This study will evaluate the effects of 3 intra-nodal injections of GAD-alum (Diamyd), together with oral vitamin D supplementation. Safety and feasibility of the treatment will be evaluated and also effects on the immune system and on the preservation of endogenous insulin production.
The purpose of the trial is to evaluate the effects of 3 intra-nodal injections of GAD-alum, together with oral vitamin D supplementation, in a population of LADA patients with high GADA titers. Effects will be summarized at 5 and 12 months after the first injection. * The primary objective is to evaluate safety and feasibility of this treatment regimen. * Secondary objectives are to test if the treatment induces a strong GAD-specific immune response similar to what has previously been observed in type 1 diabetes patients and to test for indications of preservation of endogenous insulin production. The study is an open label Phase IIa feasibility trial. It is a pilot study that does not include a placebo arm. Antidiabetic medication in the form of metformin is acceptable before and during the trial. Study participants must be insulin independent at baseline, but if the need for insulin treatment develops during the trial, such treatment will be given. GAD-alum will be injected directly into an inguinal lymph node by a qualified radiologist. Patients will be followed for a total of 12 months during which their endogenous insulin production and immune response will be evaluated at regular intervals throughout the study period. Urine and blood samples will be taken for safety, diabetes status assessments, vitamin D levels and immunological assessments. Concomitant medication and demographics will be collected.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
14
3 intra-inguinal injections (into the lymph nodes) of GAD-alum one month apart. Supplier Diamyd Medical AB in Stockholm, Sweden
1 tablet/day, total daily dose of 2000 IE given per os from day -30 through day 90. Supplier Meda, Solna, Sweden
Department of Endocrinology, St Olavs Hospital
Trondheim, Norway
Akademiskt Specialistcentrum, Centrum for Diabetes, and Karolinska Institute
Stockholm, Sweden
Injection Site Skin Reactions
Injection site skin reactions 1 hour post injection, i.e., erythema, oedema, haematoa, tenderness, pain, itching or other finding.
Time frame: 1 hour
Occurrence of Adverse Events (AEs) During 5 Months From Baseline.
AEs were continuously monitored and registered from the baseline visit (first injection of GAD-alum) to the end of study (12 months after the baseline visit). The total number of AEs registered for all 14 participants during the first 5 months from baseline was summarized when all 14 participants had completed their 5 months study visit (i.e., 5 months after the baseline visit). At the end of study, when all 14 participants had completed their 12 months study visit, the total number of AEs registered for all 14 participants during the 12 months from baseline was summarized.
Time frame: From baseline (first injection of GAD-alum) to 5 months after baseline.
Occurrence of Adverse Events (AEs) During the Study.
AEs were continuously monitored and registered from the baseline visit (first injection of GAD-alum) to the end of study (12 months after the baseline visit/first injection of GAD-alum). The total number of AEs registered for all 14 participants during the first 5 months from baseline was summarized when all 14 participants had completed their 5 months study visit (i.e., 5 months after the baseline visit). At the end of study, when all 14 participants had completed their 12 months study visit, the total number of AEs registered for all 14 participants during the 12 months from baseline was summarized.
Time frame: From baseline (first injection of GAD-alum) to 12 months after baseline.
Serum GAD65A Titers, Change From Baseline at 5 Months After Baseline.
Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 5 months after baseline. Calculation: Value at 5 months minus value at baseline.
Time frame: Baseline (first injection of GAD-alum) and 5 months after baseline.
Serum GAD65A Titers, Change From Baseline at 12 Months After Baseline.
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Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 12 months after baseline. Calculation: Value at 12 months minus value at baseline.
Time frame: Baseline and 12 months after baseline.
Serum GAD65A Titers, Change From Baseline at 12 Months After Baseline.
Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 12 months after baseline. Calculation: Value at 12 months minus value at baseline.
Time frame: Baseline (first injection of GAD-alum) and 12 months after baseline.
Insulin Secretion, Change From Baseline to 5 Months After Baseline.
Values present changes in serum values of glucagon-stimulated C-peptide from baseline (first injection of GAD-alum) to 5 months after baseline. Calculation: Value at 5 months minus value at baseline.
Time frame: Baseline (first injection of GAD-alum) and 5 months after baseline.
Insulin Secretion, Change From Baseline to 12 Months After Baseline.
Values present changes in serum values of glucagon-stimulated C-peptide from baseline (first injection of GAD-alum) to 12 months after baseline. Calculation: Value at 12 months minus value at baseline.
Time frame: Baseline (first injection of GAD-alum) and 12 months after baseline.
Change in HbA1c
HbA1c at 12 months vs. baseline (first injection)
Time frame: from baseline to 12 months after the first injection
Change in Fasting Glucose
Change in fasting glucose at 12 months vs baseline (first injection)
Time frame: From baseline to 12 months after the first injection
Change in Fasting C-peptide
Change in fasting glucose at 12 months vs baseline (first injection)
Time frame: Between baseline and 12 months after the first injection
Change in Maximum C-peptide During Mixed Meal Tolerance Test (MMTT)
Change in maximum C-peptide value at 12 months vs baseline (first injection)
Time frame: between baseline 12 months after the first injection