A Pilot Study to Evaluate the Safety of Terbutaline in Children With Type 1 Diabetes
Condition: Type 1 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 1
Study type: Interventional
Phase: Phase 1

Summary: 
      The purpose of the study is to gain experience with the use of terbutaline in children with
      T1D and to determine that there is not a frequent serious, unexpected, uncontrollable effect
      on short-term glycemic control. Some information also will be obtained with regard to whether
      terbutaline, in the dosing being used in the study, is sufficiently well tolerated to expect
      that adherence will be satisfactory in a large randomized trial. In addition, this pilot
      study will provide data on the accuracy of a continuous glucose monitor during terbutaline
      use to verify that the drug does not impact on sensor function.
    

Detailed description: 
      Approximately 10 children will be recruited from five centers in the United States to
      participate in this study. The data collected in this pilot study will be used to determine
      whether to proceed to a randomized trial using the dose of terbutaline being used in the
      pilot study or the need for additional pilot testing with a lower dose of terbutaline.

      Beginning the Study

      When a chid enters the study, the following will be done:

        1. After eligibility is determined, informed consent and assent are obtained from the
           parent/guardian and subject.

        2. An unblinded CGM will be used and blood ketones will be checked each morning by the
           subject for at least one week. Subjects may be asked to wear an Actiwatch monitor each
           night.

        3. Terbutaline will be initiated during a CRC admission and continued following the CRC
           stay for 21-28 days.

           • Subjects weighing between 25 and 45 kg will be treated with a nightly oral dose of 2.5
           mg and subjects who weigh more than 45 kg will be treated with 3.75 mg.

        4. The CRC admission will last approximately 18-20 hours and include the following:

             -  Monitoring of effects of terbutaline by measurement of heart rate, blood pressure,
                blood and interstitial glucose, lactate, ketones, NEFA, B-OH butyrate

             -  Assessment of the accuracy of the CGM by comparing sensor glucose values to blood
                glucose values

        5. The outpatient phase will last 21-28 days and include the following:

             -  Nightly use of terbutaline as described above

             -  Use of an unblinded CGM on a daily basis to monitor the glucose levels

             -  Subjects may be asked to wear the Actiwatch monitor overnight

             -  Measurement of blood ketones each morning

             -  Phone calls to each subject on the first outpatient day of terbutaline use and then
                approximately every 3 days (twice a week) until the end of the subject's follow up.

        6. Second CRC admission to mirror the first admission between 21 and 28 days after
           initiation of terbutaline

        7. Follow up for 1-2 weeks after discontinuation of terbutaline until glucose control is
           back to prestudy level.

      Procedures at home after hospital stay

        1. Terbutaline will be taken orally each day prior to bedtime.

        2. Each subject will continue to use a CGM, with instructions to use it as close to 24/7 as
           possible.

        3. Prior to each phone call, the subject will be instructed to download the CGM and either
           email or fax the file to the clinic so that the glucose data can be reviewed during the
           phone contacts.

        4. Each subject will be provided with an HGM and test strips. The HGM will be used for
           calibration of the CGM and to confirm high and low values on the CGM prior to acting on
           them. It will be downloaded at the end-of-study CRC admission. The subject will be asked
           to measure blood ketones each morning using the meter and strips that will be provided.

        5. Each subject may be asked to wear an Actiwatch each night to measure movement while the
           subject is sleeping.

        6. Phone calls to each subject will be made after the first outpatient day of terbutaline
           use and then approximately every 3 days (twice a week) until the end of the subject's
           follow up plus an about 7 days after terbutaline is discontinued.

        7. Prior to the end-of-study CRC admission, follow-up visits can occur at any time at the
           discretion of the investigator.

      End of study admission

      The end-of study CRC admission will occur after 21-28 days of the outpatient phase.The
      protocol will be identical to the protocol for the first CRC admission. The dinner and
      breakfast meals will be identical to the meals given during the first admission.

      The sensors will be removed prior to discharge, unless the investigator decides it would be
      beneficial to continue a CGM for 1-2 weeks to assist in the maintenance of glucose control
      after terbutaline has been stopped.
    

Intervention name(s): Terbutaline
Intervention type(s): Drug
Intervention description(s): Each subject will be treated with terbutaline for 21-28 days following the initiation of treatment during the CRC admission.
Subjects weighing between 25 and 45 kg will be treated with a nightly oral dose of 2.5 mg and subjects who weigh more than 45 kg will be treated with 3.75 mg.
The standard 2.5 mg terbutaline tablets available in a pharmacy will be used in the study, with subjects taking either 1 or 1.5 tablets nightly.
Other intervention name(s): Brethine
Intervention MeSH terms: Terbutaline
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Prevention