Type 2 Diabetes
Conditions
Brief summary
This is an open-label study to assess the safety and feasibility of the DyaMX device for endoscopic duodenal mucosal regeneration in individuals with type 2 diabetes inadequately controlled on glucose-lowering medications.
Detailed description
Individuals who sign the informed consent will be screened for study eligibility. Eligible participants will be treated with the DyaMX procedure and followed up for 48 weeks.
Interventions
DEVICEThe DyaMX Device
The DyaMX device is designed to induce duodenal mucosal regeneration using pulsed electric field. The DyaMX procedure is a non-surgical, endoscopic procedure.
Sponsors
Endogenex, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. 18-70 years of age 2. Current diagnosis of T2D 3. History of T2D for less than or equal to 10 years, or use insulin for less or equal to 10 years 4. HbA1C of 7.5-11.0% 5. BMI 24-40 kg/m2 6. If treated with non-insulin glucose lowering mediations, the medications (1-4 medications) should be stable for at least 12 weeks prior to baseline visit. If treated with basal insulin, the daily insulin dose should be within 20-60 IU. 7. Agree not to donate blood during participation in the study. 8. If treated with non-insulin glucose lowering medications, participant should have weight stability (defined as a \< 5% change in body weight) for at least 12 weeks prior to the screening visit 9. Able to comply with study requirements and understand and sign the Informed Consent Form 10. Women of childbearing potential must be using an acceptable method of contraception throughout the study 11. Willing and able to perform self-monitoring blood glucose and comply with study visits and study tasks as required per protocol.
Exclusion criteria
1. Diagnosed with type 1 diabetes 2. History of diabetic ketoacidosis or hyperosmolar nonketotic coma 3. Probable insulin production failure, defined as overnight fasting C-peptide serum \<1 ng/mL (333pmol/l). 4. Previous use of any types of insulin for \>1 month (at any time, except for treatment of gestational diabetes) in last 2 years for those on non-insulin medications. 5. Current use of multiple daily dose insulin or insulin pump 6. Hypoglycemia unawareness 7. History of ≥1 severe hypoglycemia (defined by needing for third-party assistance), unless a clear correctable precipitating factor can be identified, in past 6 months from the screening visit 8. Known autoimmune disease, as evidenced by a positive anti-glutamic acid decarboxylase (GAD) test, including but not limited to celiac disease, or pre-existing symptoms of systemic lupus erythematosus, scleroderma or other autoimmune connective tissue disorder. 9. Previous GI surgery that has changed GI anatomy or could limit treatment of the duodenum, such as Billroth 2, Roux-en-Y gastric bypass, gastric band or other similar procedures or conditions. 10. Known history of a structural or functional disorder of the upper GI tract that may impede passage of the device through the upper GI tract or increase risk of tissue damage during an endoscopic procedure, including esophagitis, stricture/stenosis, varices, diverticula, or other disorder of the esophagus, stomach and duodenum. 11. Active H. pylori infection (Participants with active H. pylori may continue with the screening process if they are treated with an appropriate antibiotic regimen) 12. History of, or gastrointestinal symptoms suggestive of gastroparesis. 13. Acute gastrointestinal illness in the previous 7 days 14. Known history irritable bowel syndrome, radiation enteritis or other inflammatory bowel disease, such as Crohn's disease and Celiac disease 15. History of chronic or acute pancreatitis. 16. Known active hepatitis or active liver disease other than NASH/NAFLD. 17. Alcoholic liver disease, as indicated by ANI \>0 18. Current use of anticoagulation therapy (such as warfarin) that cannot be discontinued for 7 days before and 14 days after the procedure. 19. Current use of P2Y12 inhibitors (clopidogrel, prasugrel, ticagrelor) that cannot be discontinued for 14 days before and 14 days after the procedure. 20. Unable to discontinue non-steroidal anti-inflammatory drugs (NSAIDs) during treatment through 4 weeks following the procedure. Use of acetaminophen and low dose aspirin is allowed. 21. Use of systemic glucocorticoids (excluding topical or ophthalmic application or inhaled forms) for more than 10 consecutive days within 12 weeks prior to the baseline visit. 22. Use of drugs known to affect GI motility (e.g. Metoclopramide) 23. Use of weight loss medications such as Phentermine, Meridia, Xenical, or over-the-counter weight loss medications (prescription medication) 24. Persistent anemia, defined as hemoglobin \<10 g/dL. 25. Known history of blood donation or transfusion within 3 months prior to the Screening Visit. 26. Known history of cardiac arrhythmia 27. Significant cardiovascular disease, including known history of valvular disease, or myocardial infarction, heart failure, transient ischemic attack, or stroke within 6 months prior to the Screening Visit. 28. Estimated glomerular filtration rate (eGFR) ≤ 30 ml/min/1.73m2. 29. Known immunocompromised status, including but not limited to individuals who have undergone organ transplantation, chemotherapy, or radiotherapy within the past 12 months, who have clinically-significant leukopenia, who are positive for the human immunodeficiency virus (HIV) or whose immune status makes the participant a poor candidate for clinical trial participation in the opinion of the investigator. 30. With any implanted electronic devices or duodenal metallic implants 31. Not a candidate for upper GI endoscopy or general anesthesia. 32. Active illicit substance abuse or alcoholism (\> 2 drinks/day regularly). 33. Active malignancy within the last 5 years (excluding non-melanoma skin cancers) 34. Women breast feeding 35. Participating in another ongoing clinical trial of an investigational drug or device. 36. Any other mental or physical condition which, in the opinion of the study investigator, makes the participant a poor candidate for clinical trial participation. 37. Critically ill or has a life expectancy \<3 years Additional
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Device- or Procedure-related Serious Adverse Events (SAE) | At 12 weeks post procedure | Number of participants experiencing one or more device- or procedure-related serious adverse events at 12 weeks post procedure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| HbA1c by Post Procedure Follow-up Visit | Follow up at 12, 24, and 48 weeks post procedure | Mean HbA1c (%) by Post Procedure Follow-up Visit. The unit of measure for HbA1c is %. |
| Fasting Plasma Glucose by Visit | Baseline, 12, 24, and 48 weeks | Mean Fasting Plasma Glucose by Visit |
| Weight by Visit | Baseline, 12, 24, and 48 weeks | Mean Weight by Visit |
Countries
Australia
Contacts
PRINCIPAL_INVESTIGATORAdrian Sartoretto, MD
The BMI Clinic
Participant flow
Recruitment details
Participants were recruited from 3 medical centers in Australia between January of 2021 and November of 2023. Participants were considered enrolled in the study once they passed endoscopic screening. Screen failures were defined as participants who consented for the study, started the screening process but were not subsequently enrolled. The first participant was enrolled on 20-Apr-2021 and the last on 27-Jul-2023.
Pre-assignment details
A total of 65 participants were enrolled in the study.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 52.8 years STANDARD_DEVIATION 8 |
| BMI (kg/m^2) | 31.5 kg/m^2 STANDARD_DEVIATION 3.5 |
| Duration of Diabetes | 5.5 years STANDARD_DEVIATION 2.4 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 14 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Fasting Plasma Glucose (FPG) | 9.7 mmol/L STANDARD_DEVIATION 2.3 |
| HbA1c | 8.7 % STANDARD_DEVIATION 0.9 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 9 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 41 Participants |
| Region of Enrollment Australia | 14 participants |
| Sex: Female, Male Female | 8 Participants |
| Sex: Female, Male Male | 38 Participants |
| Weight | 93.6 Kg STANDARD_DEVIATION 15.4 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 65 |
| other Total, other adverse events | 58 / 65 |
| serious Total, serious adverse events | 5 / 65 |
Outcome results
None listed