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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03765359
Other study ID # Diabetes2017
Secondary ID 2016-005031-32
Status Completed
Phase Phase 4
First received
Last updated
Start date August 5, 2019
Est. completion date December 19, 2022

Study information

Verified date June 2023
Source Tampere University Hospital
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The study investigates whether additional metformin medication in combination with regular insulin treatment will decrease the need of insulin for women with diabetes mellitus type 1 during pregnancy.


Description:

Insulin resistance during pregnancy of diabetes mellitus type 1 patients (DM1) increases the need for insulin and makes it more difficult to maintain normoglycemia. Fetal exposure to hyperglycemia induces macrosomia which increases fetal and neonatal morbidity and mortality. Further more obesity and excess weight gain during pregnancy enhances insulin resistance and it's an independent risk factor for fetal macrosomia. Metformin is a medical treatment for type 2 diabetes (DM2) where consequential pathophysiology includes insulin resistance. It reduces hepatic glucose production and enhances the use of glucose in muscles relieving insulin resistance. Metformin has also found to inhibit weight gain effectively. Metformin has approved to be safe and effective in patients with gestational diabetes (GDM). It has found to reduce weight gain and improve postprandial blood glucose levels during pregnancy and reduce neonatal birth trauma in GDM. However, there are no previous studies about the use of metformin in pregnant women with DM1. Two hundred women with DM1 will be randomized to get placebo or metformin in addition to regular insulin treatment. The sample size has been estimated to demonstrate the difference of 15 % in the need to increase insulin dosages during the pregnancy between the study groups.


Recruitment information / eligibility

Status Completed
Enrollment 101
Est. completion date December 19, 2022
Est. primary completion date December 19, 2022
Accepts healthy volunteers No
Gender Female
Age group N/A and older
Eligibility Inclusion Criteria: - a pregnancy of a woman with type 1 diabetes. Exclusion Criteria: - multiple pregnancy, significant underlying disease (hearth disease, kidney transplant, IBD (inflammatory bowel disease ), SLE (systemic lupus erythematosus ), diseases with use of high dosage corticosteroids (severe asthma or rheumatic disease), severe complications of diabetes (nephropathy, neuropathy, gastroparesis or severe retinopathy), substance abuse, smoking, BMI <18, strong early pregnancy nausea (=hyperemesis)

Study Design


Intervention

Drug:
metforminhydrochloride
metformin 500 mg tablets and insulin
Placebo Oral Tablet
Placebo tablets mimic metformin 500 mg tablets and insulin

Locations

Country Name City State
Finland Helsinki University Hospital Helsinki
Finland Central Finland Health Care District Jyväskylä
Finland Oulu University hospital Oulu
Finland Tampere University Hospital Tampere
Finland Turku University Hospital Turku

Sponsors (5)

Lead Sponsor Collaborator
Tampere University Hospital Central Finland Hospital District, Helsinki University Central Hospital, Oulu University Hospital, Turku University Hospital

Country where clinical trial is conducted

Finland, 

Outcome

Type Measure Description Time frame Safety issue
Primary Changes in the insulin need during pregnancy The insulin dosage (IU/ml) in two weeks sets from 5-10 gestational weeks until the delivery
Secondary Blood glucose balance during pregnancy HbA1c HbA1c (mmol/mol) from gestational weeks 5 until the delivery
Secondary Blood glucose balance during pregnancy AVG, SD, CV mean blood glucose (mmol/l) level, standard deviation (SD) and the coefficient of variation of the blood glucose levels from gestational weeks 5 until the delivery
Secondary Change in the weight Weight gain (g) during pregnancy from gestational weeks 5 until the delivery
Secondary Change in the blood pressure Blood pressure (mmHg) from gestational weeks 5 until the delivery
Secondary Incidence of pre-eclampsia Incidence of pre-eclampsia (%) from gestational weeks 20 until the delivery
Secondary Incidence hepatogestosis Incidence hepatogestosis (%) from gestational weeks 20 until the delivery
Secondary Pregnancy complications Incidence proteinuria (mg/mmol or mg/d) from gestational weeks 5 until the delivery
Secondary macrosomia estimated fetal weight in ultrasound (grams) from gestational weeks 20 until the delivery
Secondary Pregnancy complications incidence of miscarriage (intrauterine death before 22 weeks of gestation or fetal weigth under 500g) (%) 12-22 weeks of gestation
Secondary Pregnancy complications incidence of intrauterine death (intrauterine death after 22 weeks of gestation or fetal weigth over 500g) (%) 22-40 weeks of gestation
Secondary Thigh fractional volume ultrasound Fetal weight estimation (g) is specified by thigh fractional volume ultrasound program from gestational weeks 20 until delivery
Secondary Rate of the caesarean sections Rate of the caesarean sections (%) The delivery
Secondary Labour rate of spontaneous delivery (%) The delivery
Secondary Rate of the operative vaginal deliveries Rate of the operative vaginal deliveries (%) The delivery
Secondary Rate of the shoulder dystocia Rate of the shoulder dystocia (%) The delivery
Secondary Labor complications rate of induced delivery (%) The delivery
Secondary Rate of the perineal tears Rate of the perineal tears (%) The delivery
Secondary Postpartum bleeding postpartum bleeding (ml) The delivery
Secondary Newborn variables (gestational age) Rate of the premature deliveries (=deliveries before 37 weeks of gestation) (%) After the delivery
Secondary Newborn variables weight of the newborn (g) After the delivery
Secondary Newborn outcome Acidosis of the newborn (pH) After the delivery
Secondary Newborn outcome (intensive care) The need of NICU (neonatal intensive care unit) treatment (days) After the delivery
Secondary Newborn outcome (hypoglycemia) The occurrence of hypoglycemia (=plasma glucose under 2.6mmol/l or usage of iv glucose infusion) (%) After the delivery
Secondary Newborn outcome (Erb's) Incidence of the Erb's paresis (%) After the delivery
Secondary Cost benefit calculations (sick leaves) The need of sick leaves during pregnancy (days) from gestational weeks 12 until delivery
Secondary Cost benefit calculations (visits to maternity outpatient clinic or internal medicine policlinic) The need of polyclinical controls during pregnancy (number of visits/pregnancy) 14-40 weeks of gestation
Secondary Cost benefit calculations (hospitalization) The need of hospitalization during pregnancy (days/pregnancy) 14-40 weeks of gestation
Secondary Cost benefit calculations (all outpatient visits after delivery ) The need of policlinical controls of the diabetic mother after the delivery (number of visits) One year after the delivery
Secondary Cost benefit calculations (hospitalization after delivery, all departments) The need of hospitalization of the diabetic mother after the delivery (days) Up to one year after the delivery
Secondary Cost benefit calculations (all hospitalization of the child) The need of hospitalization of the child (days) Until the age of one year
Secondary Cost benefit calculations (all policlinical controls of the child) The need of policlinical controls of the child (number of visits) Until the age of one year
Secondary high sensitive-CRP high sensitive-CRP (mg/l) 7-10, 26-28 and 34-36 weeks of gestation
Secondary lipids cholesterol, high density lipoprotein, low density lipoprotein, triglyserids (mmol/l) 7-10, 26-28 and 34-36 weeks of gestation
Secondary Inflammatory markers adiponectin, leptin, resistin, IL-6, TNF-a (pg/ml) 7-10, 26-28 and 34-36 weeks of gestation
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