ANZCTR - Registration

Please note the ANZCTR will be unattended from Friday 20 December 2024 for the holidays. The Registry will re-open on Tuesday 7 January 2025. Submissions and updates will not be processed during that time.

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Trial registered on ANZCTR

Registration number

ACTRN12623000771651

Ethics application status

Approved

Date submitted

5/06/2023

Date registered

14/07/2023

Date last updated

14/07/2023

Date data sharing statement initially provided

14/07/2023

Type of registration

Prospectively registered

Titles & IDs

Public title

Glycemic variability in Indigenous and Non-indigenous Australians with type 2 diabetes.

Scientific title

Glycemic variability in Indigenous and Non-indigenous Australians with type 2 diabetes.

Secondary ID [1]

None

Universal Trial Number (UTN)

U1111-1293-4076

Trial acronym

GVPayCycle

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Diabetes

Indigenous Health

Food Insecurity

Condition category

Condition code

Metabolic and Endocrine

Diabetes

Intervention/exposure

Study type

Observational

Patient registry

False

Target follow-up duration

Target follow-up type

Description of intervention(s) / exposure

All participants will wear a blinded version of a continuous glucose monitoring (CGM) sensor - Freestyle libre Pro IQ for a period of 4 weeks. The glycaemic variability will be compared between those with and without food security (as determined by a validated questionnaire USDA-18).

The CGM sensor will be placed on the participant's arm by the research personnel. Each sensor lasts up to 14 days. We will be using a blinded version of this device which is approved for research purposes only and automatically measures glucose levels every few minutes. The participant does not need to take any action other than ensuring that the sensor is worn at all times. At the end of 14 days the participant simply has to return the sensor to the research team. This process will be repeated once more so that data for two consecutive fortnights or 28 days will be captured.

The CGM sensor will be provided free of cost to the participants during the period of the study.

The research staff will educate the participants prior to the sensor being worn. The participant will be provided support and help in case of any difficulty with wearing the sensor.

Clinical assessment:
1. Anthropocentric measurements: 1. Weight, 2. Height, 3. Waist and Hip Circumference (This will take ~ 5 minutes).

2. A standardized battery of tests to test cardiovascular autonomic neuropathy consisting of measuring blood pressure and heart rate at rest and in response to light exercise such as sitting/standing, deep breathing and sustained hand grip will be performed and expected to take 20-30 minutes.

3. Blood will be sampled to measure baseline full blood count, urea and electrolytes, liver function, lipid profile and glycated hemoglobin level (this will take ~20 minutes).

4. List of questionnaires: 1. Baseline demographic information,
2. Food Frequency questionnaire (DQES v3.2),
3. Diabetes Distress Score (DDS-17)
4. Gastrointestinal Symptoms Score (PAGI-SYM)
5. Diabetes Bowel Survey (DBSQ)
6. Depression Score (PHQ-9)
7. Depression and Anxiety Score (DASS-21)
8. Michigan Neuropathy Screening Instrument

This set of questionnaires will take ~40 minutes in total.

Education regarding CGM sensors will take about 25 minutes.

Intervention code [1]

Diagnosis / Prognosis

Comparator / control treatment

People with food security will be considered as the comparator.

Control group

Active

Outcomes

Primary outcome [1]

Glycemic variability (GV) expressed as a percentage (%) from the CGM sensor output data.

Timepoint [1]

14 days and 28 days post-enrolment.

Secondary outcome [1]

Depression - assessed using the Patient Health Questionnaire-9 (PHQ-9). A nine-item validated depression scale.

Timepoint [1]

28 days post-enrolment.

Secondary outcome [2]

Dietary intake - assessed using the Dietary Questionnaire for Epidemiological Study (DQES v 3.2). A 80 item validated dietary intake scale.

Timepoint [2]

28 days post-enrolment.

Secondary outcome [3]

Diabetes distress - assessed using the Diabetes Distress-17 (DDS-17). A 17-item validated diabetes distress scale.

Timepoint [3]

At the time of enrollment.

Secondary outcome [4]

Gastrointestinal Symptoms - assessed using the Patient Assessment of Upper-Gastrointestinal Symptom Severity Index-20 (PAGI-SYM-20). A 20-item validated gastrointestinal symptom scale.

Timepoint [4]

28 days-post enrolment.

Eligibility

Key inclusion criteria

Aboriginal and/or Torres Strait Islander and and Non-Indigenous peoples aged 18 to 80 years with T2DM diagnosed as per WHO criteria with or without food insecurity as per USDA (HFSSM) questionnaire, residing in South Australia who are registered with an Aboriginal health clinic and who receive payment (for salaried work or as unemployment benefits) on a fortnightly basis.

Minimum age

18 Years

Maximum age

80 Years

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

Individuals not residing in South Australia, unable to provide informed consent, refusal, or inability to have a CGM sensor applied to the back of the upper arm, or unwillingness to provide informed consent, pregnancy, or receipt of dialysis.

Study design

Purpose

Natural history

Duration

Longitudinal

Selection

Defined population

Timing

Prospective

Statistical methods / analysis

Recruitment

Recruitment status

Not yet recruiting

Date of first participant enrolment

Anticipated

15/07/2023

Actual

Date of last participant enrolment

Anticipated

7/04/2025

Actual

Date of last data collection

Anticipated

7/10/2025

Actual

Sample size

Target

Accrual to date

Final

Recruitment in Australia

Recruitment state(s)

Funding & Sponsors

Funding source category [1]

Charities/Societies/Foundations

Name [1]

Diabetes Australia Research Programme

Address [1]

GPO Box 9824, Brisbane, QLD, 4001

Country [1]

Australia

Primary sponsor type

Individual

Name

Chinmay Marathe

Address

Adelaide Medical School
The University of Adelaide
Level 5, AHMS Building,
North Terrace
Adelaide, SA 5000

Country

Australia

Secondary sponsor category [1]

University

Name [1]

The University of Adelaide

Address [1]

Faculty of Health and Medical Science,
Adelaide Medical School,
Level 5, AHMS Building,
North Terrace
Adelaide, SA 5000

Country [1]

Australia

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Aboriginal Health Research Committee (AHRC)

Ethics committee address [1]

220 Franklin Street, Adelaide SA 5000

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

Approval date [1]

03/06/2022

Ethics approval number [1]

Summary

Brief summary

Type 2 diabetes (T2DM) is a very important chronic health condition that impacts Indigenous Australians disproportionately with devastating effects. T2DM is a major contributor to the reduced life span in Indigenous Australians. It is characterized by a younger age at onset and early and aggressive development of micro- (blindness, renal disease and lower extremity amputations) and macro-vascular (cardiovascular disease) complications. The risk of the complications of T2DM – both their development and the propensity for progression is markedly reduced if good glycaemic control can be achieved. Glycated haemoglobin (HbA1c) is traditionally used for assessment of glycaemic control in T2DM but fails to capture intra- and inter-day acute fluctuations in glycaemic excursions (glycaemic variability), which are associated with postprandial hyperglycaemia. Glycaemic variability is an independent predictor of cardiovascular mortality. Recently developed diabetes-related technology, continuous glucose monitors (CGM), can now easily estimate glycaemic variability by providing 24-hour data.

Diet is a major aspect of an optimal glycaemic control strategy, but often subject to economic considerations, particularly in Indigenous Australians. The prevalence of food insecurity (a situation when availability of nutritionally adequate and safe foods or the ability to acquire acceptable food in socially acceptable ways is limited or uncertain) in Indigenous Australians is extremely high at 26%, 5-times the national prevalence.

In response to food insecurity, individuals and households often develop ‘coping strategies’ including altered dietary patterns (choosing inexpensive high glycaemic simple carbohydrates over complex carbohydrates, fruits and vegetables or excessive food consumption when money is available and starvation when not). While these coping strategies are intuitively likely to impact glycaemic control adversely, the impact of food insecurity on glycaemic control, including glycaemic excursions in Indigenous Australians with T2DM is not known.

We propose to investigate the glycaemic variability around pay cycles in Indigenous Australians with T2DM and with and without food insecurity using CGM.

Both food insecurity and pay cycles are likely to affect glycaemic control adversely in Indigenous Australians with T2DM by increasing glycaemic variability. The impact of food insecurity and coping strategies on glycaemic control has apparently never been evaluated with 24-hour CGM data anywhere in the world. While this would be a preliminary study, the findings have the potential to make a major impact on both clinical practice (e.g. actively screening for food insecurity, further interventional studies designed to reduce glycaemic variability) and health policy (e.g. implementing food assistance programs and assessing impact on glycaemic variability).

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Dr Chinmay Marathe

Address

Adelaide Medical School
The University of Adelaide
Level 5, AHMS Building
North Terrace
Adelaide, SA 5000

Country

Australia

Phone

+61431266075

Fax

chinmay.marathe@adelaide.edu.au

Contact person for public queries

Name

Chinmay Marathe

Address

Adelaide Medical School
The University of Adelaide
Level 5, AHMS Building
North Terrace
Adelaide, SA 5000

Country

Australia

Phone

+61431266075

Fax

chinmay.marathe@adelaide.edu.au

Contact person for scientific queries

Name

Chinmay Marathe

Address

Adelaide Medical School
The University of Adelaide
Level 5, AHMS Building
North Terrace
Adelaide, SA 5000

Country

Australia

Phone

+61431266075

Fax

chinmay.marathe@adelaide.edu.au

Data sharing statement

Will individual participant data (IPD) for this trial be available (including data dictionaries)?

No/undecided IPD sharing reason/comment

IPD will not be shared to protect the identity of the individual. However, de-identified data will be freely available in the public domain in the form of scientific abstracts, peer-reviewed manuscripts, and power-point presentations made by the research team upon completion of the study.

What supporting documents are/will be available?

Doc. No.	Type	Citation	Link	Email	Other Details	Attachment
19371	Study protocol			chinmay.marathe@adelaide.edu.au	This document contains study protocol, participant... [More Details]	386021-(Uploaded-21-06-2023-16-14-39)-Study-related document.pdf
19374	Ethical approval			chinmay.marathe@adelaide.edu.au	Ethics approval is attached here.	386021-(Uploaded-05-06-2023-18-29-01)-Study-related document.pdf

Results publications and other study-related documents

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No additional documents have been identified.

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