Clinical trial NCT04387422: Recurrent Hypoglycemia in Type 1 Diabetes (Aim 2)
Official title: Measurement of Glucose Homeostasis in Human Brain by NMR: Effect of Recurrent Hypoglycemia on Type 1 Diabetes (Aim 2)
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Diabetes Mellitus, Type 1
Lead sponsor: University of Minnesota
Sponsor class: OTHER
First posted: 2020-05-13
Enrollment: 50
Sex: ALL
Minimum age (years): 18
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: BASIC_SCIENCE

Brief summary: This study will explore the cerebral mechanisms of impaired awareness of hypoglycemia (IAH) in type 1 diabetics following exposure to experimental recurrent hypoglycemia (HG). To induce IAH, patients with T1D identified to have normal awareness of hypoglycemia (NAH) will undergo three 2-hour long hypoglycemic clamps. Neurochemical profiles will be measured by high field MRS before and after induction of IAH. Subject glycemic variability and activity/sleep for 1 week before each study will be monitored as all factors have been shown to alter responses to HG.

Detailed description: The long-term goal of this project is to identify how recurrent hypoglycemia (HG) leads to the clinical syndrome of impaired awareness of hypoglycemia (IAH) in type 1 diabetes (T1D).

This study will test the hypothesis that recurrent HG in T1D leads to an upregulation in brain glucose transport and alterations in glutamatergic and GABAergic tone. The investigators will use MRS methodology that permits evaluation of cerebral cortex and hypothalamus in the same session to simultaneously evaluate the cerebral correlates/mediators of impaired awareness and impaired counterregulatory hormone responses (CRR). High MR data quality and reproducibility will be ensured by using high field MR scanners and technical advances (automated voxel placement, real-time voxel position, frequency, shim updates). Continuous glucose monitoring and actigraphy will be used to chronicle glucose variability and activity/exercise/sleep in the weeks before each experiment to assess the impact of these variables on IAH.

Eligibility criteria: Inclusion Criteria:

* Type 1 diabetes diagnosed on clinical or laboratory grounds
* Diabetes duration 2 - 30 years
* Hemoglobin A1C \<8.5%

Exclusion Criteria:

* Impaired awareness of hypoglycemia as determined by the Cox and Gold questionnaires
* Pregnant or plan to become pregnant during the study period
* Uncontrolled hypertension (blood pressure \> 145/95 mmHg at screening)
* Evidence of autonomic neuropathy (presence of orthostatic hypotension or history of gastroparesis)
* Proliferative retinopathy
* Impaired kidney function (GFR \< 45)
* History of myocardial infarction, stroke, seizures, neurosurgical procedures, major depression requiring hospitalization within the last 5 years, arrhythmias
* Current substance abuse
* Use of drugs that can alter glucose metabolism including but not limited to glucocorticoids and niacin, and excluding insulin and glucose lowering drugs used to treat diabetes, as determined by a clinician
* Inability to undergo MRI scanning, including but not limited to unable to remain still in an MRI scanner for more than 30 minutes, claustrophobia, presence of paramagnetic substances or pacemakers in body, weight over 300 lbs
* Unable to complete all study visits or procedures, as determined by the investigator

Primary outcomes:
measure: Glucose kinetics during hyperglycemic clamps before and after induction of IAH
timeFrame: 240 Minutes
Secondary outcomes:
measure: Antecedent glycemia concentration
timeFrame: 14 days
measure: Antecedent physical activity - moderate to vigorous physical activity
timeFrame: 14 days
measure: Antecedent physical activity - light physical activity
timeFrame: 14 days
measure: Antecedent physical activity - sedentary time
timeFrame: 14 days
measure: Antecedent physical activity - energy expenditure
timeFrame: 14 days
measure: Antecedent physical activity - sleep quality
timeFrame: 14 days
Other outcomes:
Locations:
city: Minneapolis
country: United States
facility: University of Minnesota
state: Minnesota
Study officials:
affiliation: University of Minnesota
name: Elizabeth R Seaquist, MD
role: PRINCIPAL_INVESTIGATOR
References: