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Type 2 DiabetesPhase 4NCT02049034

Lixisenatide-The Effects on Glucose and Lipid Metabolism in Type 2 Diabetes

A Phase 4 study testing Lixisenatide in people with Type 2 Diabetes, run by University of Surrey at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Glucagon-like-peptide-1 (GLP-1) analogues are a new treatment for type 2 diabetes, which have recently been shown to have beneficial effects on weight, glycaemic control and postprandial triglyceride concentrations. Read more about this study

Who is it for?
Ages 40 to 65 years, men only
Conditions the study is for
Type 2 Diabetes
What is being tested?
Lixisenatide
Type of treatment
Injection or infusion
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
8 participants
Where
1 siteUnited Kingdom
Study dates
Jan 2014to Jan 2016
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 to 65 years
  • Men only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Subjects with type 2 diabetes inadequately controlled by metformin.
  • Stable diabetes management over last 3 months: metformin dose unchanged. HbA1c not known to have changed by >0.5% over 3 months.
  • Caucasian
  • Male
  • 40-65 years (inclusive)
  • HbA1c 7.5-9.5% (inclusive)
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  • BMI 27-40 kg/m2 (inclusive)
  • Able and willing to self-administer placebo/lixisenatide injection
  • Able and willing to perform self-blood glucose monitoring.
  • Able and willing to wear a Continuous Glucose Monitoring System (CGMS) for 3 days

Who cannot join

  • Subjects treated with insulin, any oral hypoglycaemic agents (OHA) (other than metformin), any insulin secretagogue or Thiazolidinediones (TZDs)
  • A history of heavy alcohol use (>12 to 15 g of alcohol per day)
  • Arteriopathy
  • History of significant coronary artery disease (myocardial infarction, surgical or percutaneous [balloon and/or stent] coronary revascularization procedure, or coronary angiography showing at least one stenosis ≥ 50% in a major epicardial artery or branch vessel)
  • Ischemic cerebrovascular disease, including:
  • History of ischemic stroke.
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  • History of carotid arterial disease as documented by ≥ 50 % stenosis documented by carotid ultrasound, magnetic resonance imaging or angiography, with or without neurological sequelae.
  • Atherosclerotic peripheral arterial disease, as documented by history of amputation due to vascular disease; history of surgical or percutaneous revascularization procedure; current symptoms of intermittent claudication confirmed by an ankle-brachial pressure index less than 0.9
  • Hepatic disease: alanine transaminase (ALT) >3 times upper limit of normal (ULN)
  • Renal disease: estimated glomerular filtration rate (Cockroft-Gault equation) less than 40ml/minute.
  • Subjects receiving fibrates or weight reducing drugs
  • Mental incapacity
  • Unwillingness or a language barrier precluding adequate understanding or co-operation
  • Fasting plasma triglycerides >4.0 mmol/l
  • Systolic blood pressure >160 mmHg on 2 occasions, measured at least 10-minutes apart
  • Screening amylase and/or lipase > 3 times ULN or P-calcitonin ≥20 pg/ml (5.9 pmol/L).
  • Personal or immediate family history of medullary thyroid cancer (MTC) or genetic condition that predisposes to MTC (e.g. multiple endocrine neoplasia syndromes).
  • History of unexplained pancreatitis, chronic pancreatitis, pancreatectomy.
  • Any stomach/gastric surgery other than minor endoscopic procedures such as peptic ulcer injection
  • Allergic reaction to any GLP-1 receptor agonist or to metacresol.
  • Clinically relevant history of gastrointestinal disease associated with prolonged nausea and vomiting.
  • Current smokers
  • Subject enrolled in another experimental protocol which involves the use of an investigational drug or device

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • University of Surrey FHMS Diabetes and Metabolic Medicine

    Guildford, Surrey, GU2 7WG

Other trials in United Kingdom

About this study

Official title: The Effect of Lixisenatide on Postprandial Lipid and Glucose Metabolism in Patients with Type 2 Diabetes

Glucagon-like-peptide-1 (GLP-1) analogues are a new treatment for type 2 diabetes, which have recently been shown to have beneficial effects on weight, glycaemic control and postprandial triglyceride concentrations. Postprandial hypertriglyceridaemia, which is associated with an increased risk of cardiovascular disease, is a feature of type 2 diabetes. Hypertriglyceridaemia is due to excess triglyceride-rich lipoproteins (TRL) which consist of very low-density lipoproteins, (VLDL) synthesised by the liver which contain the higher molecular weight form of apolipoproteinB (apoB), apoB-100, and chylomicrons which are synthesised in the intestine in response to an intake of dietary fat and contain the lower molecular weight form of apoB, apoB-48. A recent study has shown that GLP-1 receptor signalling is required for the control of postprandial lipoprotein synthesis and secretion in hamsters and mice. GLP-1 was shown to reduce apoB-48 TRL production while a GLP-1 receptor antagonist increased apoB-48 TRL production.

This study will investigate the effect of the GLP-1 analogue lixisenatide compared with placebo, in a double blind crossover study, on postprandial triglyceride metabolism in 12 patients with type 2 diabetes. Chylomicron and VLDL production and clearance rates will be measured in a repeated meal study by labelling apoB-100 and apoB-48 and by labelling triglycerides using stable isotope methodology. Glucose flux in response to a mixed fluid meal will also be investigated using stable isotope methodology. Gastric emptying and post heparin LPL activity will be measured.

The hypothesis is that i] lixisenatide will lower postprandial glycaemia due to a decrease in endogenous glucose output and an increase in glucose clearance by peripheral tissues as a result of an improvement in insulin sensitivity.

Read the detailed description

GLP-1 analogues are a new treatment for type 2 diabetes, which have recently been shown to have beneficial effects on weight, glycaemic control and postprandial triglyceride concentrations. Postprandial hypertriglyceridaemia, which is associated with an increased risk of cardiovascular disease, is a feature of type 2 diabetes. Hypertriglyceridaemia is due to excess triglyceride-rich lipoproteins (TRL) which consist of very low-density lipoproteins, (VLDL) synthesised by the liver which contain the higher molecular weight form of apolipoproteinB (apoB), apoB-100, and chylomicrons which are synthesised in the intestine in response to an intake of dietary fat and contain the lower molecular weight form of apoB, apoB-48. A recent study has shown that GLP-1 receptor signalling is required for the control of postprandial lipoprotein synthesis and secretion in hamsters and mice. GLP-1 was shown to reduce apoB-48 TRL production while a GLP-1 receptor antagonist increased apoB-48 TRL production.

This study will investigate the effect of the GLP-1 analogue lixisenatide compared with placebo, in a double blind crossover study, on postprandial triglyceride metabolism in 12 patients with type 2 diabetes. Chylomicron and VLDL production and clearance rates will be measured in a repeated meal study (Visits 4 and 8) by labelling apoB-100 and apoB-48 with 1-13C leucine (infusion for 8 hours) and by labelling triglycerides with [1,1,2,3,3-2H5 ]glycerol (as a bolus injection) and 13C triolein. Blood samples will be taken for 4 hours prior to during the 8 hr isotopic infusion to measure the enrichment of apoB-100 and apoB-48 with 1-13C leucine by gas chromatography mass spectrometry.

At Visits 3 and 7, glucose flux in response to a mixed fluid meal containing U-13C glucose will be investigated. Endogenous glucose production will also be measured by infusing [6,6-2H2] glucose for 6hours.

Gastric emptying will be measured by acetaminophen (1000 mg) absorption. Patients will also receive heparin (50U/kg) at the end of the study after 15 minutes a blood sample will be taken to determine post heparin lipoprotein lipase (LPL) activity.

During the study the patients will be asked to monitor their blood glucose for three days with continuous glucose monitoring and to fill in a 7 day food diary.

The hypothesis is that i] lixisenatide will lower postprandial glycaemia due to a decrease in endogenous glucose output and an increase in glucose clearance by peripheral tissues as a result of an improvement in insulin sensitivity.

ii] lixisenatide will reduce postprandial triglycerides due to a decrease in chylomicron production as a result of a direct effect on enterocyte chylomicron assembly and will also reduce VLDL secretion from the liver as a result of an improvement in insulin sensitivity.

Conditions
Type 2 Diabetes
Being tested
Lixisenatide, Placebo
Keywords
GLP-1 agonist, Lixisenatide, Postprandial glucose metabolism, Postprandial lipid metabolism, Gastric emptying, Lipoprotein lipase activity
Medical subject headings
Diabetes Mellitus, Type 2

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • LixisenatideOther

    Also called GLP-1 agonist, Lyxumia

    Lixisenatide and placebo are considered as investigational medicinal product (IMP). Metformin is not considered an investigational product but concomitant allowed antidiabetic medications.

    Lixisenatide is supplied as disposable pre-filled pen for subcutaneous injection: 10mcg Lixisenatide green pens; 20 mcg Lixisenatide purple pens. Dose titration-10mcg Lixisenatide for 14 days, 20 mcg for 14 days.

  • PlaceboOther

    Placebo for lixisenatide is supplied as green and purple colored disposable pen-injectors containing 3 mL of a sterile aqueous solution.

Study groups in NCT02049034
Study groupRoleWhat they receive
PlaceboPlacebo comparatorPlacebo for lixisenatide is supplied as green and purple colored disposable pen-injectors containing 3 mL of a sterile aqueous solution.
Receives: Other: Lixisenatide; Other: Placebo
LixisenatideExperimentalLixisenatide and placebo are considered as investigational medicinal product (IMP). Metformin is not considered an investigational product but concomitant allowed antidiabetic medications. Lixisenatide is supplied as disposable pre-filled pen for subcutaneous injection: 10mcg Lixisenatide green pens; 20 mcg Lixisenatide purple pens. Dose titration-10mcg Lixisenatide for 14 days, 20 mcg for 14 days.
Receives: Other: Lixisenatide; Other: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Postprandial glucose kinetics

    The study is a double blind cross over study comparing placebo injection with lixisenatide injection. The results will not be known until the investigator is unblinded. An intravenous infusion of [6,6 2H2] glucose will enable the quantification of endogenous hepatic glucose output while addition of [U13C] glucose to a mixed meal will enable the calculation of the contribution of meal derived glucose to postprandial glucose. Enrichment of plasma samples with 2H2 glucose and 13C glucose will be measured by gas chromatography mass spectroscopy (GCMS). Glucose uptake during the postprandial period will then be determined from these measures of glucose output and the glucose concentration at each time point. During this study, gastric emptying will be measured by oral administration of 1000mg acetaminophen.

    Measured: Two years

Secondary outcomes (1)
  1. Postprandial and intestinal triglyceride-rich lipoproteins (TRL) kinetics

    Triglyceride kinetics in TRLs will be measured by intravenous injection of isotopically labelled glycerol which will be incorporated into nascent triglyceride molecules which is then incorporated into TRL particles (endogenous pathway) and oral administration of 13C triolein which will be incorporated as fatty acids into triglycerides and then become integrated into lipoprotein particles (exogenous pathway). The study uses a feeding protocol which maintains a steady state triglyceride concentration throughout the study. Repeated blood samples will be taken over many hours after administration of the tracers. Hepatic TRL (apoB-100) will be separated from intestinal TRL (ApoB48) using an immunoaffinity method. Measuring the glycerol and 13C oleate enrichments of the triglyceride isolated from lipoproteins, will allow the calculation of the production and clearance rates of triglycerides in both hepatic and intestinal TRLs.

    Measured: Two years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Jan 2014 (estimated)
  2. Study startJan 2014
  3. Primary completionJan 2016
  4. Study completionJan 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Model description
Placebo to IMP (lixisenatide) or IMP (lixisenatide) to placebo
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
8 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02049034
Sponsor's protocol ID
LIXISL06684
Other IDs
2013-002826-22
Status last verified
Apr 2024
First submitted
18 Dec 2013
Last updated
16 Dec 2024
Results posted
No
Data monitoring committee
No
Individual data sharing
No: There is no plan to make the individual participant data available, however the averaged data has been published .

Publications

  • Whyte MB, Shojaee-Moradie F, Sharaf SE, Jackson NC, Fielding B, Hovorka R, Mendis J, Russell-Jones D, Umpleby AM. Lixisenatide Reduces Chylomicron Triacylglycerol by Increased Clearance. J Clin Endocrinol Metab. 2019 Feb 1;104(2):359-368. doi: 10.1210/jc.2018-01176.

    PubMed 30215735

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Lixisenatide in people with Type 2 Diabetes, run by University of Surrey at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 10 inclusion and 23 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Postprandial glucose kinetics (time frame: Two years). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02049034, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Dec 2024.

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