Using denosumab to improve beta cell function in type 1 diabetes

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This clinical trial evaluates the safety and efficacy of denosumab, a medication typically used for osteoporosis, in improving beta cell function and glycemic control in individuals with early type 1 diabetes (T1D). The study is a Phase 1/2, randomized, double-blind, placebo-controlled trial involving multiple centers. Participants will receive either denosumab or a placebo over a 12-month period, with assessments of beta cell function and blood sugar control through C-peptide levels and HbA1c measurements. The goal is to determine if denosumab can protect beta cells from immune-mediated injury and enhance insulin production.

Why it matters

Who can join: the full rules

Main Inclusion Criteria

* Age: Females 18-50 years; males 21-50 years (minimum age based on skeletal maturity)
* Diagnosis of type 1 diabetes (T1D) based on ADA Criteria:

  * Hyperglycemia (glycosylated hemoglobin (HbA1c) ≥ 6.5%; OR
  * fasting plasma glucose ≥ 126 mg/dl (7.0 mmol/L); OR
  * 2-hour plasma glucose ≥ 200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test; OR
  * In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥ 200 mg/dl (11.1 mmol/L)
* Documented history of at least one type 1 diabetes associated autoantibody

  * GAD specific autoantibodies (GADA);
  * Islet-antigen 2 specific autoantibody (IA-2A); and/or
  * Zinc Transporter 8 specific autoantibody (ZNT8A)
* Time from T1D diagnosis to screening MMTT must be ≥ 12 months but ≤ 5 years
* Non-fasting C-peptide concentrations of at least 0.2 nmol/L (0.6 ng/ml) at pre-screening and confirmed during a MMTT done at screening visit.
* Serum calcium (corrected for albumin)\* within normal limits per site's local lab
* Agreement by women of childbearing potential (WOCBP) and males of childbearing potential to use a highly effective method of birth control for the course of the study through at least 5 months from the last dose of protocol therapy

Main Exclusion Criteria

* History of delayed puberty unless there is radiologic evidence of skeletal maturity
* Use of other investigational agents within 3 months of enrollment
* Vitamin D3 deficiency (\< 30 ng/ml)
* History of anorexia and/or eating disorder
* BMI \> 32 kg/m2
* HbA1c \> 9.5%
* Severe hypoglycemia or diabetic ketoacidosis (DKA) within 3 months prior to screening. Subjects who had such episodes within 3-6 months prior to screening, must have written clearance from their treating physician.
* Use of any of the diabetes medications other than insulin within 3 months of enrollment (e.g., metformin, sulfonylurea, GLP-1 agonists, DPP4 inhibitors, Symlin, SGLT2-inhibitors, amylin)
* Treatment with any of the following drugs in past year: immunosuppressants, anticonvulsant therapy, adrenal or anabolic steroids, calcitonin, selective estrogen receptor modulator, sodium fluoride (other than dental treatment), teriparatide, abaloparatide, strontium or aromatase inhibitors; any history of bisphosphonate treatment.
* Bone fractures (excluding skull, facial bones, metacarpals, fingers, toes and spontaneous fractures associated with severe trauma) within the past 12 months
* Disorders associated with altered skeletal structure or function (Paget's disease, chronic liver disease (liver enzymes \> twice the upper limit of normal), malignancy, hypoparathyroidism or hyperparathyroidism, acromegaly, Cushing's syndrome, hypopituitarism, chronic obstructive pulmonary disease, alcohol intake \> 3 units/day)
* Significant dental/oral disease, including prior history or current evidence of osteonecrosis/osteomyelitis of the jaw, active dental or jaw condition requiring oral surgery, non-healed dental/oral surgery, or planned invasive dental procedures for the course of the study
* Pregnancy or actively breastfeeding (within 6 months prior to screening), or planning to become pregnant with 5 months after last dose of protocol therapy

Where it's running

• University of Alabama at Birmingham
  Birmingham, Alabama, United States Recruiting
• City of Hope Medical Center
  Duarte, California, United States Recruiting
• Indiana University
  Indianapolis, Indiana, United States Recruiting

Study contacts

• Principal investigator: Fouad Kandeel, MD, PhD — City of Hope Medical Center
• Study coordinator: Arthur Riggs Diabetes & Metabolism Research Institute at City of Hope
• Email: Islets@coh.org
• Phone: 1-866-44-ISLET(1-866-444-7538)

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.