Glucose Evaluation Through Continuous Glucose Monitors in Polycystic Ovary Syndrome

Insulin Resistance Clinical Trial

— GEMS-PCOS  

Official title:

Glucose Evaluation Through Continuous Glucose Monitors in Polycystic Ovary Syndrome

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT06050265
• Other study ID #: 23-39852
• Status: Recruiting
• Phase: N/A
• Start date: November 29, 2023
• Est. completion date: July 2025

Study information

• Verified date: November 2023
• Source: University of California, San Francisco
• Contact: Heather Huddleston, MD
• Phone: 415-885-3674
• Email: heather.huddleston[@]ucsf.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

PCOS is the most common endocrine disorder of reproductive aged women. In addition to menstrual and endocrine abnormalities, PCOS is characterized by insulin resistance and glycemic dysregulation. The pattern of glycemic abnormalities among patients with PCOS may be different than the general population, as evidenced by invasive, time consuming, and costly procedures such as the euglycemic clamp or oral glucose tolerance test. Continuous glucose monitoring (CGM) offers an opportunity to evaluate glycemic status in real world conditions. Furthermore, use of a CGM has been found to improve glycemic status among those with prediabetes and diabetes, but little is known about utility among patients with PCOS. The investigators thus seek to 1) characterize glycemic status using CGM among patients with PCOS and 2) assess the impact of CGM use on metabolic and reproductive health in patients with PCOS.

Description:

Study synopsis:

Recruitment:

• PCOS participants will be recruited from those who are being seen or have previously been seen at the UCSF multidisciplinary PCOS clinic.

• Non-PCOS participants will be recruited from patients being seen at the UCSF Center for Reproductive Health for other clinical evaluations or research projects.

Study protocol:

Aim 1:

Pre-DEXCOM evaluation:

PCOS participants:

• As part of routine clinical care all PCOS participants will have had the following procedures completed:

• Blood work for fasting and 2 hour glucose/insulin, hgba1c, CRP, lipid panel, liver enzymes, SHBG, free and total testosterone, DHEAS, androstenedione, 17-OH-Progesterone, prolactin, TSH, FSH, LH, E2, estrone, Vit D.

• Screening questionnaires on physical exercise using validated International Physical Activity Questionnaire

• In person clinical evaluation including physical exam and history.

• In person transvaginal ultrasound assessment.

• The above are part of standard of care screening for patients with concern for PCOS and are currently routinely completed at the UCSF Center for Reproductive Health in this setting.

• Participants will also be asked to complete a 10 question validated fatigue assessment scale (FAS)

Non-PCOS participants:

• Participants will have blood work for fasting and 2 hour glucose/insulin, hgba1c, CRP, lipid panel, liver enzymes, SHBG, free and total testosterone, DHEAS, androstenedione, 17-OH- Progesterone, prolactin, TSH, FSH, LH, E2, estrone, Vit D obtained.

• Screening questionnaires on physical exercise using validated International Physical Activity Questionnaire will be obtained.

• Participants will be asked to complete the same intake questionnaires that PCOS participants complete as part of standard of care practices in the UCSF multidisciplinary PCOS clinic, which include questions on ethnicity, family, medical, and social history.

• If blood work was not completed as part of standard of care for routine clinical evaluation or as part of a previously completed research study in which the patient provided consent for their data to be used in other trials, the above labs will be collected and paid for by the research protocol.

• Participants will also be asked to complete a 10 question validated fatigue assessment scale (FAS)

Procedures:

DEXCOM evaluation:

• PCOS and non-PCOS participants will be given a DEXCOM CGM to wear for 10 days. During this time they will be blinded to the results of the DEXCOM.

• Participants will be asked to complete the automated self-administered 24-hour dietary assessment (ASA24) tool, which is a web based, validated 24 hour dietary record program, produced by the National Cancer Institute (NCI)/Nation Institute of Health and made available free of charge to researchers.

• As part of the ASA24 participants will also be asked about their sleep quality the night prior to their dietary record. See attached module.

• All participants will be asked to complete the ASA24 during a 24 hour period while wearing the CGM.

Aim 2:

Recruitment:

• From those participants with PCOS recruited for Aim 1, a subgroup with evidence of dysglycemia (as outlined in the inclusion criteria) will be recruited for aim 2.

• Participants will be randomized in a 3:1 fashion to intervention with CGM vs control.

Procedures:

Intervention group:

• All participants will receive standard of care nutrition and exercise advice from a trained registered dietician.

• Participants randomized to the intervention arm will also receive education on how to use and monitor blood glucose using the DEXCOM G7 CGM and associated phone application.

• Participants will be asked to use a CGM continuously for 90 days.

• After 90 days blood work for fasting and 2 hour glucose/insulin, hgba1c, CRP, lipid panel, liver enzymes, SHBG, free and total testosterone, DHEAS, androstenedione, 17-OH-Progesterone, prolactin, TSH, FSH, LH, E2, estrone, Vit D will be obtained.

• After 90 days participants will also be asked to repeat a 10 question validated fatigue assessment scale (FAS)

• After 90 days participants will be asked about their menstrual cycle pattern over the 90 day period

Control group:

• All participants will receive standard of care nutrition and exercise advice from a trained registered dietician.

• After 90 days blood work for fasting and 2 hour glucose/insulin, hgba1c, CRP, lipid panel, liver enzymes, SHBG, free and total testosterone, DHEAS, androstenedione, 17-OH-Progesterone, prolactin, TSH, FSH, LH, E2, estrone, Vit D will be obtained.

• After 90 days, participants in the control group will be given the opportunity to receive CGM devices to monitor blood glucose up to 30 days with education on how to use the device and associated phone application to monitor blood glucose.

• After 90 days participants will also be asked to repeat a 10 question validated fatigue assessment scale (FAS)

• After 90 days participants will be asked about their menstrual cycle pattern over the 90 day period

Data Management:

Clinical and laboratory data will be stored in a Research Electronic Data Capture (REDCap) system designed by Dr. Huddleston and research staff. Fields will be designed by study coordinators with input from key investigators. Our team has extensive experience with REDCap architecture and utilization.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 56
• Est. completion date: July 2025
• Est. primary completion date: July 2025
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 45 Years

Eligibility

Inclusion Criteria:

For aim 1:

• Aged 18-45

• Female sex

• Agree to wear a CGM for 10 days

• Have access to an apple or android smart phone for CGM monitoring

• Are able to be characterized as PCOS or non-PCOS using the 2003 Rotterdam criteria for PCOS of 2 or more of the following: 1) biochemical or clinical hyperandrogenism, 2) polycystic ovarian morphology on transvaginal ultrasound, and/or 3) oligo-amenorrhea

For aim 2:

• All of the inclusion criteria for aim 1

• Meet 2003 Rotterdam criteria for PCOS as above

• Evidence of baseline glycemic dysregulation including any of the following: 1) elevated fasting glucose (100-125 mg/dL), 2) elevated 2 hour glucose (140-200 mg/dL), 3) elevated fasting insulin (>10 mIU/mL), 4) elevated 2 hour insulin (>40 mIU/mL), 5) elevated Hgba1c (5.7- 6.4)

Exclusion Criteria:

For both aims 1 and 2:

• Use of metformin or other anti-diabetic agents

• Diagnosis of type I or II diabetes mellitus (including those found to have fasting glucose >126, 2 hour glucose >200, Hgba1c >6.5)

• Prior or current use of CGM

Related Conditions & MeSH terms

• Dysglycemia
• Insulin Resistance
• Polycystic Ovary Syndrome
• Syndrome

Intervention

Device:
• DEXCOM Continuous Glucose Monitor (CGM)
Dexcom CGMs are placed every 10 days and provide a continuous assessment of blood glucose.

Locations

Country	Name	City	State
United States	UCSF Center for Reproductive Health	San Francisco	California

Sponsors (2)

Lead Sponsor	Collaborator
University of California, San Francisco	DexCom, Inc.

Country where clinical trial is conducted

United States, 

References & Publications (3)

Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev. 2012 Dec;33(6):981-1030. doi: 10.1210/er.2011-1034. Epub 2012 Oct 12. — View Citation

Legro RS, Castracane VD, Kauffman RP. Detecting insulin resistance in polycystic ovary syndrome: purposes and pitfalls. Obstet Gynecol Surv. 2004 Feb;59(2):141-54. doi: 10.1097/01.OGX.0000109523.25076.E2. — View Citation

Tatulashvili S, Baptiste Julla J, Sritharan N, Rezgani I, Levy V, Bihan H, Riveline JP, Cosson E. Ambulatory Glucose Profile According to Different Phases of the Menstrual Cycle in Women Living With Type 1 Diabetes. J Clin Endocrinol Metab. 2022 Sep 28;107(10):2793-2800. doi: 10.1210/clinem/dgac443. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Difference between change in hemoglobin A1C	Difference between change in hemoglobin A1C for 2 treatment arms from baseline to after 90 days	90 days
Secondary	Difference between change in fasting insulin	Difference between change in fasting insulin for 2 treatment arms from baseline to after 90 days	90 days