Exenatide Compared With Insulin Glargine to Change Liver Fat Content in Type 2 Diabetes

Sponsor

Fudan University (Other)

Overall Status

Completed

CT.gov ID

NCT02303730

Collaborator

Huadong Hospital (Other), Shanghai Minhang Central Hospital (Other), Shanghai 6th People's Hospital (Other), Shanghai Changzheng Hospital (Other)

Enrollment

Locations

Arms

32.1

Duration (Months)

15.2

Patients Per Site

0.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to evaluate whether exenatide is superior to insulin glargine (after 24 weeks) in reducing liver fat content (by MRS) in patients with newly diagnosed type 2 diabetes mellitus and concomitant non-alcoholic fatty-liver disease(NAFLD).

Condition or Disease	Intervention/Treatment	Phase
Diabetes Mellitus, Type 2 Non-alcoholic Fatty Liver Disease	Drug: Exenatide Drug: insulin glargine	Phase 4

Detailed Description

This is a randomized, open-label, parallel-group, active controlled, multi-center clinical trial to investigate whether exenatide is superior to insulin glargine in reducing liver fat content in patients with newly diagnosed type 2 diabetes mellitus and concomitant NAFLD.Patients with type 2 diabetes and concomitant NAFLD from 18-70 years of age, with inadequate glycaemic control defined as 7% ≤ HbA1c ≤ 10% and BMI≥24kg/ m2 at the time of screening. Patients should be on diet and exercise but drug treatment naive, no use of any glucagon-like peptide-1(GLP-1) analogues or insulin within 3 months before enrolment.Patients will have an screening period 2 weeks, and a 24-week open label treatment period.

All demographic data variables collected by descriptive analysis tests are used. Qualitative variables use absolute frequency and percentage, and numeric variables use average, mean, median, standard deviation, maximum, minimum, quartiles, etc. Unless specifically stated, statistical significance will be defined as P<0.05 in the whole analysis procedure.For the primary endpoint of this study, superiority test will be applied to the quantitative data of these two groups. For secondary and exploratory efficacy variables, difference test will be used to analyse repeated measurement data from two groups. For essential Safety parameters, difference test will be used to analyse the differences between two groups.The analysis of all primary and secondary endpoints of efficacy and safety must be based on the Full Analysis Set (FAS). As supporting evidence, the analysis of primary endpoint variables must also comply with the Pre-protocol (PPS) Analysis.

Study Design

Study Type:

Interventional

Actual Enrollment :

76 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Exenatide BID Compared With Insulin Glargine to Change Liver Fat Content in Non-alcoholic Fatty-liver Disease Patients With Type 2 Diabetes

Study Start Date :

Mar 1, 2015

Actual Primary Completion Date :

Nov 1, 2017

Actual Study Completion Date :

Nov 1, 2017

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Exenatide Exenatide 5 ug twice daily 1 hour before meal subcutaneously for 4 weeks, then add to 10 ug twice daily 1 hour before meal subcutaneously for another 20 weeks	Drug: Exenatide The starting dose of exenatide is 5 ug bid, subcutaneously, for 4 weeks, followed by 10 ug bid, subcutaneously, for 20 weeks. If hypoglycaemia (blood glucose<2.9 mmol/l or < 3.9 mmol/l at least 2 times) or serious intolerance occurs, the dose will be adjusted to 5 ug bid, subcutaneously. Other Names: Byetta
Active Comparator: Insulin glargine Insulin glargine subcutaneously, once daily, for 24 weeks	Drug: insulin glargine The starting dose of insulin glargine will depend upon the HbA1c level at screening(HbA1c <8% use 0.1 -0.2 U/kg per day;HbA1c >8% use 0.2 -0.3 U/kg per day). Dose adjustment protocol for insulin glargine (at least 3 determinations of fasting blood glucose per week): fasting blood glucose(FBG) > 180 mg/dL(10 mmol/l): add 4 U; FBG 140-180 mg/dL(7.8-10 mmol/l): add 2 U; FBG 126-139 mg/dL(7.0-7.8 mmol/l): add 1 U. If hypoglycemia, reduce insulin glargine by: blood glucose <70mg/dl（3.9mmol/l）: 10%-20%; blood glucose <40mg/dl（2.2mmol/l）: 20%-40%. Other Names: Lantus

Arm

Intervention/Treatment

Experimental: Exenatide

Exenatide 5 ug twice daily 1 hour before meal subcutaneously for 4 weeks, then add to 10 ug twice daily 1 hour before meal subcutaneously for another 20 weeks

Drug: Exenatide

The starting dose of exenatide is 5 ug bid, subcutaneously, for 4 weeks, followed by 10 ug bid, subcutaneously, for 20 weeks. If hypoglycaemia (blood glucose<2.9 mmol/l or < 3.9 mmol/l at least 2 times) or serious intolerance occurs, the dose will be adjusted to 5 ug bid, subcutaneously.

Other Names:

Byetta

Active Comparator: Insulin glargine

Insulin glargine subcutaneously, once daily, for 24 weeks

Drug: insulin glargine

The starting dose of insulin glargine will depend upon the HbA1c level at screening(HbA1c <8% use 0.1 -0.2 U/kg per day;HbA1c >8% use 0.2 -0.3 U/kg per day). Dose adjustment protocol for insulin glargine (at least 3 determinations of fasting blood glucose per week): fasting blood glucose(FBG) > 180 mg/dL(10 mmol/l): add 4 U; FBG 140-180 mg/dL(7.8-10 mmol/l): add 2 U; FBG 126-139 mg/dL(7.0-7.8 mmol/l): add 1 U. If hypoglycemia, reduce insulin glargine by: blood glucose <70mg/dl（3.9mmol/l）: 10%-20%; blood glucose <40mg/dl（2.2mmol/l）: 20%-40%.

Other Names:

Lantus

Outcome Measures

Primary Outcome Measures

Change in liver fat content（%） measured by MRS [baseline and 24 weeks]
Change in liver fat content（%） measured by MRS

Secondary Outcome Measures

Change in intra-abdominal visceral fat content (cm2), abdominal subcutaneous fat content (cm2), and ratio between intra-abdominal visceral fat and subcutaneous fat area by MRI [baseline and 24 weeks]
Change in intra-abdominal visceral fat content (cm2), abdominal subcutaneous fat content (cm2), and ratio between intra-abdominal visceral fat and subcutaneous fat area by MRI
Change in glucose metabolism (fasting blood glucose, postprandial plasma glucose, HbA1c) [baseline and 24 weeks]
Change in glucose metabolism (fasting blood glucose, postprandial plasma glucose, HbA1c)
Change in blood lipid profile (total cholesterol, triglyceride, HDL, LDL) [baseline and 24 weeks]
Change in blood lipid profile (total cholesterol, triglyceride, HDL, LDL)
Change in body weight,waist circumference and hip circumference [baseline and 24 weeks]
Change in body weight,waist circumference and hip circumference

Other Outcome Measures

Change in cardiac function measured by echocardiography [baseline and 24 weeks]
Change in cardiac function measured by echocardiography
Change in β-cell function (fasting C-peptide, 2-hour postprandial C-peptide) [baseline and 24 weeks]
Change in β-cell function (fasting C-peptide, 2-hour postprandial C-peptide)
Change in liver enzymes and laboratory parameters (hematology, biochemical tests) [baseline and 24 weeks]
Change in liver enzymes and laboratory parameters (hematology, biochemical tests)
Incidence of hypoglycaemia events [up to 24 weeks]
Incidence of hypoglycaemia events
Incidence of adverse events（AEs）and Severe adverse events(SAEs) [up to 24 weeks]
Incidence of adverse events（AEs）and Severe adverse events(SAEs)

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 70 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Male or female, 18 ≤ age ≤ 70 years old.
Newly diagnosed type 2 diabetes mellitus (WHO Diagnostic criteria for diabetes mellitus, 1999).
Patients with NAFLD, MRS measurement of liver fat content> 10%.
7% ≤ HbA1c ≤ 10%
No heavy drinking history within the last 5 years (alcohol intake: male < 20 g/d, female < 10 g/d)
HBsAg (-), hepatitis C virus antibody (HCV-Ab) (-)
BMI ≥ 24 kg/m2;

Exclusion Criteria:

Pregnancy, lactation, intended pregnancy, or failure to take adequate contraceptive measures taken (contraception measures including sterilization, intrauterine device, oral contraceptives, and persistent use of condoms).
Type 1 diabetes mellitus, gestational diabetes mellitus or other special types of diabetes.
Liver and renal dysfunction (ALT or aspartate aminotransferase(AST) is 2.5 times higher than the upper limit of normal, or total bilirubin is 1.5 times higher than the upper limit of normal, or Cr ≥ 115 μmol/L).
increased amylase (blood amylase is 2.5 times higher than the upper limit of normal) or presence of gastrointestinal disease.
Use of drugs that may affect liver fat content within one month before or during the trial period, such as glucocorticoids, thyroid hormone, etc.
Use of GLP-1 receptor agonist, dipeptidyl peptidase -4 (DPP-4) inhibitors or insulin within 3 months before enrolment
Presence of serious dyslipidemia or other endocrine diseases (hypothyroidism, hypothalamic-pituitary dysfunction, etc).
Fatty liver caused by viral hepatitis, drug, alcohol, Wilson disease or total parenteral nutrition.
Presence of liver cancer, infection, biliary tract disease or recently increased liver enzyme due to medication.
Participation in strenuous exercise or administration of any drugs that affect glucose metabolism.
History of pancreatitis, alcohol abuse, metal disorders or history of allergy to investigational drug.
Congestive heart failure defined as New York Heart Association (NYHA) class III or IV, unstable angina or myocardial infarction in recent 6 months.
Any situation that may affect the implementation or results of the study.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University	Shanghai	Shanghai	China	200032
2	Department of Endocrinology and Metabolism, Shanghai Minhang Central Hospital	Shanghai	Shanghai	China
3	Department of Endocrinology and Metabolism,Huadong Hospital	Shanghai	Shanghai	China
4	Department of Endocrinology and Metabolism,Shanghai 6th People's Hospital	Shanghai	Shanghai	China
5	Department of Endocrinology and Metabolism,Shanghai Changzheng Hospital	Shanghai	Shanghai	China