Outpatient Discharge Therapy With Saxagliptin+MetforminXR vs GlipizideXL for Type 2 Diabetes With Severe Hyperglycemia
Overview[ - collapse ][ - ]
Purpose | Saxagliptin + Metformin XR (S+M) will be effective in stabilizing blood glucose (BG) levels in patients with newly diagnosed type 2 diabetes (T2DM) with severe hyperglycemia (BG levels 300 to 450 mg/dl) and glucose toxicity and with no criteria for inpatient admission or occurrence of severe hypoglycemia compared to glipizide XL. The study may provide preliminary evidence to support the role of S+M as a bridging, stabilizing and safe therapy in patients with severe hyperglycemia |
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Condition | Diabetes Mellitus Type 2 Severe Hyperglycemia - Blood Glucose Level >300mg/dl. |
Intervention | Drug: Glipizide XL Drug: Saxagliptin + Metformin XR Drug: Metformin XR |
Phase | Phase 4 |
Sponsor | John H. Stroger Hospital |
Responsible Party | John H. Stroger Hospital |
ClinicalTrials.gov Identifier | NCT01267448 |
First Received | December 27, 2010 |
Last Updated | April 15, 2011 |
Last verified | December 2010 |
Tracking Information[ + expand ][ + ]
First Received Date | December 27, 2010 |
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Last Updated Date | April 15, 2011 |
Start Date | December 2010 |
Estimated Primary Completion Date | December 2012 |
Current Primary Outcome Measures | The proportion of responders in each arm. Responder: FBG 70-300 and/or PPBG <400 mg/dl (week1-6), FBG 70-250 and/or PPBG <300 mg/dl (week 7-12) and without metabolic exclusion criteria, repeat ED visits, hospitalization or significant hypoglycemia. [Time Frame: 12 weeks] [Designated as safety issue: Yes]Non-responder:1 FBG >300 and/or PPBG >400 mg/dl (week 1-6) and FBG >250 and/or PPBG >300 mg/dl in 4 consecutive readings or more (week 7-12). 2. A single confirmed BG of >450 mg/dl. 3. Significant hypoglycemia: Single episode of hypoglycemia with BG < 50 mg/dl or 2 episodes of BG between 50 and 70 mg/dl within 7 days or any episode of symptomatic hypoglycemia. 4. Persistently positive large ketones in urine and/or electrolyte imbalances. 5. Revisit to ED or admission to hospital because of hypoglycemia or uncontrolled hyperglycemia. |
Current Secondary Outcome Measures |
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Descriptive Information[ + expand ][ + ]
Brief Title | Outpatient Discharge Therapy With Saxagliptin+MetforminXR vs GlipizideXL for Type 2 Diabetes With Severe Hyperglycemia |
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Official Title | A Pilot Study of Outpatient Discharge Therapy With Saxagliptin + Metformin XR or Sulphonylurea for Recently Diagnosed Type 2 Diabetes Presenting With Severe Hyperglycemia |
Brief Summary | Saxagliptin + Metformin XR (S+M) will be effective in stabilizing blood glucose (BG) levels in patients with newly diagnosed type 2 diabetes (T2DM) with severe hyperglycemia (BG levels 300 to 450 mg/dl) and glucose toxicity and with no criteria for inpatient admission or occurrence of severe hypoglycemia compared to glipizide XL. The study may provide preliminary evidence to support the role of S+M as a bridging, stabilizing and safe therapy in patients with severe hyperglycemia |
Detailed Description | There is very little information regarding diabetes discharge regimens for patients with recently diagnosed diabetes (<1 year duration) who present with severe hyperglycemia (blood glucose 300-450 mg/dl) to the ED or other clinical settings and who do not need to be admitted. A combination of Saxagliptin+Metformin XR, could be a potential drug combination to be tested as an initial treatment in these circumstances compared to Glipizide XL which was shown to be effective in our previous study. We expect Saxagliptin to improve beta cell function and decrease glucagon levels as was shown for the DPP-IV class medications and in turn improve blood glucose levels, while Metformin XR may reduce insulin resistance and hepatic glucose output. Such discharge therapy may help to prevent deterioration into acute metabolic complications (DKA or hyperosmolar states) and avoid hospitalization. A high proportion of patients may achieve glycemic targets without significant hypoglycemia as measured by self glucose monitoring and objectively by continuous glucose monitoring system (CGMS). Such an easy regimen may safely bridge the time gap until patients will be seen by their providers. |
Study Type | Interventional |
Study Phase | Phase 4 |
Study Design | Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment |
Condition |
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Intervention | Drug: Glipizide XL The control group will receive Glipizide XL (10mg orally) for a total duration of 12 weeks. Other Names: Glucotrol XLDrug: Saxagliptin + Metformin XR The intervention group will receive Saxagliptin 5 mg daily for a total duration of 12 weeks. Other Names: OnglyzaDrug: Metformin XR The intervention group will receive Metformin XR 1000 mg daily and will be automatically titrated weekly in 2 weeks to Metformin XR 2000 daily for a total duration of 12 weeks. Other Names: Glucophage XR |
Study Arm (s) |
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Recruitment Information[ + expand ][ + ]
Recruitment Status | Recruiting |
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Estimated Enrollment | 100 |
Estimated Completion Date | December 2012 |
Estimated Primary Completion Date | December 2012 |
Eligibility Criteria | Inclusion Criteria: 1. Target Population 1. Subjects recently diagnosed with T2DM (less than 1 year duration) who are either drug naïve or who had not taken oral anti-diabetic agents or insulin for more than 2 weeks. 2. FBG and or RBG > 300mg/dl and < 450mg/dl 2. Age and Sex 1. Men and women aged 18 to 75 years of age. 2. Women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 4 weeks after the last dose of study drug to minimize the risk of pregnancy. WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of HCG) within 72 hours before the start of the investigational product. Exclusion Criteria: 1. Sex and Reproductive Status 1. WOCBP who are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for up to 4 weeks after the last dose of study drug. 2. Women who are pregnant or breastfeeding. 3. Women with a positive pregnancy test. 4. Sexually active fertile men not using effective birth control if their partners are WOCBP. 2. Target Disease Exceptions 1. Type 2 diabetes with weight less than 120 pounds 2. Type 1 diabetes 3. History of diabetic ketoacidosis or hyperosmolar nonketotic coma 3. Medical History and Concurrent Diseases 1. Age >75 years 2. History of congestive heart failure 3. Evidence of an impaired sensorium and/or dementia 4. Current history of alcohol or substance abuse 5. Patients with any acute or active chronic medical illness 4. Physical and Laboratory Test Findings 1. FBG and /or RGB < 300 mg/dl or >450 mg/dl 2. Unstable vitals signs (temperature >101 degrees Fahrenheit, systolic blood pressure <90 or >180 mmhg, diastolic blood pressure <60 or >110 mmhg, heart rate <60 or >120 beats/minute) 3. Electrolyte imbalances (serum bicarbonate level <20 mEq/L, serum sodium <125 or >150 mEq/L, serum potassium <3.5 or >5.5 mEq/L), serum creatinine more than 1.5 in males and 1.4 in females, creatinine clearance less than 60ml/min, liver enzymes 3 times above upper limit of normal range. 4. HbA1c > 12% (based on our previous study (4) patients with HbA1c of >12 had a high rate of non-responders) 5. Liver enzymes 3 times above upper limit of normal range. 6. Allergies and Adverse Drug Reactions -Subjects with a history of any serious hypersensitivity reaction to saxagliptin, glipizide or metformin XR. 5. Prohibited Treatments and/or Therapies a)Treatment with systemic cytochrome P450 3A4 (CYP 3A4) inhibitors. 6. Other Exclusion Criteria 1. Prisoners or subjects who are involuntarily incarcerated. 2. Subjects who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness. |
Gender | Both |
Ages | 18 Years |
Accepts Healthy Volunteers | No |
Contacts | Not Provided |
Location Countries | United States |
Administrative Information[ + expand ][ + ]
NCT Number | NCT01267448 |
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Other Study ID Numbers | IRB-10-182 |
Has Data Monitoring Committee | Yes |
Information Provided By | John H. Stroger Hospital |
Study Sponsor | John H. Stroger Hospital |
Collaborators | Bristol-Myers Squibb |
Investigators | Principal Investigator: Ambika Babu, MD,MS John H Stroger Hospital of Cook County |
Verification Date | December 2010 |
Locations[ + expand ][ + ]
John Stroger Hospital of Cook County | Chicago, Illinois, United States, 60612 Contact: Ambika Babu, M.D. | 312-864-0543 | Ambika_Babu@rush.eduPrincipal Investigator: Ambika Babu, M.D. Not yet recruiting |
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John Stroger Hospital of Cook County | Chicago, Illinois, United States, 60612 Contact: Ambika Babu, M.D. | 312-864-0543 | aamblee@hotmail.comPrincipal Investigator: Ambika Babu, M.D. Recruiting |