Clinical trial NCT03460899: Impact of Hypoglycaemia in Patients With Diabetes Mellitus Type 2 on Platelet Activation
Official title: Impact of Hypoglycaemia in Patients With Diabetes Mellitus Type 2 on Platelet Activation
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Diabetes Mellitus With Hypoglycemia
Diabetes Mellitus, Type 2
Hypoglycemia
Hypoglycemic Episode
Keywords: Hypoglycaemia
Platelet activity
Type 2 diabetes mellitus
Lead sponsor: Medical University of Graz
Sponsor class: OTHER
Collaborators: name: Merck Sharp & Dohme LLC
First posted: 2018-03-09
Enrollment: 14
Sex: ALL
Minimum age (years): 18
Maximum age (years): 64
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: This experimental study is planned to investigate the impact of hypoglycaemia on platelet activation parameters (PAP) during a hyperinsulinaemic hypoglycaemic clamp study. The hypothesis that hypoglycaemia in patients with Diabetes Mellitus, Type 2 (T2DM) leads to increased platelet activation will be tested.

Detailed description: Increased platelet activation is significantly involved in the pathophysiology of micro- and macrovascular diabetic complications. Previously performed studies suggested platelet activation in both, hyper- and hypoglycaemic states, leading to a potentially increased risk for thromboembolic complications. Hypoglycaemia, in particular severe hypoglycaemic episodes, has been associated with increased cardiovascular or overall mortality in previous studies. Potential mechanisms include arrhythmias or increased risk for thromboembolism, based on platelet activation and/or hypercoagulability.

The aim of this experimental study is to investigate the impact of hypoglycaemia on platelet activation parameters (PAP) during a hyperinsulinaemic hypoglycaemic clamp study. We hypothesize that Hypoglycaemia in patients with T2DM leads to increased platelet activation.

The primary objective is to investigate platelet activation during different levels of hypoglycaemia induced by a stepwise hyperinsulinaemic, hypoglycemic clamp experiment in patients with T2DM.

Active study duration will be 5 days for each study participant. 14 subjects with T2DM without history of cardiovascular events or manifest atherosclerosis will be enrolled. During this monocentric, single arm, open, mechanistic trial platelet activation and recovery at one week after the clamp experiment, changes of pro-atherothrombotic markers during the hypoglycaemic clamp as well as counter regulatory hormone response during the clamp will be investigated.

Eligibility criteria: Inclusion Criteria:

* Male or female aged 18-64 years (both inclusive) at the time of signing informed consent
* Subjects diagnosed with type 2 diabetes (diagnosed regarding world health organization \[WHO\] criteria) and on stable treatment for a period of 90 days prior to screening with metformin as monotherapy or diet only. Stable is defined as unchanged dose
* Body mass index (BMI) between 20.0 and 35.0 kg/m2 (both inclusive)
* HbA1c between 43 and 64 mmol/mol (6.0% - 8.0%) (both inclusive)
* No use of platelet inhibiting therapy (e.g. aspirin, clopidogrel, ticagrelor, prasugrel)

Exclusion Criteria:

* All other forms of diabetes (type 1 diabetes, gestational diabetes) than type 2 diabetes mellitus
* Treatment with any glucose lowering agent(s) other than metformin in a period of 60 days before screening. An exception is short-term treatment (≤ 7 days in total) with insulin due to intercurrent illness
* Impaired hypoglycaemic awareness determined at the discretion of the investigator
* Medical history of arrhythmia as atrial fibrillation, atrial flutter, atrioventricular dissociation disorders or ventricular arrhythmias
* Previously known cardiovascular disease and / or past cardiovascular events, or past episodes of a congestive heart failure syndrome (NYHA II - NYHA IV)
* Severe hypoglycaemic event requiring third party help in the last 6 months
* Known allergy to human insulin or dextrose solution
* Clinically significant abnormal haematology, biochemistry, lipids, hormones, coagulation or urinalysis
* Uncontrolled hypertension defined as resting blood pressure at screening (after resting for 5 min, measured in sitting position) outside the range of 90-160 mmHg for systolic or 50-100 mmHg for diastolic
* Chronic liver failure with severe liver dysfunction as assessed by the investigator
* Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) levels \> 3x upper Limit of normal (ULN)
* estimated Glomerular Filtration Rate (eGFR) \<45 ml/min/1,73 m2
* Any musculoskeletal disorders holding back from stay in bed in a lying position during the time of the clamp experiments
* Treatment with beta-blockers, antiarrhythmic agents or neuroleptic drugs
* Active smoker or intake of illicit substances
* Regular intake of nonsteroidal anti-inflammatory drugs (NSAIDs)
* Any mental disorders or psychiatric conditions which may interfere with understanding or conduction of study related procedures
* Females of child bearing potential without adequate contraceptive methods (i.e. sterilisation, intrauterine device, vasectomised partner; or medical history of hysterectomy)

Primary outcomes:
measure: Changes in Platelet Activation Marker Adenosin Diphosphate (%)
timeFrame: Measurement during different levels of hypoglycaemia as well as 1 and 7 days after the clamp experiment
Secondary outcomes:
measure: Quantification of Platelet Function and Activation PAC1CD62PCD63POS (%)
timeFrame: Measurement during different levels of hypoglycaemia as well as 1 and 7 days after the clamp experiment
measure: Markers of Coagulation Plasminogen Activator Inhibitor-1 (ng/mL)
timeFrame: Measurement during different levels of hypoglycaemia as well as 1 and 7 days after the clamp experiment
measure: Changes in Coagulation Marker Fibrinogen (g/L)
timeFrame: Measurement during different levels of hypoglycaemia as well as 1 and 7 days after the clamp experiment
Other outcomes:
Locations:
city: Graz
country: Austria
facility: Medical University of Graz, Department for Internal Medicine
Study officials:
affiliation: Medical University of Graz, Division of Endocrinology and Diabetology
name: Harald Sourij
role: PRINCIPAL_INVESTIGATOR
References:
citation: Eyileten C, Wicik Z, Keshwani D, Aziz F, Aberer F, Pferschy PN, Tripolt NJ, Sourij C, Prietl B, Pruller F, von Lewinski D, De Rosa S, Siller-Matula JM, Postula M, Sourij H. Alteration of circulating platelet-related and diabetes-related microRNAs in individuals with type 2 diabetes mellitus: a stepwise hypoglycaemic clamp study. Cardiovasc Diabetol. 2022 May 20;21(1):79. doi: 10.1186/s12933-022-01517-5.