Protocol Number: 09-DK-0056
- Type 1 diabetes (T1D) occurs when the immune system attacks insulin-producing cells (beta cells) in the pancreas, resulting in their death. - Insulin injections currently are the best method for controlling blood sugar in individuals with T1D. However, animal studies have shown that the drugs sitagliptin and lansoprazole can help reverse beta cell damage or develop new beta cells. In addition, Diamyd has been shown to weaken the immune process that attacks pancreatic beta cells. Objectives: - To find out whether a combination treatment of sitagliptin, lansoprazole, and Diamyd will help maintain functioning beta cells and/or cause new beta cells to form. - To determine how the drug combination affects insulin doses and blood sugar control. - To determine whether the drug combination affects the immune response involved in T1D. Eligibility: - Patients 16 to 30 years of age diagnosed (within the preceding 4 months) with laboratory-confirmed diabetes caused by an immune response directed against pancreatic beta cells. Design: - The study, lasting approximately 25 months, will consist of four periods: screening period (laboratory and clinical testing), run-in period (close monitoring of blood glucose via Web-based program; 4-6 weeks), active treatment period (12 months), and follow-up period (12 months). - Study participants will be randomly assigned to two groups: -Group A (placebo): Participants will receive insulin therapy adjusted to keep the blood sugar as close to normal as possible, 2 sugar pills (in place of sitagliptin and lansoprazole), and salt water injections (in place of Diamyd). -Group B (treatment): Participants will receive insulin therapy as in Group A, sitagliptin (100 mg once daily for adults; 50 mg once daily for children) and lansoprazole (30 mg twice daily for adults; 30 mg once daily for children) in pill form, and Diamyd injections (at initial treatment, 4 weeks, and 12 weeks). - Evaluations during the active treatment period: -Mixed meal studies: Participants in Groups A and B will drink the milkshake-like Boost High Protein to stimulate insulin production; blood will be drawn immediately thereafter and every 30 minutes for 2 hours to measure hormones in the blood stream. This procedure will be done a total of 5 times during the 25-month period. -Frequently sampled intravenous glucose tolerance test: After a 12-hour overnight fast, participants will be given IV glucose for 1 to 2 minutes in addition to a small amount of insulin. Blood will be collected at specified frequencies for up to 3 hours to measure sensitivity to insulin. This procedure will be done a total of 3 times during the 25-month period. - Evaluations during the follow-up period: -Blood and urine laboratory tests in addition to mixed meal studies.
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National Institutes of Health Clinical Center
Bethesda, Maryland 20892. Last update: 08/12/2009
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