Use of Terbutaline or a Reduction in Basal Insulin in the Prevention of Nocturnal Hypoglycemia

NCT ID: NCT00974051

Last Updated: 2013-10-11

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 16 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2008-03-31
• Study Completion Date: 2008-12-31

Brief Summary

The investigators hypothesize that the use of an oral dose of Terbutaline or a 20% basal reduction will be able to prevent nocturnal hypoglycemia after an afternoon exercise session. This is a randomized three period cross-over study including treatment with Terbutaline, a 20% basal reduction for six hours, or no treatment (control).

Detailed Description

In this study, a minimum of 16 youth with type 1 diabetes will be recruited. All subjects must have been diagnosed with type 1 diabetes for at least one year and on an insulin pump for at least one month. Subjects are between the ages of 10 and 17 years, inclusive, have an HbA1c less than 10.0% and normal thyroid function. Subjects can not have had a severe hypoglycemic episode in the last three months, any other illness or treatment that may affect the wearing of a continuous glucose monitor or the completion of the study as determined by the investigator. Subjects may not use drugs containing pseudoephedrine within 48 hours of the study visits.

This study consists of three overnight visits at the Clinical Translational Research Center. Meals eaten during the study will be consistent for each of the three visits.

Subjects will participate in a standardized afternoon exercise session on a treadmill as has been done in previous Diabetes Research in Children Network studies. Exercise will begin at 4pm and must be completed by 6pm. Dinner will be eaten at the end of the exercise.

At 9pm, treatment will be given as determined by the randomization group the subject is assigned to. The treatment includes either an oral dose of 2.5mg Terbutaline, a 20% basal reduction for six hours or no treatment as the control. Blood glucose levels will be measured every 30 minutes until 6am.

Conditions

Type 1 Diabetes

Keywords

Children; Exercise; Hypoglycemia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Control

Subjects complete the same exercise routine, however no treatment is given at 9:00pm.

Group Type: ACTIVE_COMPARATOR

Control

Intervention Type: OTHER

No treatment is given for the study. This arm is for comparison with the two intervention arms.

Terbutaline

Subjects complete same exercise routine. At 9:00pm, an oral dose of 2.5 mg of Terbutaline is administered.

Group Type: EXPERIMENTAL

Terbutaline

Intervention Type: DRUG

Oral (2.5mg) one time administration at 9:00pm

20% Basal Insulin Reduction

All subjects complete the same exercise session. At 9:00pm, subject's basal rate is decreased by 20% for six hours.

Group Type: EXPERIMENTAL

20% basal insulin reduction

Intervention Type: OTHER

Basal insulin rate is reduced by 20% the normal (home dose) for six hours.

Interventions

Terbutaline

Oral (2.5mg) one time administration at 9:00pm

Intervention Type: DRUG

20% basal insulin reduction

Basal insulin rate is reduced by 20% the normal (home dose) for six hours.

Intervention Type: OTHER

Control

No treatment is given for the study. This arm is for comparison with the two intervention arms.

Intervention Type: OTHER

Other Intervention Names

β2-adrenergic agonist; 80% basal insulin; No intervention

Eligibility Criteria

Inclusion Criteria

• Clinical diagnosis of Type 1 Diabetes and using daily insulin therapy for at least one year.
• Age 10 to 17 years, inclusive.
• HbA1c < 10.0%.
• BMI 5-95th % for age and gender.
• Stable Continuous Subcutaneous Insulin Infusion regimen for at least 1 month and not anticipating a change prior to the subject's completion of the study.
• Subject uses a downloadable insulin pump.
• Normal thyroid function (measured within the previous year).
• For females, subject not intending to become pregnant during the study.
• No expectation that subject will be moving out of the area for the duration of the study.
• Informed consent form signed and understood by the parent/guardian and Child Assent form signed/understood by subjects.

Exclusion Criteria

• The presence of a significant medical disorder (including epilepsy, or any cause of seizures other than hypoglycemia) that in the judgment of the investigator will affect the wearing of the sensors or the completion of any aspect of the protocol.
• A recent injury to body or limb, Addison's disease, muscular disorder or disease in the judgment of the investigator that will affect the completion of the exercise protocol.
• Asthma which has been medically treated within the last year.
• Medically diagnosed cardiac disease, hypertension, or autonomic dysfunction.
• Use of pseudoephedrine 48 hours prior to the visit (if used in the 48 hours prior to the scheduled visit, the visit will be deferred)
• Severe hypoglycemia resulting in seizure of loss of consciousness in the 3 months prior to a visit.
• Active infection (if at the time of the scheduled visit and infection is present, the visit will be deferred).
• Anticipating a significant change in exercise regimen between visits (i.e. starting or stopping an organized sport).
• Treatment with systemic or inhaled corticosteroids in the last 6 months.
• Current treatment with B-blockers or presenting with high blood pressure.
• Inpatient psychiatric treatment in the past 6 months for either the subject or the subject's primary care giver.
• Current use of oral/inhaled glucocorticoids or other medications, which in the judgment of the investigator would be a contraindication to participation in the study
• Known allergy to Terbutaline
• Treatment with atenolol (Tenormin), carteolol (Cartrol), labetalol (Normodyne, Trandate), metoprolol (Lopressor), nadolol (Corgard), phenelzine (Nardil), propranolol (Inderal), sotalol (Betapace), theophylline (Theo-Dur), timolol (Blocadren), tranylcypromine (Parnate), other medications for asthma, heart disease or depression.
• Treatment with ephedrine, phenylephrine, phenylpropanolamine, or pseudoephedrine.
• The presence of an irregular heart beat, increased heart rate glaucoma or an overactive thyroid gland.

• Minimum Eligible Age: 10 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Colorado, Denver

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Rosanna Fiallo-Scharer, MD

Role: PRINCIPAL_INVESTIGATOR

University of Colorado, Denver

Locations

Barbara Davis Center

Aurora, Colorado, United States

Countries

United States

References

Taplin CE, Cobry E, Messer L, McFann K, Chase HP, Fiallo-Scharer R. Preventing post-exercise nocturnal hypoglycemia in children with type 1 diabetes. J Pediatr. 2010 Nov;157(5):784-8.e1. doi: 10.1016/j.jpeds.2010.06.004. Epub 2010 Jul 21.

Reference Type: DERIVED

PMID: 20650471 (View on PubMed)

Other Identifiers

07-0392

Identifier Type: -

Identifier Source: org_study_id