Effects of Sitagliptin in Relatives of T1D Patients

NCT05219409 | Not Yet Recruiting Phase 2 FDA Drug FDA Device

• 1 other identifier: 01/2022
• Study Type: interventional
• Target: 70
• Locations: 1 country
• Sites: 1

Brief Summary

Type 1 Diabetes (T1D) is a chronic autoimmune disease, with a genetic background, resulting from the immune-mediated destruction of beta cells of the pancreas. It can lead to fatal short-term and long-term complications, especially if it is diagnosed late. Three stages of the disease can be identified: Stage 1 is defined by the presence of two or more anti-islet autoantibodies (GAD65, ICA, IA-2, ZnT8) with normoglycemia, Stage 2 shows progression to dysglycemia (impaired glucose tolerance) in the setting of two or more anti-islet autoantibodies, Stage 3 occurs when a patient meets ADA criteria for the diagnosis of diabetes. It's been demonstrated that Teplizumab (an Fc receptor nonbinding anti-CD3 monoclonal antibody) delays the transition from pre-symptomatic T1D (stage 2) to overt T1D (stage 3). Also Sitagliptin, a DPP4 inhibitor, has been proved effective in inhibiting inflammation in T1D both in vitro in T1D mice, and in vivo in Latent autoimmune diabetes in adults (LADA) patients. Furthermore, it has been confirmed that Sitagliptin reduces the prevalence of worse forms of acute GVHD after myeloablative allogeneic hematopoietic stem-cell transplantation. The study aims to investigate if Sitagliptin can have a delaying effect on progression to overt T1D, on the account of its anti-inflammatory properties. The cohort is made of screened relatives of T1D patients, who are classified as high-risk of developing T1D. Screening relatives of T1D patients for dysglycemia and anti-islet autoantibodies. Selecting the patients in Stage 2 Pre-symptomatic T1D (dysglycemia and at least two types of autoantibodies) and then beginning therapy with Sitagliptin, while monitoring their glucose metabolism with a Continuous Glucose Monitoring (CGM) system.

Conditions

Type 1 Diabetes

Keywords

Sitagliptin

Outcome Measures

Primary Outcomes (1)

• Rate of new diagnoses of Type 1 Diabetes Mellitus per year

  3 years

Secondary Outcomes (1)

• Number of participants with adverse effects on Sitagliptin

  3 years

Other Outcomes (3)

• To study the effects of Sitagliptin on metabolic markers (C-peptide, OGTT, Insulin) over time up to the diagnosis of diabetes

  3 years

• To study the prevalence of T1D, T1D-related Auto-antibodies and Dysglycemia in relatives of T1D patients

  3 years

• Monitor Stage 2 patients with a CGM system (continuous blood glucose detection)

  3 years

Study Arms (2)

Treatment group

ACTIVE COMPARATOR

Sitagliptin

Drug: Sitagliptin; Device: Professional CGM

Control group

PLACEBO COMPARATOR

Placebo

Device: Professional CGM

Interventions

Sitagliptin DRUG

The dose of sitagliptin will be established on the basis of the estimated glomerular filtrate: 100 mg in single daily administration (estimated glomerular filtration rate less than or equal to 45 mL / min / 1.73 m2) or 50 mg (estimated glomerular filtration rate 30-45 mL / min / 1.73 m2)

Treatment group

Professional CGM DEVICE

The sensor records the patient's glucose readings every 15 minutes for up to 14 days.

Control group; Treatment group

Eligibility Criteria

• Age: 10 Years - 45 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• Age of the subject between 10 and 45 years
• Subject (or legal guardian in the case of a minor) is able to provide informed consent
• If a first degree relative of the proband with T1D must be between 6 and 45 years old (brother, sister, parent, child)
• If a relative of the proband with T1D is second degree, he must be between 6 and 20 years old (nephew, uncle, aunt, grandfather, grandmother, cousin)
• Presence of at least two autoantibodies associated with diabetes
• Impaired glucose tolerance on the OGTT test (fasting glucose greater than 110 mg/dl but less than 126 mg/dl or 2-hour glucose greater than or equal to 140 mg/dl but less than 200 mg/dl or 'OGTT at 30', 60 ', 90' greater than or equal to 200 mg/dl)
• If the subject is a female with reproductive potential, she must have a negative pregnancy test at the enrollment visit and must agree not to seek pregnancy for at least one year from randomization
• If the subject is male, he must agree not to seek pregnancies with any partner for at least one year from the randomization
• The subject must agree to renounce other types of trials during this study
• Weight at the time of recruitment of at least 26 kg
• It must be favorable and clinically acceptable to postpone vaccinations with live and attenuated agents for at least one year after treatment

You may not qualify if:

• Type 1 Diabetes Mellitus previously diagnosed or diagnosed during screening investigations
• Serological evidence of current or past HIV, Hepatitis C, Hepatitis B
• Changes in blood counts, INR or liver enzymes
• Being pregnant or breastfeeding
• Evidence of pancreatic changes in the laboratory
• Having undergone a previous experimental treatment for Type 1 Diabetes Mellitus
• Chronic Renal Failure stage IIIa onwards (eGFR \<45 ml / min / 1.7 m2)
• History of previous pancreatitis
• Lymphopenia (\<1000 lymphocytes / µL)
• Neutropenia (\<1500 PMN / µL)
• Thrombocytopenia (\<150,000 platelets / µL)
• Anemia (Hgb \<10 grams / deciliter \[g / dL\])
• AST or ALT\> 1.5 x ULN
• Total bilirubin\> 1.5 x upper limit of normal (ULN) with the exception of subjects diagnosed with Gilbert's syndrome who may be eligible provided they have no other cause leading to hyperbilirubinemia
• INR\> 0.1 above the upper limit of the norm at the laboratory of the participating center

Sponsors & Collaborators

• University of Milan: lead

Study Sites (1)

ASST FBF Sacco

Milan, 20157, Italy

Location

Related Publications (16)

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Related Links

• Related Info

MeSH Terms

Conditions

Diabetes Mellitus, Type 1

Interventions

Sitagliptin Phosphate

Condition Hierarchy (Ancestors)

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

Intervention Hierarchy (Ancestors)

Triazoles; Azoles; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Pyrazines

Study Design

• Study Type: interventional
• Phase: phase 2
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: A randomized controlled open label intervention study is proposed. Relatives of patients with type 1 diabetes in stage 2 will be included in the study and divided into two groups by randomization: sitagliptin add-on therapy vs placebo(group of control)

Study Record Dates

• First Submitted: January 20, 2022
• First Posted: February 2, 2022
• Study Start: July 1, 2023
• Primary Completion: December 1, 2025
• Study Completion (Estimated): December 1, 2027
• Last Updated: May 10, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

IT (1)