The objective of this study is to evaluate feasibility, safety, and efficacy of endoscopic DMR Treatment Paradigm 1 (compared to sham) and to evaluate feasibility, safety, and efficacy of re-treatment with DMR at 24 weeks (compared to baseline and a single DMR procedure) in patients with type 2 diabetes with non-insulin glucose lowering medications.
The objective of this study is to evaluate feasibility, safety, and efficacy of endoscopic DMR Treatment Paradigm 1 (compared to sham) and to evaluate feasibility, safety, and efficacy of re-treatment with DMR at 24 weeks (compared to baseline and a single DMR procedure) in patients with type 2 diabetes with non-insulin glucose lowering medications. The aimed effect is an adequate or improved glucose regulation and a decrease of HbA1c. Secondary effects include improved cardiovascular, hepatic, and metabolic parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
18
The Revita® System is an endoscopic treatment consisting of a single catheter and console designed to lift the duodenal mucosa with saline followed by controlled circumferential hydrothermal ablation of the mucosa. For this study Revita® DMR procedure will be conducted as follows: DMR Treatment Paradigm 1- After initial 2 Lift and Ablate step, remaining Lift: Ablate steps will be conducted in 1:1 manner.
The sham control for the Revita DMR procedure.
Amsterdam UMC, locatie VUmc
Amsterdam, Netherlands
Safety endpoint
Safety endpoint is evaluated 12 weeks post DMR and 12 weeks post retreatment with DMR \- Number (percentage) of patients experienced device and procedure-related Serious Adverse Events (SAEs), Unanticipated Device Effects (UADEs), Serious Adverse Device Effects (SADEs), Suspected Unexpected Serious Adverse Reaction (SUSARs)
Time frame: 12 weeks post DMR and 12 weeks post retreatment with DMR
Feasibility endpoint 1
Feasibility endpoint is evaluated during and after the procedure: \- Number of ablations, whether a DMR was successful (\>3 ablations)
Time frame: During procedure
Feasibility endpoint 2
Feasibility endpoint is evaluated during and after the procedure: \- Procedure time, defined as time between catheter in and catheter out.
Time frame: During procedure
Efficacy endpoint 1
Efficacy is evaluated at 24 weeks compared to baseline and sham: \- Mean change in Fasting Plasma Glucose (FPG)/Flash Glucose Monitoring (FGM)
Time frame: 24 weeks post DMR/sham
Efficacy endpoint 2
Efficacy is evaluated at 24 weeks compared to baseline and sham: \- Change in HbA1c
Time frame: 24 weeks post DMR/sham
Secondary safety endpoint
Secondary safety endpoint is evaluated during follow-up and compared to baseline and sham at week 24 and compared to baseline and 12 weeks after (re)-DMR for all patients: incidences and event rates of hypoglycemic events during complete study period
Time frame: Through study completion, an average of 1 or 1,5 years
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Efficacy endpoint 1: mean change in HbA1c
Efficacy endpoint 1: mean change in HbA1c
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 2: mean Change in Fasting Glucose
Efficacy endpoint 2: mean Change in Fasting Glucose
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 2: mean Change in Time in Range (TIR)
Efficacy endpoint 2: mean Change in Time in Range
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 3: In patients with baseline abnormal Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), and Gamma Glutamyl Transferase (GGT) values, change in ALT, AST, GGT
Efficacy endpoint 3: In patients with baseline abnormal ALT, AST and GGT values, change in ALT, AST, GGT
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 4: Change in body weight
Efficacy endpoint 4: Change in body weight
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 5: Change in Fasting C-peptide
Efficacy endpoint 5: Change in Fasting C-peptide
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 6: Change in FPG
Efficacy endpoint 6: Change in FPG
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 7: Change in homeostasis model assessment for insulin resistance (HOMA-IR)
Efficacy endpoint 7: Change in HOMA-IR
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 8: Change in Framingham Risk Score-Cardiovascular risk score (FRS-CVD)
Efficacy endpoint 8: Change in Framingham Risk Score-Cardiovascular risk score (FRS-CVD)
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 9: Change in MRI-proton density fat fraction (MRI-PDFF)
Efficacy endpoint 9: Change in MRI-PDFF
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 10: Achievement of HbA1c ≤ 53 mmol/mol (7.0%)
Efficacy endpoint 10: Achievement of HbA1c ≤ 53 mmol/mol (7.0%)
Time frame: Through study completion, an average of 1 or 1,5 years
Efficacy endpoint 11: Change in food intake (amount of calories, fat, carbohydrates, proteins etc.) based on intake registration data
Efficacy endpoint 11: Change in food intake (amount of calories, fat, carbohydrates, proteins etc.) based on intake registration data
Time frame: Through study completion, an average of 1 or 1,5 years
Mechanistic: Change in resection tissue findings in morphological features
Mechanistic: Change in morphological features
Time frame: Week 12 after (re)DMR
Mechanistic: Change in resection tissue findings in functional level changes
Mechanistic: Change in functional level changes
Time frame: Week 12 after (re)DMR
Mechanistic: Change in resection tissue findings in cellular level changes
Mechanistic: Change in cellular level changes
Time frame: Week 12 after (re)DMR
Mechanistic: Mean Changes in small intestinal biopsy gene expression
Mechanistic: Mean Changes in small intestinal biopsy gene expression
Time frame: Week 12 after (re)DMR
Mechanistic: Mean Changes in small intestinal biopsy metabolomics/proteomics
Mechanistic: Mean Changes in small intestinal biopsy metabolomics /proteomics
Time frame: Week 12 after (re)DMR
Mechanistic: Change in Plasma Citrulline
Mechanistic: Change in Plasma Citrulline
Time frame: Through study completion, an average of 1 or 1,5 years
Mechanistic: Change in Cystatin Value
Mechanistic: Change in Cystatin Value
Time frame: Through study completion, an average of 1 or 1,5 years