This is a non-inferiority, multi-center, randomized, controlled, single-blind, two-way crossover efficacy and safety study in subjects with Type 1 diabetes mellitus. The study involves two daytime clinical research center (CRC) visits with random assignment to receive G-Pen™ glucagon 1 mg during one period and Lilly Glucagon 1 mg during the other. Each daytime visit is preceded by an overnight stay in the CRC. In the morning of the inpatient study visit, the subject is brought into a state of hypoglycemia through IV administration of regular insulin diluted in normal saline. After a hypoglycemic state with plasma glucose \< 50 mg/dL is verified, the subject is administered a dose of G-Pen or Lilly Glucagon via subcutaneous injection. Plasma glucose levels are monitored for up to 180 minutes post-dosing, with a value of \>70.0 mg/dL within 30 minutes of glucagon administration indicating a positive response. After 3 hours, the subject is given a meal and discharged when medically stable. After a wash-out period of 7 to 28 days, subjects return to the CRC, and the procedure are repeated with each subject crossed over to the other treatment. A follow-up visit as a safety check is conducted 2-7 days following administration of the final dose of study drug.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
81
1 mg subcutaneous injection of G-Pen (glucagon injection) administered via auto-injector
1 mg subcutaneous injection of Lilly Glucagon (glucagon injection \[RNDA Origin\])
ProSciento, Inc.
Chula Vista, California, United States
Diablo Clinical Research, Inc.
Walnut Creek, California, United States
Atlanta Diabetes Associates
Atlanta, Georgia, United States
Rainier Clinical Research Center, Inc.
Renton, Washington, United States
LMC ESD, Inc.
Toronto, Ontario, Canada
Altasciences Algorithme Pharma
Montreal, Quebec, Canada
Number of Subjects With a Positive Glucose Response
Increase in plasma glucose concentration from below 50.0 mg/dL to greater than 70.0 mg/dL within 30 minutes after receiving glucagon
Time frame: 0 to 30 minutes post dose
Time for Positive Glucose Response
Time from administration of glucagon for plasma glucose to rise from below 50.0 mg/dL to above 70.0 mg/dL
Time frame: 0 to 180 minutes post dose
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Positive Glucose Increase
A positive response for this endpoint is a return of plasma glucose to \> 70 mg/dL or an increase in plasma glucose by ≥20 mg/dL within 30 minutes after receiving glucagon
Time frame: 0 to 30 minutes post dose
Number of Subjects With a Positive Glucose Increase
Increase in plasma glucose by ≥ 20.0 mg/dL within 30 minutes after receiving glucagon
Time frame: 0 to 30 minutes post dose
Time for Positive Glucose Increase
Time from administration of glucagon for plasma glucose to increase by ≥20 mg/dL from baseline
Time frame: 0 to 180 minutes post dose
Number of Subjects With a Positive Response for the Combination Endpoint: Positive Glucose Response/Relief of Neuroglycopenic Symptoms
A positive response for this endpoint is a return of plasma glucose to \> 70 mg/dL or clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time frame: 0 to 30 minutes post dose
Number of Subjects With Relief of Neuroglycopenic Symptoms
Clearance of all neuroglycopenic symptoms of hypoglycemia within 30 minutes after receiving glucagon. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time frame: 0 to 30 minutes post dose
Time to Resolution of Autonomic Symptoms
Time from administration of glucagon to complete resolution of 4 autonomic symptoms of hypoglycemia. Symptoms included: sweating, tremor, palpitations and feeling of nervousness.
Time frame: 0 to 180 minutes post dose
Time to Resolution of Neuroglycopenic Symptoms
Time from administration of glucagon to complete resolution of 4 neuroglycopenic symptoms of hypoglycemia. Four symptoms were assessed: dizziness, blurred vision, difficulty in thinking and faintness.
Time frame: 0 to 180 minutes post dose
Time to Resolution of the Feeling of Hypoglycemia
Time from administration of glucagon to resolution of the overall sensation of hypoglycemia. Subjects were asked to answer yes/no to the question, "Do you feel hypoglycemic?" The time point as which the subject first answered "no" was considered the time of resolution.
Time frame: 0 to 180 minutes post dose
Glucose AUC
Area under the curve for plasma glucose.
Time frame: 0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Glucose Cmax
Maximum concentration of plasma glucose.
Time frame: 0 to 180 minutes post dose - Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Glucose Tmax
Time to maximum concentration of plasma glucose. Blood samples for assessment of blood glucose concentration were collected every 5 minutes post-dose to 90 minutes, and then at 120, 150 and 180 minutes post dose.
Time frame: 0 to 180 minutes post dose
Glucagon Preparation and Administration Time
Time required to prepare and inject glucagon as measured between a "decision to dose" and completion of the injection
Time frame: 0 to 5 minutes pre-dose
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