Randomized Controlled Trial of Insulin Versus Tablets for Latent Autoimmune Diabetes in Adults (LADA)

NCT00776607 | Unknown DMC

• 3 other identifiers: 2006-004662-14ISRCTN6381512107/MRE09/8
• Study Type: interventional
• Target: 200
• Locations: 1 country
• Sites: 2

Brief Summary

Background: Latent autoimmune diabetes in adults \[LADA\] is a type 1 diabetes that is slowly developing. This means many people are treated as having type 2 diabetes at diagnosis as they are adults who are not immediately insulin dependent. LADA can be distinguished from type 2 diabetes by antibody tests. Patients who are antibody positive have an autoimmune reaction which is similar to that of type 1 diabetes and is not found in type 2 diabetes. We would like to examine the best way of treating LADA in the early phase of the conditions, with tablets (similar to type 2 diabetes) or with insulin (similar to type 1 diabetes). Methods/Design: This is an open parallel group prospective randomised trial. Participants need to have a GAD antibody test results of 101 WHO units or more and a diagnosis of diabetes not requiring insulin at diagnosis. Participants will need to have been diagnosed within 12 months and not treated with insulin at study entry. They will be randomised to receive either insulin (NovoMix 30) or tablets (diet treated followed by metformin followed by glitazone (with or without metformin) followed by insulin). Primary outcome assessment will be for change in HbA1c and change in fasting C-peptide over 24 months. Secondary outcome measures will include Quality of life, GAD antibody levels, adverse events, inflammatory markers, insulin resistance, and markers of the metabolic syndrome. Discussion: This study seeks the best treatment for early LADA in terms of maintaining glycaemic control and maintaining natural insulin production.

Conditions

Latent Autoimmune Diabetes in Adults LADA

Keywords

LADA; Latent autoimmune diabetes in adults; Type 1.5; Slowly progressive type 1 diabetes

Outcome Measures

Primary Outcomes (1)

• Change in fasting serum C-peptide level over 24 months and (2) change in HbA1c level over 24 months in patients with LADA.

  24 months

Secondary Outcomes (1)

• Hypoglycaemic events

  24 months

Study Arms (2)

Insulin

EXPERIMENTAL

Insulin: NovoMix 30. Patients will be given advice on diet and exercise and life style and will be started on NovoMix 30, one dose of 6 U at the evening/main meal.

Drug: NovoMix 30

Tablet

ACTIVE COMPARATOR

Patients will progress from lifestyle modification to metformin, to metformin with Rosiglitazone and finally insulin depending on HbA1c levels.

Drug: Tablet treatment

Interventions

NovoMix 30 DRUG

Insulin arm: Patients will be given advice on diet and exercise and life style and will be started on NovoMix 30, one dose of 6 U at the evening/main meal. Dose will be adjusted in increments of 2-6U depending on fasting glucose level When total dose equals 16 U patient will be started on 4 units with breakfast and continue with 16 units with evening meal. Breakfast and/or evening meal dose will be adjusted where necessary at increments of 2-6 U depending on fasting and/or pre-evening meal glucose level. Patient needs to keep a daily diary of insulin doses taken.

Insulin

Tablet treatment DRUG

Step 1: Lifestyle modification. If HbA1c at 7%+ or if on metformin/sulphonylurea go to step 2. Step 2: Glucophage. If HbA1c of 7%-7.5% give 500mg x 1 per day. If HbA1c 7.6%-8.0%, week 1 - 500mg x 1 day and then 500mg x 2 day. If HbA1c 8.0%+ then 500mg x 3 per day (Titrated). If HbA1c remains 7%+ give additional tablet until 2gms per day then progress to Step 3. Step 3: Rosiglitazone. HbA1c of 7%+ give 4 mg per day. If HbA1c remains 7%+ titrate to maximal dose 4 mg twice daily +/-Metformin. If HbA1c remains 7% + for an 3 months move to step 4. Before initiation of Rosiglitazone repeat medical history with special emphasis on cardiovascular disease, if patient has a history of CVD move to Step 4 (insulin). Any adverse events suggestive of heart disease move to step 4. Step 4: Insulin (oral agents will be stopped). Initiation of insulin will the same as for the insulin arm and will follow the protocol detailed in the Insulin arm.

Tablet

Eligibility Criteria

• Age: 18 Years - 90 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Male, non-fertile female (i.e., post menopausal, post hysterectomy, or sterilized by tubal ligation) or female of childbearing potential using a medically approved birth control method.
• The patient has a diagnosis of diabetes mellitus according to WHO classification.
• The patient has a positive GAD antibody test of 101 WHO units or more on two separate occasions.
• Age 18 +
• The patient did not start on insulin within 1 month of diagnosis
• Written informed consent to participate in the study.
• Ability to comply with all study requirements.

You may not qualify if:

• Pregnant or breast-feeding females and females who plan pregnancy or breast-feeding during the course of the study.
• A history of:
• Diabetes that is a result of pancreatic injury, or secondary forms of diabetes, e.g., Cushing's syndrome and acromegaly.
• Acute metabolic diabetic complications such as ketoacidosis or hyperosmolar state (coma) within the past 6 months
• Acute infections, which may affect blood glucose control within 4 weeks prior to visit 1.
• Malignancy including leukaemia and lymphoma (not including basal cell skin cancer) within the last 5 years.
• The patient has a known immune deficiency from any disease, or a condition associated with an immune deficiency.
• The patient is receiving immunosuppressive or immunomodulating agents or cytotoxic therapy, or any medication that, in the opinion of the site investigator, might interfere with the study.
• Any of the following significant laboratory abnormalities:
• Patients with severe renal failure as defined previous renal transplant or currently having renal dialysis or GFR \<30.
• Clinically significant laboratory abnormalities, confirmed by repeat measurement, that may interfere with the assessment of safety and/or efficacy of the study drug, other than hyperglycemia and glycosuria at visit 1.
• Severe ketonuria (+++ on urine sticks testing; ++ on repeated urine sticks testing).
• The patient is a known or suspected drug abuser.
• The patient has chronic hepatitis or liver cirrhosis, or any other chronic liver disease.
• The patient is known to test positive for hepatitis B antigens or hepatitis C antibodies

Sponsors & Collaborators

• Abertawe Bro Morgannwg University NHS Trust: lead
• Novo Nordisk A/S: collaborator

Study Sites (2)

Diabetes Unit

Cardiff, Wales, CF64 2XX, United Kingdom

NOT YET RECRUITING

Clinical Research Unit

Swansea, Wales, SA6 6NL, United Kingdom

RECRUITING

Related Publications (1)

• Brophy S, Davies H, Bain S, Stephens JW, Cheung WY, Richards K, Wareham K, Beaverstock C, Lloyd J, Page D, Williams M, Russell I, Williams R. Randomized, controlled, parallel-group prospective study to investigate the clinical effectiveness of early insulin treatment in patients with latent autoimmune diabetes in adults. BMC Endocr Disord. 2008 Jul 24;8:8. doi: 10.1186/1472-6823-8-8.

  PMID: 18652676 BACKGROUND

MeSH Terms

Conditions

Latent Autoimmune Diabetes in Adults

Interventions

insulin aspart, insulin aspart protamine drug combination 30:70

Condition Hierarchy (Ancestors)

Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Autoimmune Diseases; Immune System Diseases

Study Officials

• Sinead Brophy

  Swansea University

  PRINCIPAL INVESTIGATOR

• Stephen Bain

  Swansea University

  STUDY DIRECTOR

Central Study Contacts

Sinead Brophy

CONTACT

00 44 1792 602058; s.brophy@swansea.ac.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER GOV

Study Record Dates

• First Submitted: October 20, 2008
• First Posted: October 21, 2008
• Study Start: April 1, 2007
• Primary Completion: April 1, 2011
• Study Completion: April 1, 2011
• Last Updated: October 21, 2008

Record last verified: 2008-09

Locations

GB (2)