Cystic Fibrosis - Insulin Deficiency Early Action

  • STATUS
    Recruiting
  • End date
    Jun 27, 2023
  • participants needed
    100
  • sponsor
    Sydney Children's Hospitals Network
Updated on 27 September 2021
diabetes
insulin
antibiotic therapy
antibiotics
oral glucose tolerance test
pulmonary function test
malnutrition
genetic disorder
fibrosis
insulin treatment
blood glucose monitoring

Summary

Cystic Fibrosis (CF) is the most common life-threatening genetic condition affecting Australian children. As well as repeated lung infections, children with CF develop insulin deficiency and eventually diabetes. The CF-IDEA trial (Cystic Fibrosis - Insulin Deficiency, Early Action) will determine whether starting insulin treatment before the onset of diabetes (earlier than current practice) will improve the health of children with CF by improving body weight and lung function.

Description

As well as progressive lung disease, patients with Cystic Fibrosis (CF) suffer pancreatic destruction, leading to slow but progressive insulin deficiency. Deficiency of insulin, a powerful anabolic hormone, causes accelerated decline of weight and lung function (important predictors of early mortality in CF).

We analysed Oral Glucose Tolerance Tests sampled every 30 mins and defined stages of CF Insulin Deficiency (CFID) as early glucose abnormalities, CFID1 (BGmax >=8.2 and <11.1mmol/L) and CFID2 (BGmax >=11.1 and BG120min <11.1), progressing to diabetes without fasting hyperglycaemia (CFID3), and finally to diabetes with fasting hyperglycaemia (CFID4). Currently insulin treatment is standard only for CFID3 and 4, but we have data showing that the earlier stages (CFID1 and 2) are also associated with declining weight and lung function.

In the CF-IDEA Trial, subjects with CF aged >=5 years with early glucose abnormalities (CFID1 or 2) will be randomised to once-daily insulin detemir (Levemir) for 12 months, or to observation only. We aim to determine whether starting insulin earlier than current practice will prevent decline in weight and lung function, reduce frequency of hospitalisation, improve quality of life, and slow progression through CFID categories.

Our pilot studies using once-daily Levemir in children with CFID1 and 2 found that this simple insulin regimen (rather than multiple daily injections) was well accepted by patients, with minimal hypoglycaemia, and resulted in significant weight gain and improved lung function (compared with 12 months prior to insulin). Sample size calculations for the CF-IDEA Trial are based on our pilot studies. When 70-80% of patients have completed the protocol, the study statistician will perform an interim analysis (blinded to the other investigators) to check the original power calculations.

Stages of CF Insulin Deficiency:

CFID1 Peak BG on OGTT >=8.2mmol/L and <11.1mmol/l.

CFID2 Peak BG on OGTT >=11.1mmol/L and 120 minute BG <11.1.

CFID3 120 minute BG on OGTT >=11.1mmol/L.

CFID4 Fasting hyperglycemia (Fasting BG >=7mmol/L).

Details
Condition diabetes mellitus (dm), Diabetes Mellitus Types I and II, Diabetes Mellitus, Pulmonary Disease, type ii diabetes, Diabetes Mellitus Type 2, Diabetes, Cystic Fibrosis, Pancreatic disorder, Diabetes Mellitus, Type 2, Pancreatic Disorders, NIDDM, type 2 diabetes, Lung Disease, Diabetes (Pediatric), noninsulin-dependent diabetes mellitus, type 2 diabetes mellitus, Diabetes Prevention, diabetes type 2
Treatment Once-daily insulin detemir
Clinical Study IdentifierNCT01100892
SponsorSydney Children's Hospitals Network
Last Modified on27 September 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Patients with CF aged >=5 yrs attending one of the study sites
CFID1 or CFID2 (defined as BGmax >=8.2 and BG120 <11.1mmol/l on OGTT performed within the last 6 months, when respiratory function stable as judged by the treating respiratory team, not taking fluoroquinolone antibiotics, and not taking systemic glucocorticoids)

Exclusion Criteria

Cystic Fibrosis Related Diabetes, defined as CFID3 (BG120 >11.1mmol/L) or CFID4 (fasting BG >7mmol/L). Such patients will be offered insulin treatment as standard clinical care
Unstable respiratory disease (hospital admission for treatment of respiratory exacerbation within the last month)
Treatment with systemic glucocorticoids of more than 1 month duration, within the last 12 months
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