The Effects of Exenatide on Post-Prandial Glucose Excursions and Vascular Health in Obese/Pre-Diabetic Young Adults
试验速览
- 阶段
- 4 期
- 状态
- 撤回
- 主要终点
- Whether treatment with exenatide attenuates post-prandial glycemic excursions as assessed by oral glucose tolerance testing (OGTT) and continuous monitoring system (CGMS) technology.
研究概览
简要总结
The primary aim of this study is to evaluate the effect of exenatide on daily glycemic excursions obtained by continuous glucose monitoring system (CGMS). The CGMS summary parameters that we are most interested in include:
- The percent of glucose values above 140 mg/dl and/or AUC of glucose values above 140 mg/dl
- AUC of glucose values over 100 mg/dl during three days
- Maximal meal-related glucose excursions
- Three-day mean glucose (including low readings - below 100 mg/dl)
Secondary Study Endpoints:
Secondary endpoints will include:
- glucose tolerance status as assessed by OGTT
- Vascular function scores as assessed by PAT, FMD and step test.
- Biochemical markers of vascular health, including inflammatory markers, markers of oxidative stress and microalbuminuria.
- Changes in BMI
详细描述
Obese insulin resistant adolescents with impaired glucose tolerance (IGT) or evidence of glucose excursions ≥ 140 mg/dl on CGMS will be enrolled in a two armed randomized, parallel group - open label study. There will also be a lean control group for baseline assessments only.
One arm will be exenatide the other arm will be no drug. Subjects will be stratified according to state of glucose tolerance. Stratification will also occur according to gender and family history of premature cardiovascular disease.
Obese adolescents age 16-25 years with a family history of type 2 diabetes, whom have completed or reached tanner IV stage of pubertal development and have normal or impaired oral glucose tolerance. Obese adolescents age 13-15 with a family history of type 2 diabetes, whom have completed or reached tanner III stage of pubertal development and have impaired oral glucose tolerance with a 2-hour glucose of 180-199 mg/dl will also be invited to participate. For cardiovascular assessment only age matched lean control subjects without diabetes will be recruited.
Obese subjects will have a baseline and post intervention oral glucose tolerance test (OGTT), screening labs (liver/kidney functions, lipid profile, thyroid function tests, CBC, metabolic and cardiovascular laboratory parameters -- such as inflammatory cytokines and pro-thrombotic factors), wear a CGMS for 3-days on 3 separate occasions (baseline, 2-month and 4-month), have a standardized snack once during each CGMS session, collect urine samples for microalbumin and have vascular tests (PAT, FMD and exercise step test) done at baseline and post intervention.
Subjects randomized to treatment will undergo a four month intervention with exenatide on the following dosing schedule: exenatide - 5 μg twice a day for 7 days, followed by exenatide 10 μg twice a day for the remainder of the four month intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 13 Years 至 25 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Obesity (BMI > 97%tile for age and sex matched normative data)
- •Insulin resistance: fasting insulin> 25 mIU/ml
- •Good general health, taking no medication on a chronic basis
- •Age 16-25 yrs, late pubertal stage (girls: breast: Tanner stage IV to V, boys: testicular volume > 15 ml) or age 13-15 yrs (with a family history of type 2 diabetes, whom have completed or reached tanner stage III and have impaired oral glucose tolerance with a 2-hour glucose of 180-199 mg/dl)
- •Girls who are sexually active must use adequate birth control methods (such as barrier method or oral contraception) and must have a negative pregnancy test
- •Normal liver function tests
排除标准
- •Hx of gallstones
- •Elevated triglycerides >400 mg/dl
- •Hx of alcohol use/ binge drinking
- •Raynaud's syndrome
- •Pregnancy or breastfeeding mothers
- •Cigarette smokers
- •Anemia (Hct < 35)
- •Baseline creatinine > 1.0 mg
- •Abnormal liver transaminases > 2.0 X the upper limit of normal
- •Presence of endocrinopathies except for adequately treated hypothyroidism
- •Presence or history of gastrointestinal disorders (inflammatory bowl disease, irritable bowl disease, hernia, ileus)
- •Presence of significant chronic illness of any kind.
- •Use of any drugs that might be expected to affect glucose tolerance, insulin resistance or weight gain, cardiovascular health.
- •Psychiatric disorders
- •History of substance abuse
- •Lean Control Subjects (only for cardiovascular studies and CGMS):
- •Inclusion Criteria:
- •Lean (BMI < 85%tile for age and sex matched normative data)
- •Fasting insulin <15 mIU/m
- •Fasting glucose <100 mg/dll
- •Excellent general health, having no acute or chronic health problems and taking no current medications
- •Age 13-25 yrs, in puberty (age matched with obese subjects)
- •Girls who are sexually active must use adequate birth control methods (such as barrier method or oral contraception) and must have a negative pregnancy test
- •Exclusion Criteria:
- •Raynaud's syndrome
- •Pregnancy or breastfeeding mothers
- •Cigarette smokers
- •Psychiatric disorders
- •History of substance abuse
- •First degree relative with either T1DM or T2DM
- •Presence of acanthosis nigricans
研究组 & 干预措施
Exenatide
Subjects randomized to treatment will receive a four month supply of exenatide.
干预措施: Exenatide (Drug)
结局指标
主要结局
Whether treatment with exenatide attenuates post-prandial glycemic excursions as assessed by oral glucose tolerance testing (OGTT) and continuous monitoring system (CGMS) technology.
时间窗: OGTT (Pre- and post-intervention), CGMS (Pre-intervention, 2-months and post-intervention)
次要结局
- Cardiovascular risk parameters will be assessed via flow mediated vasodilation, peripheral arterial tonometry, a self-paced step test and biochemical markers of vascular health.(Pre- (baseline) and post- (4-months) intervention)
- Change in body mass index (BMI).(Pre-intervention, 2-month and post-intervention.)