E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
type 2 diabetes with morbid obesity |
type 2 diabetes met morbide obesitas |
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E.1.1.1 | Medical condition in easily understood language |
diabetes and obesity |
diabetes and obesitas |
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E.1.1.2 | Therapeutic area | Diseases [C] - Hormonal diseases [C19] |
MedDRA Classification |
E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To establish the efficacy of 1.8 mg liraglutide compared to liraglutide-placebo in reducing glycemic variability and achieving glycemic control during 16 weeks treatment before surgery and 48 weeks (week 4 to 52) treatment after gastric bypass surgery for morbid obesity complicated by DM2. |
De effectiviteit van 1.8 mg liraglutide te vergelijken met placebo in het verminderen van glycemische variabiliteit en controle gedurende 16 weken behandeling voor bariatrische chirurgie en 48 weken (week 4 tot 52) na behandeling middels een gastric bypass voor morbide obesitas gecompliceerd door type 2 diabetes. |
|
E.2.2 | Secondary objectives of the trial |
To establish the efficacy of 1.8 mg liraglutide compared to liraglutide-placebo in inducing a change in body weight, cardiovascular risk profile and patient reported outcomes (quality of life, eating behaviour and dumping syndrome score).
To establish a biobank containing blood (plasma), DNA, subcutaneous and visceral fat, as well as gastro-intestinal tissues with the intention to future research on the effects of liraglutide on adipose tissue and gastro-intestinal endocrine cells. |
De effectiviteit van 1.8 mg liraglutide te vergelijken met placebo in het induceren van een verandering in lichaamsgewicht, cardiovasculair risicoprofiel en door de patient zelf gerapporteerde uitkomstmaten zoals kwaliteit van leven, dumpingklachten en eetgedrag.
Een biobank te maken met bloed (plasma) monsters, DNA, subcutaan en visceraal vet en gastrointestinaal weefsel met de bedoeling daarmee toekomstig onderzoek te kunnen doen naar de effecten van liraglutide op vetweefsel en entero-endocriene cellen. |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- give written informed consent,
- age ≥ 18 and ≤65 years,
- type 2 diabetes mellitus on diet/lifestyle intervention with or without metformin,
- a body mass index ≥ 35 kg/m2 (1991 NIH Guidelines for Bariatric Surgery),
- for women of childbearing age, must have a negative pregnancy test at screening, and agree to use contraceptives for the duration of the study,
- are able to understand and comply with the study process. |
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E.4 | Principal exclusion criteria |
- a diagnosis of type 1 diabetes mellitus, LADA or MODY,
- patients with severe gastrointestinal disease, including gastroparesis,
- have a contraindication for bariatric surgery,
- an endocrine form of obesity (e.g. Cushing syndrome),
- breastfeeding
- currently using or have used within three months before this trial: any drug for the treatment of obesity (patients must also agree to not use these medications for the duration of the study),
- treatment with any investigational drug in the last 30 days,
- symptomatic coronary heart disease,
- impaired renal function (creatinin clearance < 60 ml/min/m2),
- hepatic disease other than steotosis hepatis,
- an active malignancy other than basal cell skin carcinoma,
- previous treatment with GLP-1 receptor agonists (including liraglutide or exenatide) within the last 3 months,
- use any other medication for the treatment diabetes than metformin (e.g. TZD, SU, DPP-IV inhibitors, insulin). If considered appropriate on the basis of glycemic regulation this medication can be stopped, thereby making patients eligible for the study.
- have experienced hypersensitivity reaction or a worsening of glycemic control on GLP-1 receptor agonists (including liraglutide or exenatide),
- a history of Major Depressive Disorder within the last 2 years,
- a history of other severe psychiatric disorders, e.g., schizophrenia, bipolar disorder,
- a PHQ-9 score of ≥ 15,
- any lifetime history of a suicidal attempt,
- in the opinion of the investigator, patient is abusing alcohol and/or drugs,
- screening calcitonin ≥ 50 ng/L,
- a family or personal history of multiple endocrine neoplasia type 2 (MEN2) or familial medullary thyroid carcinoma (FMTC),
- a personal history of non-familial medullary thyroid carcinoma,
- a history of chronic pancreatitis or idiopathic acute pancreatitis.
- Insufficient mental capacity in the opinion of the investigator |
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E.5 End points |
E.5.1 | Primary end point(s) |
1. Glycemic variability (glucose SD, Mean Amplitude of Glucose Excursions (MAGE), 24 hour glycemic variation) as measured by blinded CGM,
2. Glycemic control (SMBG and HbA1c, time spend in hyper- and hypoglycaemia, 1.5-anhydroglucitol),
3. Glucose peak and nadir after a Mixed Meal Tolerance Test (MMTT). |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
Change from baseline to day before operation and to 52 weeks post-operation.
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E.5.2 | Secondary end point(s) |
Change from baseline to day before operation and to 52 weeks post-operation in
1. percentage body weight, absolute body weight, and excess BMI.
2. Cardiovascular risk profile: waist circumference, systolic and diastolic blood pressure, hsCRP, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, urinary albumin-creatinin ratio, medication for hypertension and dyslipidemia.
3. Insulin, incretins and other gut hormones after an MMTT.
4. Quality of Life (SF-36), Dumping syndrome score, Eating behavior (Dutch Eating Behaviour Questionnaire). |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
Change from baseline to day before operation and to 52 weeks post-operation.
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | No |
E.7.4 | Therapeutic use (Phase IV) | Yes |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | No |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | No |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | No |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 2 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | No |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | No |
E.8.6.2 | Trial being conducted completely outside of the EEA | No |
E.8.7 | Trial has a data monitoring committee | No |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 3 |
E.8.9.1 | In the Member State concerned months | |
E.8.9.1 | In the Member State concerned days | |