Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes (PRISM) in Chinese Patients With Young Onset Diabetes
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 884
- 试验地点
- 1
- 主要终点
- Prevalence of C-Peptide (CP) and Glutamic Acid Decarboxylase Antibody (GADA) in Chinese adult patients with T2D (Part 1 of study)
研究概览
简要总结
Patients with young onset diabetes (YOD) are one of the most challenging groups of patients due to their long disease duration, complex causes, delayed interventions, psychosocial stress, poor adherence and frequent default. The investigator's previous studies indicate that provision of biogenetic information improved satisfaction, reduced ambiguity and improved self-efficacy in patients with T2D. Provision of personalized information using the web-based Joint Asia Diabetes Evaluation (JADE) Technology with risk stratification and decision support empowers better self care and medical intervention with improved control of risk factors. To further improve the precision of diagnosis for individualizing care, the use of CP, GADA, genetic risk scores (GRS) or rare genetic variants of maturity onset of diabetes (MODY) can help doctors select the most appropriate therapy in a timely manner. While patients with low CP, GADA and high GRS will benefit from early insulin therapy, some MODY variants are associated with good response to insulin-releasing oral drugs (e.g. sulphonylurea) which may spare the use of insulin with reduced patient distress and over-insulinization. By contrast, patients with high CP often due to obesity-associated insulin resistance should undergo intensive lifestyle modification and use of drugs with weight-reducing or neutral effects to avoid weight gain due to excessive dose of insulin.
详细描述
Patients with young onset diabetes (YOD) are one of the most challenging groups of patients due to their long disease duration, complex causes, delayed interventions, psychosocial stress, poor adherence and frequent default. The investigator's previous studies indicate that provision of biogenetic information improved satisfaction, reduced ambiguity and improved self-efficacy in patients with T2D. Provision of personalized information using the web-based Joint Asia Diabetes Evaluation (JADE) Technology with risk stratification and decision support empowers better self care and medical intervention with improved control of risk factors. To further improve the precision of diagnosis for individualizing care, the use of CP, GADA, genetic risk scores (GRS) or rare genetic variants of maturity onset of diabetes (MODY) can help doctors select the most appropriate therapy in a timely manner. While patients with low CP, GADA and high GRS will benefit from early insulin therapy, some MODY variants are associated with good response to insulin-releasing oral drugs (e.g. sulphonylurea) which may spare the use of insulin with reduced patient distress and over-insulinization. By contrast, patients with high CP often due to obesity-associated insulin resistance should undergo intensive lifestyle modification and use of drugs with weight-reducing or neutral effects to avoid weight gain due to excessive dose of insulin.
PART 1:
Objective: To characterize Chinese patients diabetes classified by fasting CP and GADA positivity and their prognostic significance.
Methods: Fasting CP levels and GADA in stored biosamples of 4000 patients in the Hong Kong Diabetes Register (HKDR) followed up since 1995.
PART 2:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 50 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Part 1: Prospective cohort of Chinese with type 2 diabetes
- •Between 1995 and December 2004, 10,129 patients were assessed using structured protocol to esetablish the HKDR and of them, we have measured GADA and CP in 1400 patients with YOD. In this study, we shall measure CP and GADA in 4000 subjects from the HKDR with available GWAS data irrespective of their age of diagnosis. These samples were linked to our various databases by a unique identification code which will enable us to track the clinical outcomes including development of complications.
- •Part 2: Family-based cohort of first-degree relatives of diabetic probands
- •We shall utilize the resource of the HKDFS and control subjects to discover novel genetic variants of YOD. Subjects will be selected based on their status with or without diabetes. In 2012-2013, we ascertained the glycemic status of 365 siblings in the HKDFS and 452 participants of the community-based LKS cohort (aged 18-55 years) without diabetes at baseline (1998-2002).
- •In this cohort, 167 participants (53.7%) with a family history of YOD, 68 participants (30.1%) with a family history of late onset diabetes and 40 (14.4%) participants without family history of diabetes developed diabetes. Amongst the 313 siblings with family history of YOD, 167 had diabetes at baseline or developed diabetes during follow up and 146 did not develop diabetes after 13 years giving 100-120 sibpairs for linkage analysis. These sequence data will be imputed with 500 YOD patients and 500 control subjects with exome data as well as 6000 patients in the HKDR with GWAS data for analysis for validation purpose.
- •Part 3: RCT (PRISM)
- •Non-type 1 diabetes (T1D)
- •Chinese ethnicity
- •Age between 18-50 years inclusive
- •Age at diabetes diagnosis 40 years
- •Able to understand study requirements and voluntarily agree to participate by providing written informed consent
排除标准
- •Subjects in the HKDR, HKFDS and LKS cohorts without or insuffiicent amount of biosamples for assays or sequencing.
- •T1D, defined by presentation with diabetic ketoacidosis or insulin requirement within 6 months of diagnosis.
- •Reduced life expectancy due to terminal illness or otherwise deemed not appropriate per discretion of the investigator
结局指标
主要结局
Prevalence of C-Peptide (CP) and Glutamic Acid Decarboxylase Antibody (GADA) in Chinese adult patients with T2D (Part 1 of study)
时间窗: through study completion, an average of 4 years
Between 1995 to 2004, all patients in the HKDR had structured assessment with storage of blood samples (collected at registration) for future research purpose. We shall measure CP and GADA in 4000-5000 patients.
Incidence of young-onset type 2 diabetes and its genetic susceptibility (Part 2 of study)
时间窗: through study completion, an average of 4 years
Between 1998 to 2013, subjects from the HKFDS and the community-based LKS cohort had storage of blood samples at registration.
The correlation of C-Peptide (CP) and Glutamic Acid Decarboxylase Antibody (GADA) on clinical outcomes (Part 1 of study)
时间窗: through study completion, an average of 4 years
Between 1995 to 2004, all patients in the HKDR had structured assessment with storage of blood samples (collected at registration) for future research purpose.
Incidence of any diabetes-related micro/macrovascular endpoints (Part 3 of study)
时间窗: through study completion, an average of 4 year
Incident including cardiovascular disease (coronary heart disease, congestive heart failure, stroke, peripheral artery disease), chronic kidney disease, all-cause death and/or incident/progression/remission of albuminuria, estimated glomerular filtration rate, retinopathy, visual acuity and sensory neuropathy
次要结局
- The levels of CP and GADA and the number of genetic variants for disease prognositication and classification to guide precision medicine in YOD (Part 1 and 2 of study)(through study completion, an average of 4 years)
- Incidence of severe hypoglycaemia (Part 3 of study)(through study completion, an average of 4 year)
- On-treatment changes in blood pressure (Part 3 of study)(through study completion, an average of 4 year)
- The number of novel targets and pathways for discovery of drug targets with companian diagnostics (Part 1 and 2 of study)(through study completion, an average of 4 years)
- Rate of changes in glycaemic control (Part 3 of study)(through study completion, an average of 4 year)
- On-treatment changes in lipid profiles (Part 3 of study)(through study completion, an average of 4 year)
- The number of genetic variants for disease prognositication and classification to guide precision medicine in YOD (Part 1 and 2 of study)(through study completion, an average of 4 years)
- On-treatment changes in CP (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's Quality of life (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's compliance (Part 3 of study)(through study completion, an average of 4 year)
- On-treatment changes in Body Mass Index (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's diabetes empowerment (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's perceived personal control (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's Depression Anxiety Stress (Part 3 of study)(through study completion, an average of 4 year)
- The number of patients attaining ≥3 cardiometabolic risk factors (Part 3 of study)(through study completion, an average of 4 years)
- Rate of changes in use of medications (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's reported outcomes : Depression (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's diabetes self care activities (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's genetic counseling satisfaction (Part 3 of study)(through study completion, an average of 4 year)
- Changes in patient's diabetes related distress (Part 3 of study)(through study completion, an average of 4 year)
研究者
Juliana Chan
Professor
Chinese University of Hong Kong