoma
  • History of chronic pancreatitis or idiopathic acute pancreatitis
  • Amylase or lipase levels three times higher than the upper normal range
  • Obesity induced by other endocrinologic disorders (e.g. Cushing's Syndrome)
  • Current or history of treatment with medications that may cause significant weight gain, within 12 weeks prior to screening, including systemic corticosteroids (except for a short course of treatment, i.e. 7−10 days), atypical antipsychotic and mood stabilizers (e.g. clozapine, olanzapine, valproic acid and its derivatives, and lithium)
  • History of major depressive episode during the last 2 years
  • History of initiation of antidepressants during the last 12 weeks
  • Simultaneous participation in other clinical trials of investigational drugs, lifestyle or physical activity interventions.
  • Previous surgical treatment for obesity (excluding liposuction if performed >1 year before trial entry)
  • History of other severe psychiatric disorders
  • History of known or suspected abuse of alcohol and/or narcotics
  • Any lifetime history of a suicidal attempt
  • A history of any suicidal behaviour in the last month prior to randomization.
  • Any suicidal ideation of type 4 or 5 on the Columbian Suicidality Severity Rating Scale (C-SSRS) in the last month prior to randomization
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 75 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Melanie Davies, Prof 0116258 ext 6481 melanie.davies@uhl-tr.nhs.uk
Contact: Emer Brady, Dr 0116258 ext 8959 emer.brady@uhl-tr.nhs.uk
Listed Location Countries  ICMJE Ireland,   United Kingdom
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03036800
Other Study ID Numbers  ICMJE U1111-1189-5726
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party University of Leicester
Study Sponsor  ICMJE University of Leicester
Collaborators  ICMJE Novo Nordisk A/S
Investigators  ICMJE
Principal Investigator: Melanie Davies, Prof Univesrity of Leicester
PRS Account University of Leicester
Verification Date June 2018

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