Impact of Hypoglycaemia in Patients With Diabetes Mellitus Type 2 on Platelet Activation

NCT ID: NCT03460899

Last Updated: 2019-11-18

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 14 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-02-12
• Study Completion Date: 2018-06-11

Brief Summary

This experimental study is planned to investigate the impact of hypoglycaemia on platelet activation parameters (PAP) during a hyperinsulinaemic hypoglycaemic clamp study. The hypothesis that hypoglycaemia in patients with Diabetes Mellitus, Type 2 (T2DM) leads to increased platelet activation will be tested.

Detailed Description

Increased platelet activation is significantly involved in the pathophysiology of micro- and macrovascular diabetic complications. Previously performed studies suggested platelet activation in both, hyper- and hypoglycaemic states, leading to a potentially increased risk for thromboembolic complications. Hypoglycaemia, in particular severe hypoglycaemic episodes, has been associated with increased cardiovascular or overall mortality in previous studies. Potential mechanisms include arrhythmias or increased risk for thromboembolism, based on platelet activation and/or hypercoagulability.

The aim of this experimental study is to investigate the impact of hypoglycaemia on platelet activation parameters (PAP) during a hyperinsulinaemic hypoglycaemic clamp study. We hypothesize that Hypoglycaemia in patients with T2DM leads to increased platelet activation.

The primary objective is to investigate platelet activation during different levels of hypoglycaemia induced by a stepwise hyperinsulinaemic, hypoglycemic clamp experiment in patients with T2DM.

Active study duration will be 5 days for each study participant. 14 subjects with T2DM without history of cardiovascular events or manifest atherosclerosis will be enrolled. During this monocentric, single arm, open, mechanistic trial platelet activation and recovery at one week after the clamp experiment, changes of pro-atherothrombotic markers during the hypoglycaemic clamp as well as counter regulatory hormone response during the clamp will be investigated.

Conditions

Diabetes Mellitus With Hypoglycemia; Diabetes Mellitus, Type 2; Hypoglycemia; Hypoglycemic Episode

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: NONE

Study Groups

Clamp Arm

All 14 subjects will undergo an Euglycaemic Clamp at Visit 2 as well as a Hyperinsulinaemic/Hypoglycaemic Clamp at Visit 3 with the Intervention of reaching certain plasma glucose levels for blood sampling regarding platelet activity parameters. Infusion of Dextrose and human soluble insulin (Actrapid) will be used to reach certain plasma glucose levels.

Group Type: EXPERIMENTAL

Euglycaemic Clamp

Intervention Type: OTHER

All 14 subjects will undergo an euglycaemic clamp at Visit 2 with a plasma Glucose target of 5.5 mmol/L +/- 10% (4 timepoints for platelet activity parameter blood sampling)

Hyperinsulinaemic/Hypoglycaemic Clamp

Intervention Type: OTHER

All 14 subjects will undergo a hypoglycaemic/hyperinsulinaemic clamp at Visit 3 with 4 timepoints for platelet activity Parameter blood sampling 30 minutes after reaching certain plasma glucose plateaus (5.5 mmol/L; 3.5 mmol/L; 2.5 mmol/L; after recovery again at 5.5 mmol/L)

Interventions

Euglycaemic Clamp

All 14 subjects will undergo an euglycaemic clamp at Visit 2 with a plasma Glucose target of 5.5 mmol/L +/- 10% (4 timepoints for platelet activity parameter blood sampling)

Intervention Type: OTHER

Hyperinsulinaemic/Hypoglycaemic Clamp

All 14 subjects will undergo a hypoglycaemic/hyperinsulinaemic clamp at Visit 3 with 4 timepoints for platelet activity Parameter blood sampling 30 minutes after reaching certain plasma glucose plateaus (5.5 mmol/L; 3.5 mmol/L; 2.5 mmol/L; after recovery again at 5.5 mmol/L)

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Male or female aged 18-64 years (both inclusive) at the time of signing informed consent
• Subjects diagnosed with type 2 diabetes (diagnosed regarding world health organization [WHO] criteria) and on stable treatment for a period of 90 days prior to screening with metformin as monotherapy or diet only. Stable is defined as unchanged dose
• Body mass index (BMI) between 20.0 and 35.0 kg/m2 (both inclusive)
• HbA1c between 43 and 64 mmol/mol (6.0% - 8.0%) (both inclusive)
• No use of platelet inhibiting therapy (e.g. aspirin, clopidogrel, ticagrelor, prasugrel)

Exclusion Criteria

• All other forms of diabetes (type 1 diabetes, gestational diabetes) than type 2 diabetes mellitus
• Treatment with any glucose lowering agent(s) other than metformin in a period of 60 days before screening. An exception is short-term treatment (≤ 7 days in total) with insulin due to intercurrent illness
• Impaired hypoglycaemic awareness determined at the discretion of the investigator
• Medical history of arrhythmia as atrial fibrillation, atrial flutter, atrioventricular dissociation disorders or ventricular arrhythmias
• Previously known cardiovascular disease and / or past cardiovascular events, or past episodes of a congestive heart failure syndrome (NYHA II - NYHA IV)
• Severe hypoglycaemic event requiring third party help in the last 6 months
• Known allergy to human insulin or dextrose solution
• Clinically significant abnormal haematology, biochemistry, lipids, hormones, coagulation or urinalysis
• Uncontrolled hypertension defined as resting blood pressure at screening (after resting for 5 min, measured in sitting position) outside the range of 90-160 mmHg for systolic or 50-100 mmHg for diastolic
• Chronic liver failure with severe liver dysfunction as assessed by the investigator
• Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) levels > 3x upper Limit of normal (ULN)
• estimated Glomerular Filtration Rate (eGFR) <45 ml/min/1,73 m2
• Any musculoskeletal disorders holding back from stay in bed in a lying position during the time of the clamp experiments
• Treatment with beta-blockers, antiarrhythmic agents or neuroleptic drugs
• Active smoker or intake of illicit substances
• Regular intake of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Any mental disorders or psychiatric conditions which may interfere with understanding or conduction of study related procedures
• Females of child bearing potential without adequate contraceptive methods (i.e. sterilisation, intrauterine device, vasectomised partner; or medical history of hysterectomy)

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 64 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role: collaborator

Medical University of Graz

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Harald Sourij

Role: PRINCIPAL_INVESTIGATOR

Medical University of Graz, Division of Endocrinology and Diabetology

Locations

Medical University of Graz, Department for Internal Medicine

Graz, , Austria

Countries

Austria

References

Eyileten C, Wicik Z, Keshwani D, Aziz F, Aberer F, Pferschy PN, Tripolt NJ, Sourij C, Prietl B, Pruller F, von Lewinski D, De Rosa S, Siller-Matula JM, Postula M, Sourij H. Alteration of circulating platelet-related and diabetes-related microRNAs in individuals with type 2 diabetes mellitus: a stepwise hypoglycaemic clamp study. Cardiovasc Diabetol. 2022 May 20;21(1):79. doi: 10.1186/s12933-022-01517-5.

Reference Type: DERIVED

PMID: 35596173 (View on PubMed)

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

HS-2017-04

Identifier Type: -

Identifier Source: org_study_id