Glucagon Ready-to-Use (RTU) for Prevention of Exercise-Induced Hypoglycemia During Aerobic Exercise in Adults With T1D
Condition: Hypoglycemia
MeSH terms: Hypoglycemia
Intervention: Glucagon RTU Injection With Insulin Pump Reduction; Vehicle for Glucagon RTU Injection With Insulin Pump Reduction; Glugaon RTU Injection Without Insulin Pump Reduction
Intervention description: 0.15 mg injection with 50% pump reduction; vehicle injection with 50% pump reduction; 0.15 mg injection without pump reduction
Intervention MeSH terms: Insulin; Insulin, Globin Zinc; Glucagon; Glucagon-Like Peptide 1
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: CRC Phase: randomized, placebo-controlled, double-blind, two-treatment, two-period, crossover comparison in a clinical research center (CRC) setting. The subjects were re-randomized into the Outpatient Phase: randomized, placebo-controlled, partially double-blind, 3-arm parallel comparison in an outpatient setting.
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Masking description: CRC Phase was a fully masked double-blind crossover with each subject receiving each treatment 1 time. In the Outpatient Phase, the two arms with 50% insulin pump reduction were double-blind (fully masked) and the arm with Glucagon RTU and no insulin pump reduction was open-label.
Enrollment: 48.0
Sex: All
Minimum age: 18 Years
Maximum age: 64 Years
Healthy volunteers: No
Keywords: Exercise; Glucagon; Insulin

Summary:

      This study is a randomized, placebo-controlled, double-blind, 2-treatment, 2-period,
      crossover comparison in a clinical research center (CRC) setting, followed by a randomized,
      placebo-controlled, double-blinded, 2-arm parallel comparison with a third open-label arm in
      an outpatient setting. The purpose of the study is to evaluate the preliminary efficacy and
      safety of Glucagon Ready-to-Use [RTU] to prevent exercise-induced hypoglycemia (EIH) in
      adults with Type 1 diabetes mellitus (T1D), who perform regular, moderate-to-high intensity
      aerobic exercise.
    

Eligibility criteria:

        Inclusion Criteria:

          1. Clinical diagnosis of presumed autoimmune type 1 diabetes, receiving daily insulin via
             continuous subcutaneous insulin infusion.

          2. Age 18 to < 65 years.

          3. Duration of type 1 diabetes ≥ 2 years.

          4. Random C-peptide < 0.6 ng/mL (<198 pmol/L).

          5. Using insulin therapy by continuous subcutaneous insulin infusion pump for at least 6
             months.

          6. History of exercise-related hypoglycemia.

          7. Performs aerobic exercise regularly (2-3 times per week), and desires to exercise per
             American Diabetes Association guidelines (150 minutes per week). Examples of aerobic
             exercise include: power walking, hiking, running/jogging, cycling, swimming, cross
             country skiing, and aerobic fitness classes.

          8. Will abstain from the use of non-insulin diabetes therapies such as sodium glucose
             co-transporter 2, glucagon like peptide-1, and metformin for the duration of the
             study.

          9. Subject must be willing to adhere to the protocol requirements for the duration of the
             study.

         10. Subject has provided informed consent as evidenced by a signed/dated informed consent
             form completed before any trial-related activities occur.

        Exclusion Criteria:

          1. Frequently experience hyperglycemia with exercise, in the clinical judgement of the
             investigator.

          2. Pregnant and/ or Nursing: For female subjects of childbearing potential, there is a
             requirement for a negative urine pregnancy test and for agreement to use contraception
             and to refrain from breast feeding during the study, and for at least 1 week after the
             last dose of study drug. Acceptable contraception includes birth control pill / patch
             / vaginal ring, Depo-Provera, Norplant, an intra-uterine device, the double barrier
             method (the woman uses a diaphragm and spermicide and the man uses a condom), or
             abstinence.

          3. One or more severe hypoglycemic episodes in the past 12 months (as defined by an
             episode that required third party assistance for treatment).

          4. Uses inhaled insulin.

          5. Hemoglobin A1c > 9.0% at Screening.

          6. Renal insufficiency (serum creatinine greater than 3 mg/dL (0.17 mmol/L)).

          7. Serum alanine aminotransferase or aspartate aminotransferase equal to or greater than
             3 times the upper limit of normal.

          8. Hepatic synthetic insufficiency as defined as a serum albumin of less than 3 mg/dL
             (0.17 mmol/L); or serum bilirubin greater than 2 mg/dL (0.11 mmol/L).

          9. Hematocrit of less than or equal to 30%.

         10. Mean of triplicate blood pressure (BP) readings at Screening where systolic BP <90 or
             >150 mm Hg, or diastolic BP <50 or >100 mm Hg.

         11. Clinically significant electrocardiogram abnormalities.

         12. Use of > 2.0 U/kg total insulin dose per day.

         13. Inadequate bilateral venous access in both arms.

         14. Congestive heart failure, New York Heart Association class III or IV.

         15. Active malignancy within 5 years from Screening, except basal cell or squamous cell
             skin cancers.

         16. Major surgical operation within 90 days prior to screening, or planned surgical
             operation during the study.

         17. History of seizure disorders.

         18. Bleeding disorder, treatment with warfarin or any anticoagulants, or platelet count
             below 50,000 mm3 at Screening.

         19. History of pheochromocytoma or disorder with increased risk of pheochromocytoma
             (multiple endocrine neoplasia type 2, neurofibromatosis, or Von Hippel-Lindau
             disease).

         20. History of insulinoma.

         21. History of allergies to glucagon or glucagon-like products, or any history of
             significant hypersensitivity to glucagon or any related products or to any of the
             excipients (dimethylsulfoxide, mannitol, & trehalose) in the investigational
             formulation.

         22. History of glycogen storage disease.

         23. Subject tests positive for human immunodeficiency virus, hepatitis C virus, or active
             hepatitis B virus infection at Screening.

         24. Any concurrent illness, other than diabetes, that is not controlled by a stable
             therapeutic regimen.

         25. Active substance or alcohol abuse, in the opinion of the investigator. Subjects
             reporting active marijuana use or testing positive for tetrahydrocannabinol via rapid
             urine test will be allowed to participate in the study at the discretion of the
             investigator.

         26. Participation in other studies involving administration of an investigational
             therapeutic agent (drug or device) within 30 days or 5 half-lives, whichever is
             longer, before Screening for the current study and during participation in the current
             study.

         27. Any reason the investigator deems exclusionary.