Clinical trial NCT04357392: Effect of Glucocorticoid on Exogenous Insulin Antibody Syndrome
Official title: Study on the Effect of Glucocorticoid Intervention on the Improvement of Blood Glucose in Patients With Exogenous Insulin Antibody Syndrome
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: EARLY_PHASE1
Conditions: Diabetes Mellitus, Type 2
Keywords: Insulin
HbA1c
Exogenous Insulin Antibody Syndrome
Glucocorticoids
Lead sponsor: Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University
Sponsor class: OTHER
First posted: 2020-04-22
Enrollment: 20
Sex: ALL
Minimum age (years): 30
Maximum age (years): 60
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomized, double-blind, placebo-controlled, single center, pragmatic clinical trial
Primary purpose: TREATMENT

Brief summary: Diabetic patients who have long-term insulin used can product antibody against exogenous insulin, the investigators named this condition Exogenous insulin antibody syndrome (EIAs). Exogenous insulin antibody can cause blood glucose fluctuation, high blood glucose and refractory hypoglycemia, and have a serious impact on the health of diabetic patients. After adding glucocorticoid, some EIAs patients can reduce insulin dosage, correct hypoglycemia, even eliminate insulin antibody in about half a year, and achieve the goal of blood glucose stability. But up to now, there is no study to evaluate the improvement of blood glucose by glucocorticoid intervention in EIAS patients receiving insulin therapy. This project plans to collect 20 cases of EIAS and carry out a randomized, double-blind, placebo-controlled clinical trial to evaluate the improvement of blood glucose by glucocorticoid intervention.

Detailed description: Diabetic patients who have long-term insulin used can product antibody against exogenous insulin, the investigators named this condition Exogenous insulin antibody syndrome (EIAs).Exogenous insulin antibody can lead to serious clinical consequences , such as blood glucose fluctuations, high blood glucose and refractory hypoglycemia, which is not only affect patients' blood glucose control, but also have a serious impact on the health of diabetic patients. Change to the oral antidiabetic drugs, change the insulin type or add glucocorticoids to the patients with serious disease are the main treatments. However, most of these treatment schemes are case reports, and there is no randomized controlled cohort study on the treatment scheme. The biosynthetic human insulin sequence is exactly the same as that of human insulin. Why do some diabetics have insulin antibody? The investigators speculated that insulin antibody production in some patients with EIAs is related to autoimmune disorder. After adding glucocorticoid, some EIAs patients can reduce insulin dosage, correct hypoglycemia, even eliminate insulin antibody in about half a year, and achieve the goal of blood glucose stability. However, there is no study to evaluate the effect of glucocorticoid intervention on the improvement of blood glucose in the EIAs population. This project plans to collect 20 cases of EIAs and carry out a randomized, double-blind, placebo-controlled clinical trial to evaluate the improvement of blood glucose by glucocorticoid intervention, so as to provide scientific basis for the standardized diagnosis and treatment of EIAs.

Eligibility criteria: Inclusion Criteria:

1. The diagnosis of type 2 diabetes was in accordance with the WHO diagnostic criteria of diabetes in 1999:fasting blood glucose ≥ 7.0mmol/l and / or blood glucose ≥ 11.1mmol/l in 2 hours after OGTT
2. Aged between 30-60 years
3. Positive detection of insulin antibody, hyperinsulinemia (refer to WHO standard in 1999, fasting insulin \> 15 μ IU / ml or 2h postprandial insulin \> 80 μ IU / ml)
4. Type 2 diabetes mellitus patients who receiving insulin therapy
5. Those meeting all the above standards can be included

Exclusion Criteria:

1. Patients who had used animal insulin before the study
2. Type 1 diabetes, gestational diabetes and special type diabetes
3. Diabetic acute complications (ketoacidosis, hyperosmotic nonketotic coma, lactic acidosis) or serious chronic complications ; serious chronic complications (proliferative retinopathy, foot ulcer or gangrene, Complications of heart, brain and kidney)
4. Patients with other serious heart disease, endocrine disease, autoimmune or chronic wasting disease
5. Patients with severe primary diseases such as liver, kidney and hematopoietic system , Patients with psychosis
6. Patients who are using or need to use thiol containing drugs in the near future
7. Patients with severe insulin allergy
8. Glucocorticoid contraindications (severe psychosis and epilepsy, active peptic ulcer or tuberculosis, recent gastrointestinal anastomosis, fracture, wound repair period, corneal ulcer, adrenocortical hyperfunction, severe hypertension, pregnant women, infection beyond the control of antibiotics, such as varicella, mould infection, etc.)

Primary outcomes:
measure: Number of patients with HbA1c <7% at 12 and 24 weeks
timeFrame: 24 weeks
Secondary outcomes:
measure: Blood glucose fluctuation at 4, 12 and 24 weeks
timeFrame: 24 weeks
Other outcomes:
Locations:
Study officials:
affiliation: The Ninth People's Hospital Affiliated to Shanghai Jiaotong University
name: Chen
role: PRINCIPAL_INVESTIGATOR
References: