Longitudinal Study of the GLUcagon REsponse to Hypoglycemia in Children and Adolescents With New-onset Type 1 DIAbetes (GLUREDIA Study): Characteristics and Predictive Biomarkers.

Status: Recruiting
Location: See location...
Intervention Type: Diagnostic test, Other
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

The GLUREDIA study investigates the counter-regulatory response (CRR) during hypoglycemia in children with type 1 diabetes (T1D). Hypoglycemia can lead to severe symptoms, but is normally counteracted by CRR, corresponding to the secretion of hormones to maintain normoglycemia. Hypoglycemia is common in T1DM but some patients develop severe hypoglycemia as a result of CRR dysfunction. Despite several studies in adults, the presence of CRR dysfunction remains unpredictable and not well understood. The objective of GLUREDIA is therefore to describe and predict the evolution of CRR in children with T1DM.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 2
Maximum Age: 30
Healthy Volunteers: t
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‣ De novo type 1 diabetic patient, as per ISPAD criteria;

⁃ Symptoms of hyperglycemia: polyuria-polydipsia-amaigrin +/- Acido ketosis.

⁃ Fasting blood glucose ≥126 mg/dL AND/OR blood glucose ≥200 mg/dL at 120 minutes of an OGTT AND/OR HbA1c ≥6.5% AND/OR a patient with symptoms of hyperglycemia/hyperglycemic crisis (see 8. a. 2.) with random blood glucose ≥200 mg/dL.

∙ Presence in serum of one or more anti-islet autoantibodies (anti-insulin, anti-IA2, anti-GAD65, anti-ZnT8)

• Patients aged between 2 and 30 years

• Minimum weight: 17 kg (for blood samples)

• Male - female patients

• Free, written and oral consent.

‣ De novo type 1 diabetic patient, as per ISPAD criteria;

⁃ Symptoms of hyperglycemia: polyuria-polydipsia-amaigrin +/- Acido ketosis.

⁃ Fasting blood glucose ≥126 mg/dL AND/OR blood glucose ≥200 mg/dL at 120 minutes of an OGTT AND/OR HbA1c ≥6.5% AND/OR a patient with symptoms of hyperglycemia/hyperglycemic crisis (see 8. a. 2.) with random blood glucose ≥200 mg/dL.

⁃ Presence in serum of one or more anti-islet autoantibodies (anti-insulin, anti-IA2, anti-GAD65, anti-ZnT8)

⁃ Patients aged between 2 years and 18 years (\<18 years).

⁃ Male - female patients

⁃ Free, written and oral consent.

‣ Adult older than 18 years.

⁃ Absence of blood marker of diabetes (Absence of antibodies, HbA1C \<6.5%, C-peptide \> 0.18 nmol/L, Fasting blood glucose \< 100 mg/dL, blood glucose at any time \< 200 mg/dL).

⁃ Be a first-degree relative with a patient being followed for diabetes (meeting ISPAD criteria).

⁃ Male - Female

⁃ Free written and oral consent

∙ Cohort of patients followed for cystic fibrosis:

• Pediatric patient between 2 and 18 years of age.

• Diagnosed with cystic fibrosis with impaired pancreatic endocrine function.

• Presents glucose homeostasis disorders (regular hypo/hyper-glycemia).

• Male - female patient

• Free, written and oral consent

∙ Cohort of patients with (sub)total pancreatectomy:

• Pediatric patients between 2 and 18 years of age.

• Follow-up for total pancreatectomy or caudal pancreatectomy

• Presents disorders of carbohydrate homeostasis (regular hypo-/hyper-glycemia)

• Male - female patient

• Free, written and oral consent

‣ Patient who has undergone insulin testing due to suspected growth hormone deficiency or adrenal insufficiency or hypopituitarism.

⁃ Patients between the ages of 2 years and 18 years (\<18 years).

⁃ Male - female patient.

⁃ Free written and oral consent.

‣ Type 1 diabetic patient, as per ISPAD criteria;

⁃ Symptoms of hyperglycemia: polyuria-polydipsia-amaigrin +/- Acido ketosis.

⁃ Fasting blood glucose ≥126 mg/dL AND/OR blood glucose ≥200 mg/dL at 120 minutes of an OGTT AND/OR HbA1c ≥6.5% AND/OR a patient with symptoms of hyperglycemia/hyperglycemic crisis (see 8. a. 2.) with random blood glucose ≥200 mg/dL.

⁃ Presence in serum of one or more anti-islet autoantibodies (anti-insulin, anti-IA2, anti-GAD65, anti-ZnT8)

⁃ Patients aged between 2 and 18 years (\<18 years).

⁃ Male - female patients

⁃ Free, written and oral consent.

‣ De novo type 1 diabetic patient, as per ISPAD criteria;

⁃ Symptoms of hyperglycemia: polyuria-polydipsia-amaigrin +/- Acido ketosis.

⁃ Fasting blood glucose ≥126 mg/dL AND/OR blood glucose ≥200 mg/dL at 120 minutes of an OGTT AND/OR HbA1c ≥6.5% AND/OR a patient with symptoms of hyperglycemia/hyperglycemic crisis (see 8. a. 2.) with random blood glucose ≥200 mg/dL.

⁃ Presence in serum of one or more anti-islet autoantibodies (anti-insulin, anti-IA2, anti-GAD65, anti-ZnT8)

⁃ Patients aged between 2 and 18 years

⁃ Minimum weight: 17 kg (for blood samples)

⁃ Male - female patients

⁃ Free, written and oral consent.

Locations
Other Locations
Belgium
Clinique Universitaires Saint Luc
RECRUITING
Brussels
Contact Information
Primary
Philippe Lysy, Pr
antoine.harvengt@saintluc.uclouvain.be
027641370
Backup
Antoine Harvengt, Dr
antoine.harvengt@saintluc.uclouvain.be
027641370
Time Frame
Start Date: 2022-05-25
Estimated Completion Date: 2025-10-25
Participants
Target number of participants: 1000
Treatments
Experimental: To investigate the evolution of pancreatic α-cell function. (WP1)
Regular clinical and biological monitoring will be conducted during this period, as well as four insulin-induced hypoglycemia (IIH) tests. Hormones and other blood parameters will be measured, and an analysis of the genome, proteome, and micro-RNAs (miRs) will be performed during these IIH tests and throughout the biological monitoring. The primary goal of this study is to find a correlation between the patient's phenotype and the various biological results obtained, mainly blood biomarkers, in order to subsequently determine models to predict the state of pancreatic α-cell function in the first months post-diagnosis.
Active_comparator: Conduct an assessment of the management of severe hypoglycemia. (WP2)
Study of glycemic variations collected by the continuous glucose monitoring sensor in the days preceding a severe hypoglycemia. The aim of this analysis is to identify a specific glycemic profile in patients in the days leading up to severe hypoglycemia in order to better anticipate such events.
Experimental: Evaluate the α-cell function in first-degree relatives of patients with type 1 diabetes. (WP3)
In this cohort of relatives, the investigators will evaluate the function of pancreatic α-islets and the counter-regulation mechanism. This evaluation will have two main objectives. The first objective will be to compare this counter-regulation mechanism between individuals without type 1 diabetes and patients with type 1 diabetes. The second objective is to determine whether the dysfunction of the counter-regulation mechanism in diabetic patients is solely due to type 1 diabetes or if there is a familial component to this dysfunction.
Experimental: Characterize the glycemic profile and α-cell function. (WP4)
The aim is to assess residual function in patients with pancreatic disease, the phenomenon of counter-regulation and its impact on carbohydrate metabolism. To this end, IIH tests will be carried out in these patients, during which blood samples will be taken as in patients with type 1 diabetes (see above). This group of patients will also serve as a control group for the study of our diabetic patients.~Patient with : exocrine dysfunction of the pancreas either as a consequence of cystic fibrosis or as a consequence of (sub)total pancreatectomy.
Active_comparator: Evaluate the phenomenon of counter-regulation in patients with proven growth hormone. (WP5)
These patients will serve as control groups for our GLUREDIA study to assess counter-regulation in our diabetic patients.~Patient with : groth hormone or adrenal hormone deficiency and in healthy patients with no proven hormone deficiency.
Experimental: Study the link between the clinical characteristics of diabetic patients and their genome (WP6)
For each participant, the investigators will study their clinical history and the evolution of their glycemic parameters from diagnosis to the date they agreed to take part in the study (retrospective analysis). Next, each patient's exome will be analyzed from a blood tube taken during a consultation following agreement to take part in the study. With these analyses, the investigators hope to gain a better understanding of the clinical course of our diabetic patients and their risk of severe hypoglycemia.
Experimental: Evaluation of the circadian rhythm of glucagon (WP7)
After recruitment, each participant will complete a questionnaire assessing their sensitivity to hypoglycemia. Based on their responses and phenotype, participants will be divided into two cohorts for analysis. Subsequently, a glucagon profile will be established for each participant through quarterly consultations involving blood samples taken by a pediatric nurse.
Related Therapeutic Areas
Sponsors
Collaborators: The Leona M. and Harry B. Helmsley Charitable Trust
Leads: Cliniques universitaires Saint-Luc- Université Catholique de Louvain

This content was sourced from clinicaltrials.gov