Dulaglutide + Exercise for Type 1 Diabetes

(KML002 Trial)

Overseen By Kaitlin Love, MD

Age: 18 - 65

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Virginia

Must be taking: Insulin

Must not be taking: Vasoactive medications

Disqualifiers: Pregnancy, Smoking, Microvascular complications, others

Prior Safety Data This treatment has passed at least one previous human trial

Approved in 2 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

Duration: 14 weeks

64 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are taking certain blood pressure medications (like calcium channel blockers or ACE inhibitors).

What data supports the effectiveness of the drug Dulaglutide (Trulicity) for Type 1 Diabetes?

Dulaglutide (Trulicity) is effective in managing type 2 diabetes by lowering blood sugar levels and reducing body weight, and it has shown benefits in reducing the risk of major heart-related events in patients with type 2 diabetes. While this data is specific to type 2 diabetes, it suggests potential benefits for blood sugar control and heart health that might be relevant for type 1 diabetes when combined with exercise. ^{1 2 3 4 5}

Is the combination of Dulaglutide and exercise safe for people with type 1 diabetes?

The research highlights that exercise can increase the risk of hypoglycemia (low blood sugar) in people with type 1 diabetes, which is a safety concern to consider. However, there is no specific safety data available for the combination of Dulaglutide and exercise in this context. ^{6 7 8 9 10}

How is the drug Dulaglutide unique for treating type 1 diabetes?

Dulaglutide is unique for type 1 diabetes as it is typically used for type 2 diabetes and works by mimicking a hormone that helps control blood sugar levels, which is different from the usual insulin-based treatments for type 1 diabetes. Combining it with exercise may offer a novel approach to managing blood sugar levels in type 1 diabetes patients. ^{6 11 12 13 14}

What is the purpose of this trial?

The investigators will test the hypothesis that, in adults with type 1 diabetes (T1D), glucagon-like peptide-1 receptor agonism (GLP-1RA, i.e. dulaglutide) and exercise training each enhance insulin-mediated skeletal muscle microvascular perfusion via attenuating endothelial oxidative stress and thereby improving endothelial function.

Research Team

Kaitlin Love, MD

Principal Investigator

Associate Professor - Endocrinology

Eligibility Criteria

Adults aged 18-40 with type 1 diabetes for over 5 years, managing it with insulin only, and a stable health condition can join. They must have an HbA1c level below 8.5% and a BMI between 19-34.9 kg/m^2. Those who've smoked recently, have musculoskeletal issues preventing exercise, severe diabetes complications or other unstable diseases cannot participate.

Inclusion Criteria

Your C-peptide level is less than 0.6 ng/ml.

Your body mass index (BMI) is between 19 and 34.9.

I use insulin for my diabetes, either through injections or a pump.

Exclusion Criteria

Your oxygen level is below 90% during screening.

You are allergic to perflutren, which is in the Definity© contrast.

I have diabetes with complications like heart disease, stroke, or nerve damage.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to 14 weeks of either dulaglutide, placebo, or exercise training

14 weeks

2 visits (in-person) at baseline and 14 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Dulaglutide
• Exercise Training

Trial Overview The trial is testing if Dulaglutide (a medication) and regular exercise improve blood flow in muscles by reducing stress on blood vessels in adults with type 1 diabetes. Participants will either receive Dulaglutide or a placebo while following an exercise routine to see which combination works best.

Participant Groups

Group I: Exercise training Active Control 1 Intervention

Supervised high intensity interval training on a stationary bicycle will be conducted 3 days per week for 14 weeks. Participants will warm up at low intensity for 3 min then repeat 1-min bouts of 100% peak power output followed by 1-min recovery at 50 W. Training will start with 6 intervals per session, increasing by 2 intervals every 2 weeks. Sessions will end with a 10-min cool-down.

Group II: Dulaglutide Active Control 1 Intervention

Dulaglutide (0.75 mg/0.5 mL weekly for 2 weeks, then 1.5 mg/0.5 mL weekly for 12 weeks) subcutaneous injection

Group III: Placebo Placebo Group 1 Intervention

Saline subcutaneous injection, volume matched to dulaglutide, i.e. 0.5 mL weekly for 14 weeks

Dulaglutide is already approved in United States, European Union for the following indications:

Approved in United States as Trulicity for:

• Type 2 diabetes mellitus
• Cardiovascular risk reduction in adults with established cardiovascular disease or multiple cardiovascular risk factors

Approved in European Union as Trulicity for:

• Type 2 diabetes mellitus
• Cardiovascular risk reduction in adults with established cardiovascular disease or multiple cardiovascular risk factors

Who Is Running the Clinical Trial?

University of Virginia

Lead Sponsor

Trials

802

Recruited

1,342,000+

Findings from Research

Dulaglutide (Trulicity) is a once-weekly GLP-1 agonist that has been approved for the treatment of type 2 diabetes, providing a convenient dosing schedule for patients.

As the third GLP-1 agonist available, dulaglutide offers an effective option for managing blood sugar levels in individuals with type 2 diabetes, contributing to improved glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dulaglutide (Trulicity): The Third Once-Weekly GLP-1 Agonist. Smith, LL., Mosley, JF., Parke, C., et al.[2020]

Dulaglutide (Trulicity®) is an effective once-weekly treatment for adults with type 2 diabetes, showing good tolerance and efficacy both as a standalone therapy and in combination with other diabetes medications, even in high-risk patients.

In the REWIND trial, dulaglutide significantly reduced the risk of major adverse cardiac events over a median follow-up of 5.4 years, highlighting its cardiovascular benefits alongside glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dulaglutide: A Review in Type 2 Diabetes. Scott, LJ.[2021]

Dulaglutide (Trulicity®) is an effective once-weekly treatment for type 2 diabetes, showing greater glucose-lowering effects compared to metformin, sitagliptin, exenatide, and insulin glargine in Phase III clinical trials involving various patient backgrounds.

It is considered non-inferior to liraglutide, another GLP-1 receptor agonist, and is currently reimbursed in Belgium for patients who have not achieved adequate control with dual oral therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Dulaglutide (Trulicity®), a new once-weekly agonist of glucagon-like peptide-1 receptors for type 2 diabetes]. Scheen, AJ.[2016]

Dulaglutide, a GLP-1 receptor agonist, has shown superior efficacy in lowering blood sugar levels compared to placebo and other diabetes medications, making it a strong option for treating type 2 diabetes.

The drug is administered once a week, has a favorable safety profile with common gastrointestinal side effects, and offers patient satisfaction similar to other GLP-1 receptor agonists, while also promoting weight loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advances in the treatment of type 2 diabetes: impact of dulaglutide. Thompson, AM., Trujillo, JM.[2020]

Dulaglutide (Trulicity™) is an effective once-weekly treatment for type 2 diabetes, showing significant improvements in glycemic control compared to oral metformin and non-inferiority to daily liraglutide in trials lasting up to 104 weeks.

It is generally well tolerated with a low risk of hypoglycemia, although gastrointestinal side effects like nausea and diarrhea are common; it also helps with weight loss, particularly at the higher dose of 1.5 mg.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Dulaglutide: A Review in Type 2 Diabetes. Burness, CB., Scott, LJ.[2015]

A study involving 16 individuals with type 1 diabetes showed that reducing the bolus insulin dose (IAsp) by 50% before and after evening exercise significantly decreased the occurrence of hypoglycemia during and after exercise, enhancing glycemic safety.

Implementing this dose reduction strategy resulted in higher blood glucose levels during the acute post-exercise and nocturnal periods, indicating that careful insulin management can effectively minimize the risk of hypoglycemia in individuals with type 1 diabetes engaging in physical activity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. McCarthy, O., Deere, R., Churm, R., et al.[2021]

In a study involving 48 adults with type 1 diabetes, the use of mini-dose glucagon significantly reduced the incidence of exercise-associated hypoglycemia (EAH) during aerobic exercise, with only 12% experiencing hypoglycemia when using glucagon compared to 39% with a placebo.

Both glucagon treatment arms showed a lower incidence of hypoglycemia without significant differences in adverse events, suggesting that mini-dose glucagon is a safe and effective option for managing blood sugar levels during exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Mini-Dose Ready-to-Use Liquid Glucagon on Preventing Exercise-Associated Hypoglycemia in Adults With Type 1 Diabetes. Aronson, R., Riddell, MC., Conoscenti, V., et al.[2023]

Exercise offers significant protective health benefits for individuals with type 1 diabetes, yet many do not meet recommended activity levels due to concerns about blood glucose management and hypoglycemia.

Advancements in glucose monitoring and insulin pump therapy have improved the ability of people with type 1 diabetes to engage in regular physical activity, and new training methods show promise in enhancing these benefits beyond just insulin regulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Why should people with type 1 diabetes exercise regularly? Codella, R., Terruzzi, I., Luzi, L.[2022]

In a study involving nine adolescents with type 1 diabetes, it was found that glucose infusion rates needed to maintain stable blood sugar levels were higher during and shortly after exercise, indicating an increased risk of hypoglycemia immediately following physical activity.

The research revealed a biphasic pattern of glucose requirements, suggesting that adolescents may face both immediate and delayed risks of nocturnal hypoglycemia after exercising, highlighting the need for careful monitoring and management of glucose levels post-exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. McMahon, SK., Ferreira, LD., Ratnam, N., et al.[2022]

In a study involving 10 adolescents with type 1 diabetes, moderate-intensity exercise performed at midday significantly increased the glucose infusion rate (GIR) needed to maintain normal blood sugar levels, indicating a heightened risk of hypoglycemia during and after exercise.

Unlike previous findings of a biphasic pattern of hypoglycemia risk after late-afternoon exercise, this study found that the risk of hypoglycemia remained elevated for several hours post-exercise without showing a second peak, suggesting different management strategies may be needed based on the timing of exercise.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of midday moderate-intensity exercise on postexercise hypoglycemia risk in individuals with type 1 diabetes. Davey, RJ., Howe, W., Paramalingam, N., et al.[2013]

Regular physical exercise can help individuals with Insulin-Dependent Diabetes Mellitus (IDDM) achieve better body weight management, improve self-image, and reduce cardiovascular risk factors, although its impact on long-term blood sugar control is still debated.

To safely participate in athletic activities, IDDM patients need to understand their metabolic responses to exercise and may require careful monitoring and adjustments to their insulin doses and nutrition plans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diabetes mellitus and exercise. Landry, GL., Allen, DB.[2006]

Consuming 30 g of glucose before moderate-intensity exercise significantly increased blood glucose levels compared to not consuming glucose, indicating that pre-exercise glucose intake can help prevent hypoglycemia in individuals with type 1 diabetes using glargine/glulisine insulin.

Interspersing brief high-intensity intervals during moderate-intensity exercise also reduced the need for dextrose infusions to maintain blood glucose levels, suggesting that this strategy can be effective in managing exercise-induced hypoglycemia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM. Dubé, MC., Lavoie, C., Weisnagel, SJ.[2022]

The online educational tool ExT1D significantly reduced the total duration of exercise-related hypoglycaemia (ErH) by 71% in adults with Type 1 Diabetes, indicating its potential efficacy in managing hypoglycaemia during exercise.

Participants using ExT1D also reported increased confidence in preventing glucose drops during exercise, suggesting that the tool not only helps with safety but also encourages more active lifestyles for those with diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An on-line support tool to reduce exercise-related hypoglycaemia and improve confidence to exercise in type 1 diabetes. Piotrowicz, AK., McGill, MJ., Overland, J., et al.[2022]

Maintaining blood glucose levels close to normal and keeping HbA1c under 7% are crucial for managing type 1 diabetes in children and adolescents, with successful control largely depending on quality diabetes education rather than just the number of daily insulin injections.

Fast-acting and long-acting insulin analogues can improve quality of life for patients, but they do not always lead to lower HbA1c levels, highlighting the importance of individualized insulin regimens and careful monitoring during physical activity to prevent complications like hypoglycemia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Management of type 1 diabetes (insulin, diet, sport): "Dorchy's recipes"]. Dorchy, H.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Dulaglutide (Trulicity): The Third Once-Weekly GLP-1 Agonist. [2020]

2. New Zealand pubmed.ncbi.nlm.nih.gov

Dulaglutide: A Review in Type 2 Diabetes. [2021]

3. Belgium pubmed.ncbi.nlm.nih.gov

[Dulaglutide (Trulicity®), a new once-weekly agonist of glucagon-like peptide-1 receptors for type 2 diabetes]. [2016]

4. New Zealand pubmed.ncbi.nlm.nih.gov

Advances in the treatment of type 2 diabetes: impact of dulaglutide. [2020]

5. New Zealand pubmed.ncbi.nlm.nih.gov

Dulaglutide: A Review in Type 2 Diabetes. [2015]

6. Netherlands pubmed.ncbi.nlm.nih.gov

Extent and prevalence of post-exercise and nocturnal hypoglycemia following peri-exercise bolus insulin adjustments in individuals with type 1 diabetes. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Effect of Mini-Dose Ready-to-Use Liquid Glucagon on Preventing Exercise-Associated Hypoglycemia in Adults With Type 1 Diabetes. [2023]

8. Germany pubmed.ncbi.nlm.nih.gov

Why should people with type 1 diabetes exercise regularly? [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Glucose requirements to maintain euglycemia after moderate-intensity afternoon exercise in adolescents with type 1 diabetes are increased in a biphasic manner. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

The effect of midday moderate-intensity exercise on postexercise hypoglycemia risk in individuals with type 1 diabetes. [2013]

11. United States pubmed.ncbi.nlm.nih.gov

Diabetes mellitus and exercise. [2006]

12. United States pubmed.ncbi.nlm.nih.gov

Glucose or intermittent high-intensity exercise in glargine/glulisine users with T1DM. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

An on-line support tool to reduce exercise-related hypoglycaemia and improve confidence to exercise in type 1 diabetes. [2022]

14. Belgium pubmed.ncbi.nlm.nih.gov

[Management of type 1 diabetes (insulin, diet, sport): "Dorchy's recipes"]. [2022]