Metformin and Transient Hyperglycemia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01486043
Recruitment Status : Terminated (The research project was terminated due to lower than projected patient recruitment within the period of time allowed for the study.)
First Posted : December 6, 2011
Results First Posted : January 30, 2015
Last Update Posted : January 30, 2015
Information provided by (Responsible Party):
Dr. Jamie R. Wood, Children's Hospital Los Angeles

Brief Summary:
The purpose of this study is to determine whether metformin is an effective adjunctive treatment for transient hyperglycemia in patients with acute lymphoblastic leukemia (ALL) undergoing induction chemotherapy

Condition or disease Intervention/treatment Phase
Acute Lymphoblastic Leukemia Hyperglycemia Insulin Resistance Diabetes Mellitus Drug: Metformin Not Applicable

Detailed Description:

ALL is the most common childhood cancer, representing one fourth of all cancers diagnosed under the age of 15 years. One of the most common side effects of ALL chemotherapy is transient hyperglycemia. Patients that develop this complication require treatment with insulin via injections to prevent severe medical complications such as dehydration, weight loss, ketoacidosis and life-threatening infections. Although insulin therapy is effective, it adds a lot of physical and psychological burden to patients because multiple daily insulin injections are required to achieve adequate blood glucose control.

In this pilot study, investigators aim to examine the effectiveness of metformin as an adjunctive treatment for transient hyperglycemia. Investigators will be comparing two groups of subjects (up to 40 subjects per group). Patients in the treatment group will be prospectively recruited, and they will be treated with metformin in addition to insulin therapy. Investigators will compare the treatment group to a historical control group acquired via chart review. These patients will have been treated with insulin alone.

Statistical comparison will be made between the two groups in terms of the length of insulin treatment, the total daily dose of insulin required, number of insulin injections, hemoglobin A1c level (measure of glycemic control over preceding 8- 12 weeks), and fructosamine level (measure of glycemic control over preceding 2-3 weeks).

Investigators hypothesize that the use of metformin will result in fewer numbers of insulin injections and fewer days of insulin therapy.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 4 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Metformin as an Adjunctive Therapy For Transient Hyperglycemia in Patients With Acute Lymphoblastic Leukemia During Induction Chemotherapy
Study Start Date : December 2011
Actual Primary Completion Date : May 2013
Actual Study Completion Date : May 2013

Arm Intervention/treatment
Experimental: Metformin and insulin therapy
Up to 30-40 patients will be in the prospectively recruited treatment group, which will receive both metformin and insulin therapy for transient hyperglycemia
Drug: Metformin
All subjects will be started on metformin 500 mg orally twice daily. The dose will be increased by 500 mg weekly as tolerated until subjects' blood glucoses are well controlled or until the patient reaches metformin 1000 mg PO BID.
Other Name: Glucophage, Metformin HCl

Primary Outcome Measures :
  1. Length of Insulin Therapy (Days) [ Time Frame: During the 30 days of induction chemotherapy (plus or minus 2 weeks) ]

Secondary Outcome Measures :
  1. Serum Fructosamine Level [ Time Frame: At 1 month ]
  2. Hemoglobin A1c [ Time Frame: At 1 month ]

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Ages Eligible for Study:   10 Years to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • ALL patients on induction chemotherapy who develop transient hyperglycemia(definition of transient hyperglycemia: random blood glucose > 200 mg/dL x 2)
  • Adequate renal function (serum Cr < 1.5 mg/dL in males, < 1.2 mg/dL in females)
  • Adequate hepatic function (AST < 5x upper limit of normal)

Exclusion Criteria:

  • Patients with known diagnosis of diabetes or those that are already on oral hypoglycemic agents or insulin
  • Allergy to metformin or any component of the formulation
  • Patients with pancreatitis (lipase level > 300 Units/L)
  • Patients with active infection (positive blood culture within 48 hours of study registration)
  • Patients with hemodynamic instability (PICU status, need for vasopressors within 48 hours of study entry)
  • Elevated hemoglobin A1c (greater than 6.0%)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01486043

United States, California
Children's Hospital Los Angeles
Los Angeles, California, United States, 90027
Sponsors and Collaborators
Children's Hospital Los Angeles
Principal Investigator: Jamie R Wood, M.D. Children's Hospital Los Angeles

Responsible Party: Dr. Jamie R. Wood, Assistant Professor of Clinical Pediatrics; Director of Clinical Diabetes Programs at Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Children's Hospital Los Angeles Identifier: NCT01486043     History of Changes
Other Study ID Numbers: CCI-11-00295
First Posted: December 6, 2011    Key Record Dates
Results First Posted: January 30, 2015
Last Update Posted: January 30, 2015
Last Verified: January 2015

Keywords provided by Dr. Jamie R. Wood, Children's Hospital Los Angeles:
Induction chemotherapy
Transient hyperglycemia
Acute lymphoblastic leukemia
Insulin resistance

Additional relevant MeSH terms:
Diabetes Mellitus
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Leukemia, Lymphoid
Insulin Resistance
Neoplasms by Histologic Type
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Lymphoproliferative Disorders
Lymphatic Diseases
Immunoproliferative Disorders
Immune System Diseases
Insulin, Globin Zinc
Hypoglycemic Agents
Physiological Effects of Drugs