Type 1 Diabetes Clinical Trial
Official title:
A Pilot Study to Evaluate the Safety of Terbutaline in Children With Type 1 Diabetes
The purpose of the study is to gain experience with the use of terbutaline in children with T1D and to determine that there is not a frequent serious, unexpected, uncontrollable effect on short-term glycemic control. Some information also will be obtained with regard to whether terbutaline, in the dosing being used in the study, is sufficiently well tolerated to expect that adherence will be satisfactory in a large randomized trial. In addition, this pilot study will provide data on the accuracy of a continuous glucose monitor during terbutaline use to verify that the drug does not impact on sensor function.
Approximately 10 children will be recruited from five centers in the United States to
participate in this study. The data collected in this pilot study will be used to determine
whether to proceed to a randomized trial using the dose of terbutaline being used in the
pilot study or the need for additional pilot testing with a lower dose of terbutaline.
Beginning the Study
When a chid enters the study, the following will be done:
1. After eligibility is determined, informed consent and assent are obtained from the
parent/guardian and subject.
2. An unblinded CGM will be used and blood ketones will be checked each morning by the
subject for at least one week. Subjects may be asked to wear an Actiwatch monitor each
night.
3. Terbutaline will be initiated during a CRC admission and continued following the CRC
stay for 21-28 days.
• Subjects weighing between 25 and 45 kg will be treated with a nightly oral dose of
2.5 mg and subjects who weigh more than 45 kg will be treated with 3.75 mg.
4. The CRC admission will last approximately 18-20 hours and include the following:
- Monitoring of effects of terbutaline by measurement of heart rate, blood pressure,
blood and interstitial glucose, lactate, ketones, NEFA, B-OH butyrate
- Assessment of the accuracy of the CGM by comparing sensor glucose values to blood
glucose values
5. The outpatient phase will last 21-28 days and include the following:
- Nightly use of terbutaline as described above
- Use of an unblinded CGM on a daily basis to monitor the glucose levels
- Subjects may be asked to wear the Actiwatch monitor overnight
- Measurement of blood ketones each morning
- Phone calls to each subject on the first outpatient day of terbutaline use and
then approximately every 3 days (twice a week) until the end of the subject's
follow up.
6. Second CRC admission to mirror the first admission between 21 and 28 days after
initiation of terbutaline
7. Follow up for 1-2 weeks after discontinuation of terbutaline until glucose control is
back to prestudy level.
Procedures at home after hospital stay
1. Terbutaline will be taken orally each day prior to bedtime.
2. Each subject will continue to use a CGM, with instructions to use it as close to 24/7
as possible.
3. Prior to each phone call, the subject will be instructed to download the CGM and either
email or fax the file to the clinic so that the glucose data can be reviewed during the
phone contacts.
4. Each subject will be provided with an HGM and test strips. The HGM will be used for
calibration of the CGM and to confirm high and low values on the CGM prior to acting on
them. It will be downloaded at the end-of-study CRC admission. The subject will be
asked to measure blood ketones each morning using the meter and strips that will be
provided.
5. Each subject may be asked to wear an Actiwatch each night to measure movement while the
subject is sleeping.
6. Phone calls to each subject will be made after the first outpatient day of terbutaline
use and then approximately every 3 days (twice a week) until the end of the subject's
follow up plus an about 7 days after terbutaline is discontinued.
7. Prior to the end-of-study CRC admission, follow-up visits can occur at any time at the
discretion of the investigator.
End of study admission
The end-of study CRC admission will occur after 21-28 days of the outpatient phase.The
protocol will be identical to the protocol for the first CRC admission. The dinner and
breakfast meals will be identical to the meals given during the first admission.
The sensors will be removed prior to discharge, unless the investigator decides it would be
beneficial to continue a CGM for 1-2 weeks to assist in the maintenance of glucose control
after terbutaline has been stopped.
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Endpoint Classification: Safety Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Prevention
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