E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
Diabetes Mellitus, Type 1 |
Diabete Mellito tipo 1 |
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E.1.1.1 | Medical condition in easily understood language |
Type 1 diabetes |
diabete tipo 1 |
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E.1.1.2 | Therapeutic area | Diseases [C] - Nutritional and Metabolic Diseases [C18] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | LLT |
E.1.2 | Classification code | 10045228 |
E.1.2 | Term | Type I diabetes mellitus |
E.1.2 | System Organ Class | 100000004861 |
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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 |
1. To compare the effect on glycaemic control of insulin degludec once daily plus insulin aspart 2-4 times daily with meals and insulin detemir once daily or twice daily plus insulin aspart 2-4 times daily with meals in a population of pregnant women with type 1 diabetes mellitus. |
Confrontare l'effetto in termini di controllo glicemico del trattamento con insulina degludec IDeg OD rispetto all'insulina detemir OD/BID entrambe in aggiunta all' insulina aspart 2-4 volte al giorno assunta ai pasti in donne incinte con DMT1. |
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E.2.2 | Secondary objectives of the trial |
1. To compare the effect on maternal safety of insulin degludec once daily plus insulin aspart 2-4 times daily with meals and insulin detemir once daily or twice daily plus insulin aspart 2-4 times daily with meals in a population of pregnant women with type 1 diabetes mellitus. 2. To compare the effect on pregnancy outcome of insulin degludec once daily plus insulin aspart 2-4 times daily with meals and insulin detemir once daily or twice daily plus insulin aspart 2-4 times daily with meals in a population of pregnant women with type 1 diabetes mellitus. |
Confrontare l'effetto del trattamento con insulina degludec IDeg OD rispetto all'insulina detemir OD/BID entrambe in aggiunta all' insulina aspart 2-4 volte al giorno assunta ai pasti in donne incinte con DMT1, in termini di: sicurezza materna esito della gravidanza |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
- Female, age at least 18 years at the time of signing informed consent - Diagnosed with type 1 diabetes mellitus for at least 1 year prior to the day of screening - Treated with multiple daily subcutaneous insulin injections or continuous subcutaneous insulin infusion (CSII) or inhaled insulin for at least 90 days prior to the day of screening - The subject is planning to become pregnant within 12 months from randomisation and willing to undertake pre-pregnancy counselling or the subject is pregnant with an intrauterine singleton living foetus (gestational week 8 to 13 (+6 days)) without any observed anomalies at randomisation, confirmed by an ultrasound scan - HbA1c at screening below or equal to 8.0% (64 mmol/mol) by central laboratory |
- Sesso femminile, maggiore/uguale 18 anni di età al momento della firma del modulo di consenso informato. - Soggetti che hanno ricevuto diagnosi di diabete mellito tipo 1 maggiore /uguale 1 anno prima del giorno dello screening (visita 1). - Trattamento con iniezioni giornaliere multiple di insulina per via sottocutanea o con infusione continua di insulina per via sottocutanea (Continuous Subcutaneous Insulin Infusion, CSII) o insulina inalatoria maggiore /uguale 90 giorni prima della visita di screening (visita 1). - Intenzione di avviare una gravidanza nei 12 mesi successivi alla randomizzazione e volontà a sottoporsi a una consulenza pre-gravidanza, oppure il soggetto gravidanza con un feto singolo vivo intrauterino (settimana gestazionale da 8 a 13 [+6 giorni]) senza alcuna anomalia osservata alla randomizzazione, confermata da ecografia. - HbA1c allo screening inferiore /uguale 8,0% (64 mmol/mol) analizzata dal laboratorio centrale. |
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E.4 | Principal exclusion criteria |
- Treatment with any medication for the indication of diabetes or obesity other than stated in the inclusion criteria within the past 90 days prior to the day of screening - Pregnant and having proteinuria as evaluated by urine protein-to-creatinine ratio above or equal to 300 mg/g in urine sample measured at screening - Subject being treated or became pregnant with assistance of in vitro fertilisation or other medical infertility treatment - Receipt of any concomitant medication contraindicated in pregnancy according to local label within 28 days before screening and between screening and randomisation for non-pregnant subjects and 28 days before conception and between conception and randomisation for pregnant subjects - Proliferative retinopathy or maculopathy requiring acute treatment. Verified by fundus photography or pharmacologically dilated fundoscopy performed within the past 90 days prior to randomisation for non-pregnant subjects or within 28 days prior to randomisation for pregnant subjects - History of severe hyperemesis gravidarum (requiring hospitalisation) |
- Trattamento con qualsiasi farmaco indicato per il diabete o l’obesità, diverso da quelli stabiliti nei criteri di inclusione, nei 90 giorni precedenti la visita di screening. - Soggetto in stato di gravidanza e con proteinuria valutata in base al rapporto proteine/creatinina nell’urina maggiore /uguale 300 mg/g in un campione di urina misurato allo screening. - Il soggetto viene sottoposto a oppure avvia una gravidanza supportata da fecondazione in vitro o altro trattamento per l’infertilità. - Trattamento con qualsiasi farmaco concomitante controindicato in gravidanza in base all’etichetta locale nei 28 giorni precedenti lo screening e tra lo screening e la randomizzazione per i soggetti non in stato di gravidanza e nei 28 giorni precedenti il concepimento e tra il concepimento e la randomizzazione perle donne in stato di gravidanza. - Retinopatia proliferativa o maculopatia che necessita di trattamento acuto, verificata per mezzo di fotografia del fondo oculare o fondoscopia per dilatazione farmacologica eseguita entro i 90 giorni precedenti la visita randomizzazione (visita 2) per i soggetti non in stato di gravidanza o entro 28 giorni precedenti la visita randomizzazione (visita 2) per i soggetti in stato di gravidanza. - Anamnesi di iperemesi gravidica grave (tale da richiedere un ricovero in ospedale). |
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E.5 End points |
E.5.1 | Primary end point(s) |
Last planned HbA1c prior to delivery after gestational week (GW) 16. |
Variazione dei valori di emoglobina glicata (HbA1c) alla visita programmata prima del parto rispetto alla settimana gestazionale (GW) 16. |
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E.5.1.1 | Timepoint(s) of evaluation of this end point |
After gestational week 16. |
Dopo la settimana gestazionale (GW) 16. |
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E.5.2 | Secondary end point(s) |
Supportive maternal efficacy endpoints 1- HbA1c minore uguale 6.0% (42 mmol/mol) from last planned HbA1c prior to delivery (yes/no) 2. Last planned average post-prandial glucose (PPG) prior to delivery. Average of three main meals 3. Last planned fasting plasma glucose (FPG) prior to delivery after GW 16 Supportive maternal safety endpoints 4. Number of hypoglycaemic episodes 5. Development of sight-threatening retinopathy defined as proliferative retinopathy or maculopathy (yes/no) 6. Number of adverse events during the pregnancy period 7. Pre-eclampsia defined as new-onset hypertension (blood pressure major equal 140 mmHg systolic or major equal 90 mmHg diastolic, based on at least 2 measurements taken at least 4 hours apart) and simultaneous proteinuria (defined as major = 300 mg protein in a 24 hours urine sample, a protein-to-creatinine ratio of major = 300 mg/g in a urine sample or a urine dipstick protein of 1+) or presence of eclampsia, HELLP syndrome, or other severe organ involvement (yes/no) Supportive pregnancy outcome endpoints 8. Birth weight (kg) 9. Pre-term delivery (delivery < 37 completed GWs) (yes/no) 10. Presence of major abnormalities (classified according to EUROCAT) (yes/no) 11. Live born infants (yes/no) 12. Number of adverse events in the infant 13. Neonatal hypoglycaemic episodes defined as plasma glucose minor = (31 mg/dL) during the first 24 hours after birth or minor = (45 mg/dL) between 24 hours and 48 hours after birth (yes/no) |
Endpoint di supporto di efficacia materna 1. Valori di emoglobina glicata inferiori o uguali a 6,0% alla visita programmata prima del parto(si/no) 2. Ultimo valore medio previsto di glucosio post-prandiale (Post-Prandial Glucose, GPP) alla visita programmata prima del parto. Media di tre pasti principali. 3. Ultimo valore previsto di glicemia a digiuno (Fasting Plasma Glucose, FPG) alla visita programmata prima del parto. Endpoint di supporto di sicurezza materna 4. Numero di episodi ipoglicemici 5. Sviluppo di retinopatia pericolosa per la vista, definita come retinopatia proliferativa o maculopatia (si/no) 6. Numero di eventi avversi durante il periodo di gravidanza 7. Preeclampsia definita come ipertensione di nuovo esordio (pressione sanguigna sistolica maggiore =140 mmHg o diastolica maggiore =90 mmHg, basata su almeno 2 misurazioni acquisite a distanza di almeno 4 ore l'una dall'altra) e proteinuria simultanea (definita come maggiore/uguale 300 mg di proteine in un campione di urine delle 24 ore, un rapporto proteine/creatinina maggiore =300 mg/g in un campione di urine o un valore di proteine 1+ alla striscia reattiva delle urine), oppure presenza di eclampsia, sindrome da HELLP [Hemolysis-Elevated Liver enzyme-Low Platelet (Emolisi-enzimi epatici elevati-piastrine basse)] o altro coinvolgimento serio di organi (s¿/no) Endpoint di supporto di esito della gravidanza 8. Peso alla nascita (kg) 9. Parto pretermine (parto <37 GW completate) (s¿/no) 10. Presenza di anomalie maggiori (classificate secondo la EUROCAT) 11. Bambini nati vivi (si/no) 12. Numero di eventi avversi nel bambino 13. Episodi ipoglicemici neonatali definiti come glicemia minore /uguale (31 mg/dl) o minore/uguale (45 mg/dl) (si/no) |
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E.5.2.1 | Timepoint(s) of evaluation of this end point |
1.-3. After gestational week 16 4. during the pregnancy period (from first day of pregnancy (date of conception) or randomisation (whichever comes last) to delivery) 5. From treatment baseline as well as from pregnancy baseline to the end of treatment visit 6. From first day of pregnancy (date of conception) or randomisation (whichever comes last) to delivery) 7. Occurring from gestational week 20 to delivery 8. -11. At birth 12. From delivery to final follow-up 13. During the first 24 hours after birth or between 24 hours and 48 hours after birth |
1.-3. Dopo la settimana gestazionale 16 4. Durante il periodo di gravidanza (dal primo giorno di gravidanza (data del concepimento) oppure dalla data di randomizzazione (a seconda dell'evento che si verifica per ultimo) fino alla data del parto. 6. Dal primo giorno di gravidanza [inteso come data del concepimento] o dalla randomizzazione [in base all'evento che si verifica per ultimo] al parto) 7. Dalla settimana gestazionale 20 al parto 8.-11. Alla nascita 12. Dal parto al follow-up finale 13. Durante le prime 24 ore dopo il parto o tra le 24 e le 48 ore dopo il parto |
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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 | No |
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) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | No |
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) | Yes |
E.8.2.2 | Placebo | No |
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
| No |
E.8.4 | The trial involves multiple sites in the Member State concerned | Yes |
E.8.4.1 | Number of sites anticipated in Member State concerned | 5 |
E.8.5 | The trial involves multiple Member States | Yes |
E.8.5.1 | Number of sites anticipated in the EEA | 22 |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Information not present in EudraCT |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
Australia |
Brazil |
Canada |
Israel |
Russian Federation |
Serbia |
European Union |
Argentina |
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E.8.7 | Trial has a data monitoring committee | Yes |
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 | 5 |
E.8.9.1 | In the Member State concerned days | 6 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 5 |
E.8.9.2 | In all countries concerned by the trial days | 6 |