GLP-1 Receptor Agonist Therapy and Albuminuria in Patients With Type 2 Diabetes

Study Overview
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Brief Summary
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This is a prospective study to evaluate effect of Exenatide extended release treatment for 1 year on albuminuria levels in T2DM patients with micro- and macroalbuminuria compared to placebo.

Detailed Description
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This is a prospective study to evaluate effect of Exenatide extended release treatment for 1 year on albuminuria levels in T2DM patients with micro- and macroalbuminuria compared to placebo. The similarities in baseline values between the study groups will be compared using appropriate parametric tests. Transformations of the data on order to meet statistical assumptions may be considered. All statistical analysis will be carried out using SPSS software (SPSS Inc, Chicago, Illinois) based on intention to treat principle. Data will be presented as mean±standard error. The primary endpoint of the study is the change from baseline in albuminuria level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments. Fasting samples collected at weeks 0, 12, 26, 39 and 56 will be used for this assessment with values at week 0 considered as baseline. Changes from baselines form both drugs arms will be compared to those from the placebo arms in both the micro and macroalbuminuria groups. The statistical analysis will be done using mixed model for repeated measurement (MMRM) analysis with assigned α value of 0.05. Our preliminary data on retrospective analysis of the difference in albuminuria following GLP-1RA treatment for 2.5 yrs in T2DM patients with micro and macroalbuminuria show regression of albuminuria (UACR) by approximately 55mg/mg and 500mg/g (about 50% reduction), respectively. Conservatively estimating a difference in the change from baseline in albuminuria after 1 year between the Exenatide extended release and placebo groups (across both albuminuria groups) of 60mg/g, with standard deviation of no more than 91mg/g, a sample size of 38 patients per group should provide adequate power (beta = 0.2) to detect a significant difference (alpha = 0.05). Assuming a drop-out rate of 15% and 2:1 drug:placebo randomization ratio, 60 active and 30 control will be recruited for a total of 90 patients (rounded up). Patients will be enrolled based on a predetermined stratification according to the two albuminuria categories (micro and macro at 1:1 ratio) with 45 patients in each. The secondary end points include the comparison of the changes in albuminuria based on baseline albuminuria category (micro or macro), creatinine clearance, Cystatin C, TGFβ, type I and IV collagen, CTGF, and fibronectin levels, the expression of SMAD3, SMAD4, NQO-1, GST-1P and HO-1, Nrf-2/keap-1 system activation between the Exenatide extended release and placebo groups and across albuminuria categories

Official Title
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GLP-1 Receptor Agonist Therapy and Albuminuria in Patients With Type 2 Diabetes

Conditions
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Type2 Diabetes, Kidney Diseases

Intervention / Treatment
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* Drug: Exenatide Extended Release for Inj Susp 2 MG
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Type 2 Diabetes for at least 1 year. Microalbuminuria for at least 6 months (UACR: 30-300 mg/g) Macroalbuminuria for at least 6 months (UACR: >300 mg/g) HbA1c of ≤10% Ages 18-65 years (inclusive of ages 18 and 65) On ARBs/ACEi for at >3months Exclusion Criteria: Use of GLP-1 Receptor agonists or SGLT-2 inhibitors therapy in the last 3 months History or risk for pancreatitis (e.g., history of gallstones, alcohol abuse, and hypertriglyceridemia) Coronary event or procedure (myocardial infarction, unstable angina, coronary artery bypass, surgery or coronary angioplasty) in the previous 3 months Hepatic disease: Severe hepatic insufficiency and/or significant abnormal liver function defined as: Aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN Total bilirubin >2.0 mg/dL (34.2 µmol/L) Positive serologic evidence of current infectious liver disease including Hepatitis B viral antibody IGM, Hepatitis B surface antigen and Hepatitis C virus antibody Liver function tests more than 3 times the upper limit of normal Renal impairment (serum eGFR <30 ml/min) HIV Inability to give informed consent History of gastroparesis History of medullary thyroid carcinoma or MEN 2 syndrome Alcoholism Hypertriglyceridemia (>500 mg/dl). Any other life-threatening, non-cardiac disease Uncontrolled hypertension (BP > 160/100 mm of Hg) Congestive Heart Failure class III or IV Use of an investigational agent or therapeutic regimen within 30 days of study Participation in any other concurrent clinical trial Pregnant or breastfeeding patients or females of childbearing age not on 2 forms of acceptable contraceptives.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exenatide extended release<br>Exenatide extended release treatment for 1 year on albuminuria levels in T2DM patients with micro- and macroalbuminuria compared to placebo. | Drug: Exenatide Extended Release for Inj Susp 2 MG<br>* Exenatide extended release treatment weekly for 1 year in T2DM patients with micro- and macroalbuminuria<br>* Other names: Bydureon;|
| Placebo Comparator: Placebo<br>Placebo treatment for 1 year on albuminuria levels in T2DM patients with micro- and macroalbuminuria compared to Exenatide extended release. | Drug: Placebo<br>* placebo treatment weekly for 1 year in type 2 diabetes with micro-and macroalbuminuria<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change from baseline in albuminuria levels | change from baseline in albuminuria level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change in albuminuria category (micro or macro) | change in albuminuria category between normal to micro to macro albuminuria at12, 26, 39, 56 weeks | 12, 26, 39, 56 weeks | 
| change in creatinine clearance | change from baseline in creatinine at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in Cystatin C | change from baseline in cystatin C at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in TGFβ | change from baseline in TGFβ level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in type I and IV collagen | change from baseline in Type I and IV collagen levels at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| Change in CTGF | change from baseline in CTGF level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in fibronectin levels | change from baseline in fibronectin level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in the expression of SMAD3 | change from baseline in SMAD3 level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in SMAD4 | change from baseline in SMAD4 level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12 26, 39, 56 weeks | 
| change in NQO-1 | change from baseline in NQO-1 level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in GST-1P | change from baseline in GST-1P level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| change in HO-1 | change from baseline in HO-1 level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 
| Change in Nrf-2/keap-1 | change from baseline in Nrf-2/keap-1 level at weeks 12, 26, 39 and 56 following Exenatide extended release and placebo treatments | 12, 26, 39, 56 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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albuminuria, GLP-1 Receptor Agonist, Type 2 Diabetes