PERL Continuous Glucose Monitoring (CGM) Study
- Conditions
- Diabetic Nephropathies
- Interventions
- Other: Mean blood glucoseOther: Blood glucose CVOther: % time 70-180 mg/dLOther: % time below 54 mg/dLOther: % time above 180 mg/dLOther: % time above 250 mg/dLOther: MAGE (Mean amplitude of glucose excursions)Other: LBGI (Low Blood Glucose Index)Other: HBGI (High Blood Glucose Index)Drug: PlaceboDrug: Allopurinol
- Registration Number
- NCT03334318
- Lead Sponsor
- Joslin Diabetes Center
- Brief Summary
Seven-point capillary profiles have shown that mean glucose correlates with both diabetic retinopathy and nephropathy risk. However, there remains great controversy as to whether the degree of variability around mean glucose may also contribute to these microvascular complications. The PERL trial (NCT02017171), testing whether treatment with allopurinol can slow down kidney function loss in type 1 diabetes, provides a unique opportunity to assess the role of glycemic variability in the progression of diabetic kidney disease in individuals who already have mild to moderate kidney disease. By applying Continuous Glucose Monitoring (CGM) in the PERL Study population, the investigators will be able to better understand how metrics of glycemia (mean, time above and below range, and various measures of variability) are associated with renal outcomes in the PERL population as a whole, but also in important subgroups (e.g., albuminuric vs. normoalbuminuric subjects with ongoing GFR decline, allopurinol vs. placebo arms). The nvestigators also aim to obtain precise information on the range of blood glucose corresponding to any given HbA1c value in this population since previous studies generally excluded patients with renal disease.
- Detailed Description
Participants who consent to the study will have an Abbott Freestyle Libre Pro sensor placed on the back of their upper arm at their first PERL visit after this ancillary study has begun and at all subsequent PERL Visits. The sensor will be continuously worn by participants for 14 days. At the end of the 14 days, the sensor will be removed and mailed by the participant to the Coordinating center. Since subjects are at various stages of the PERL protocol, the number of remaining visits at which the CGM will be applied will vary among subjects.
STUDY AIMS
1. To assess the effect of glycemic variability, as measured by the coefficient of variation of CGM glucose (CV, the ratio of standard deviation and the mean of CGM glucose values), on the PERL renal functional endpoint (iohexol GFR at the end of study).
2. To assess the effect of other glycemic parameters measured by CGM (mean glucose, % time 70-180 mg/dL, % time below 54 mg/dL, % time below 70 mg/dL, % time above 180 mg/dL, % time above 250 mg/dL, mean amplitude of glucose excursions \[MAGE\], low blood glucose index \[LBGI\], high blood glucose index \[HBGI\]) on the PERL renal functional endpoint.
3. To assess the relationship between CGM-measured glycemic parameters and HbA1c at various levels of renal function.
4. To compare the effects of CGM metrics on the PERL renal endpoint and the corresponding effect of HbA1c.
5. To assess the effect of allopurinol treatment on all of the different glycemic metrics including HbA1c, CV, etc. and on their association with the PERL renal endpoint.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 175
• Being an active participant in the PERL clinical trial
- Having completed PERL Visit 16
- Pregnancy
- History of skin reactions in relation to the application of Abbott Freestyle Libre Pro
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Placebo-treated % time below 54 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated % time above 180 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated % time above 250 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated MAGE (Mean amplitude of glucose excursions) Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated LBGI (Low Blood Glucose Index) Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated HBGI (High Blood Glucose Index) Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Allopurinol-treated Mean blood glucose Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Placebo-treated Placebo Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Allopurinol-treated Blood glucose CV Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated % time 70-180 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated % time below 54 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated % time above 180 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated % time above 250 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated MAGE (Mean amplitude of glucose excursions) Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Placebo-treated Mean blood glucose Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated Blood glucose CV Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Placebo-treated % time 70-180 mg/dL Participants in the PERL Clinical Trial (NCT02017171) randomized to placebo Allopurinol-treated LBGI (Low Blood Glucose Index) Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated HBGI (High Blood Glucose Index) Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol Allopurinol-treated Allopurinol Participants in the PERL Clinical Trial (NCT02017171) randomized to allopurinol
- Primary Outcome Measures
Name Time Method iGFR at the end of the PERL trial Week 164 of the PERL trial Glomerular filtration rate (GFR) at the end of the PERL trial, measured by the plasma clearance of non-radioactive iohexol (iGFR) and adjusted for the iGFR at baseline.
- Secondary Outcome Measures
Name Time Method HbA1c at week 142 of the PERL trial Week 142 of the PERL Trial Hba1c value at week 142 of the PERL trial
HbA1c at week 80 of the PERL trial Week 80 of the PERL Trial Hba1c value at week 80 of the PERL trial
HbA1c at week 96 of the PERL trial Week 96 of the PERL Trial Hba1c value at week 96 of the PERL trial
HbA1c at week 112 of the PERL trial Week 112 of the PERL Trial Hba1c value at week 112 of the PERL trial
HbA1c at week 128 of the PERL trial Week 128 of the PERL Trial Hba1c value at week 128 of the PERL trial
% time above 250 mg/dL From week 80 to week 164 of the PERL trial Percentage of time with blood glucose above 250 mg/dL (as measured by continuous glucose monitoring)
HbA1c at week 156 of the PERL trial Week 156 of the PERL Trial Hba1c value at week 156 of the PERL trial
HbA1c at week 164 of the PERL trial Week 164 of the PERL Trial Hba1c value at week 164 of the PERL trial
Mean blood glucose From week 80 to week 164 of the PERL trial Mean of blood glucose values measured by continuous glucose monitoring
CV (coefficient of variation) of blood glucose From week 80 to week 164 of the PERL trial Coefficient of variation of blood glucose values measured by continuous glucose monitoring
% time 70-180 mg/dL From week 80 to week 164 of the PERL trial Percentage of time with blood glucose in the 70-180 mg/dL range (as measured by continuous glucose monitoring)
% time below 54 mg/dL From week 80 to week 164 of the PERL trial Percentage of time with blood glucose below 54 mg/dL (as measured by continuous glucose monitoring)
% time above 180 mg/dL From week 80 to week 164 of the PERL trial Percentage of time with blood glucose above 180 mg/dL (as measured by continuous glucose monitoring)
MAGE (Mean amplitude of glucose excursions) From week 80 to week 164 of the PERL trial Mean amplitude of glucose excursions as measured by continuous glucose monitoring
LBGI (Low blood glucose index) From week 80 to week 164 of the PERL trial Low blood glucose index based on blood glucose values measured by continuous glucose monitoring
HBGI (High blood glucose index) From week 80 to week 164 of the PERL trial High blood glucose index based on blood glucose values measured by continuous glucose monitoring
Trial Locations
- Locations (19)
ICAHN School of Medicine at Mount Sinai
🇺🇸New York, New York, United States
Washington University
🇺🇸Saint Louis, Missouri, United States
Unversity of Calgary
🇨🇦Calgary, Alberta, Canada
Barbara Davis Center / University of Colorado Denver
🇺🇸Aurora, Colorado, United States
Northwestern University Feinberg School of Medicine
🇺🇸Chicago, Illinois, United States
Emory University - Grady Memorial Hospital
🇺🇸Atlanta, Georgia, United States
Brehm Center for Diabetes Research / University of Michigan
🇺🇸Ann Arbor, Michigan, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
University of Minnesota
🇺🇸Minneapolis, Minnesota, United States
SUNY Upstate Medical University
🇺🇸Syracuse, New York, United States
UT Southwestern Dallas
🇺🇸Dallas, Texas, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
University of Washington
🇺🇸Seattle, Washington, United States
University of Toronto
🇨🇦Toronto, Ontario, Canada
Joslin Diabetes Center
🇺🇸Boston, Massachusetts, United States
BC Diabetes
🇨🇦Vancouver, British Columbia, Canada
Providence Sacred Heart Medical Center
🇺🇸Spokane, Washington, United States
Albert Einstein College of Medicine / Montefiore Medical Center
🇺🇸Bronx, New York, United States
University of Alberta
🇨🇦Edmonton, Alberta, Canada