Ignite Creation Date:
2024-07-17 @ 11:44 AM
Last Modification Date:
2024-10-26 @ 3:34 PM
Study NCT ID:
NCT06497595
Status:
NOT_YET_RECRUITING
Last Update Posted:
2024-07-12
First Post:
2024-06-27
Brief Title:
Lifestyle Intervention to Reduce the Risk of Sarcopenia in Adults With Diabetes Obesity Treated With Semaglutide
Sponsor:
Sheba Medical Center
Organization:
Sheba Medical Center
Study Overview
Official Title:
Exercise and Nutritional Intervention to Reduce the Risk of Sarcopenia in Older Adults With Type 2 Diabetes and Obesity Treated With Semaglutide A Randomized Controlled Trial
Status:
NOT_YET_RECRUITING
Status Verified Date:
2024-08
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study aims to test whether a multi-disciplinary intervention involving exercise and nutrition can slow down the decline in physical function muscle strength and mass in older adults aged 65-75 with Type 2 diabetes T2D and obesity treated with Semaglutide
The main questions it aims to answer are
In older people with T2D and obesity treated with Semaglutide does a multi-disciplinary intervention of exercise and nutrition compared to standard health recommendations
1 Reduce the rate of decline in muscle mass
2 Reduce the rate of decline in muscle strength
3 Reduce the rate of decline in physical function
Participants will
Administer Semaglutide once weekly for 6 months Visit the clinic once every 8 weeks for checkups and tests Keep a diary of their exercise and food consumption Participants in the intervention group will participate in an online exercise program and will receive personal nutritional counseling
The main questions it aims to answer are
In older people with T2D and obesity treated with Semaglutide does a multi-disciplinary intervention of exercise and nutrition compared to standard health recommendations
1 Reduce the rate of decline in muscle mass
2 Reduce the rate of decline in muscle strength
3 Reduce the rate of decline in physical function
Participants will
Administer Semaglutide once weekly for 6 months Visit the clinic once every 8 weeks for checkups and tests Keep a diary of their exercise and food consumption Participants in the intervention group will participate in an online exercise program and will receive personal nutritional counseling
Detailed Description:
The study will be conducted at the Center for Successful Aging with Diabetes Sheba Medical Center and the Clinical Research Center for Diabetes Hadassah Medical Center Israel The research will include a team with expertise in endocrinology nutritional interventions physical therapy fitness training medical imaging and biostatistics
Participants aged 65-75 years with both type 2 diabetes T2D and overweight obesity will be randomly allocated to either a 1 Semaglutide and multi-disciplinary intervention group MDIG comprised of exercise and diet or 2 Semaglutide and general health recommendations control group GHRG The drug dosage Wegovy Semaglutide will be gradually increased every 4 weeks starting with 025 milligrams mg on week 0 and reaching 24 mg by week 16 as per the Wegovy label and maintained at 24 mg until the end of the trial week 26 If a participant is unable to tolerate the 24 mg subcutaneous weekly dose SC QW of Semaglutide the highest tolerable dose will be administered with continued efforts to gradually increase the dose over time
Participants in the MDIG will undergo a once-weekly group exercise training that will be delivered online followed by 2 unsupervised home-based sessions Weekly phone calls and a personal exercise diary will be used in order to measure adherence to the exercise program In addition personal nutritional counseling will be administered by a certified dietitian every 2 weeks for the first 4 weeks and every 4 weeks for the remaining 22 weeks via a virtual meeting platform ie ZOOM In addition a 2-day food diary will be filled out for tracking and documentation All group exercise training will be conducted via a virtual meeting platform as well Participants allocated to the GHRG will receive general health recommendations both verbally and in writing and continue with their regular daily routine They will also be required to complete a personal exercise and food diary
Visit 1- screening All potential eligible subjects will be invited for a screening Visit during which the following information would be obtained a Informed consent b Eligibility criteria form c Physician interview and examination d Demographic and medical information e Medical History and recent blood work
Visits 2 - 5 After being allocated to the two study arms 4 additional measurement visits will be booked 1 baseline - week 0 visit 2 2 week 8 visit 3 3 week 16 visit 4 and 4 end of treatment - week 26 visit 5 The following information will be collected on each visit a Anthropometric measurements including waist and hip circumference waist to hip ratio weight height and body mass index BMI calculated in kgm2 b Body composition measured with Magnetic Resonance Imaging MRI and Dual-energy X-ray Absorptiometry DXA c Functional and strength assessments including balance aerobic capacity gait speed and strength tests d Blood pressure BP and heart rate HR e lipid profile and hemoglobin A1C test HbA1C only on visits 2 and 5 f frailty assessment only on visits 2 and 5 g Distribution of Semaglutide usage and titration guidance only visits 2-4 h Documentation of 2-day self-reported food diary for MDIG only on visits 3-5 i Nutritional counseling for MDIG jcollection and recording of partly used and full pens for estimation of Semaglutide adherence only on visits 3-5 k Documentation of exercise adherence through self-reported exercise diary only on visits 3-5 l Target Physical Examination m Adverse events collection only on visits 3-5 All baseline measurements will be conducted within one week before the trial commences
Measures of complianceadherence Compliance to the drug would be monitored in both arms Consumption of 80 or 120 of study background medication Semaglutide would be considered poor adherence to therapy Patients will be instructed to bring back all empty partly used and full Semaglutide pens at each site visit and all pens will be counted and estimation of Semaglutide adherent will be recorded In the MDIG the subjects adherence to the exercise regimen will be assessed during weekly phone calls based on subject reporting and by documentation in a personal diary they will bring to each visit Good complianceadherence would be considered as performing 2 of the exercise sessions In order to perform a protein consumption evaluation the nutritional sessions will be recorded and the patients will be asked to fill out a 2-day food diary before each visit
Glucagon-like Peptide-1 Receptor Agonist GLP-1-RA treatment All patients will receive Semaglutide 24 mg once a week for 26 weeks Semaglutide will start at 025 mg per week and escalate in a fixed-dose regimen every 4 weeks until the target dose is reached ie 24 mg by week 16 until the end of trial If a participant will not be able to tolerate Semaglutide 24 mg SC QW dose the highest tolerable dose of Semaglutide will be used and further attempts to increase Semaglutide dose will continue
Changes in body composition will be carried out using whole-body MRI DXA and body composition measures
Functional assessments will include the following tests
1 Timed up and Go TUG test which examines dynamic balance and mobility skills The participant is asked to get up from a chair with handles walk three meters turn walk back and sit down in the shortest possible time Data suggests that the TUG test is a reliable and valid test for quantifying functional mobility and risk for falls that may also be useful in following clinical change over time
2 Short Physical Performance Battery SPPB The SPPB is an objective assessment tool for evaluating three domains of lower extremity physical function in older adults balance repeated chair stands and gait speed It is associated with various adverse health outcomes in older adults including mobility impairments difficulties performing basic activities of daily living ADL or instrumental activities of daily living IADL and falls Poor performance on the SPPB and its components independently predict higher fall risk over 1 and 4 years of follow-up
3 The 6-minute walk test 6MWT The 6MWT assesses aerobic capacity The test measures the distance walked over six minutes on a hard flat surface The goal is for the individual to walk as far as possible in six minutes The 6MWT has been linked to frailty and mortality in older adults
410-meter walk 10MW The 10MW determines gait speed The participant is asked to walk at a comfortable pace for 14 meters The score achieved is determined by the walking time of the central 10 meters Studies have shown that better gait speed is associated with a lower risk for functional decline hospitalization and mortality
Strength tests
1 30 second chair stand STS The purpose of this test is to evaluate lower limb muscle strength The instructions are to get up from sitting to standing as many times as possible without the assistance of the arms for 30 seconds The number of times within 30 seconds that the participant succeeds to rise from a seated position is counted The strength of the lower limb muscles has a crucial impact on daily function Failure to perform STS movements efficiently and smoothly may lead to falls
2 Hand grip strength test The maximum grip strength test evaluates upper limb strength using the Jamar dynamometer The test is conducted in a neutral hand position and repeated 3 times Grip strength assessment has been shown to have predictive validity and low values are associated with falls disability impaired health-related quality of life and prolonged length of stay in hospital as well as increased mortality
Screening for frailty will be performed using the Fried scale The scale includes five criteria and pre-frailty is defined as the presence of two components while frailty is defined as the presence of at least three of the following components 1 unintentional weight loss - loss of 10 lbs45 kg or more in 1 year 2 self-reported exhaustion fatigue 3 low physical activity level as assessed by a modified Baecke questionnaire 4 slow gait speed - less than 08 ms with or without a walking aid 5 low grip strength relative to gender and body weight
Anthropometric measurements Weight and height with body mass index BMI calculated as kgm2 and waist and hip circumference measured and waist to hip ratio calculated
Glycemic control GC Hba1c will be collected at baseline and at the end of trial
Socio-demographic questionnaire Socio-demographic characteristics including age gender education marital status employment status ethnicity and smoking status will be collected at visit 1
Discontinuation Participants may withdraw consent for any reason at any time or be discontinued from the trial by the investigator if based upon his clinical judgment continuation in the trial is deemed inappropriate In addition the investigator may discontinue a subject if enrollment into the trial is inappropriate the trial plan is violated or for administrative andor any other safety reasons or if the trial is terminated early for any reason
Participants aged 65-75 years with both type 2 diabetes T2D and overweight obesity will be randomly allocated to either a 1 Semaglutide and multi-disciplinary intervention group MDIG comprised of exercise and diet or 2 Semaglutide and general health recommendations control group GHRG The drug dosage Wegovy Semaglutide will be gradually increased every 4 weeks starting with 025 milligrams mg on week 0 and reaching 24 mg by week 16 as per the Wegovy label and maintained at 24 mg until the end of the trial week 26 If a participant is unable to tolerate the 24 mg subcutaneous weekly dose SC QW of Semaglutide the highest tolerable dose will be administered with continued efforts to gradually increase the dose over time
Participants in the MDIG will undergo a once-weekly group exercise training that will be delivered online followed by 2 unsupervised home-based sessions Weekly phone calls and a personal exercise diary will be used in order to measure adherence to the exercise program In addition personal nutritional counseling will be administered by a certified dietitian every 2 weeks for the first 4 weeks and every 4 weeks for the remaining 22 weeks via a virtual meeting platform ie ZOOM In addition a 2-day food diary will be filled out for tracking and documentation All group exercise training will be conducted via a virtual meeting platform as well Participants allocated to the GHRG will receive general health recommendations both verbally and in writing and continue with their regular daily routine They will also be required to complete a personal exercise and food diary
Visit 1- screening All potential eligible subjects will be invited for a screening Visit during which the following information would be obtained a Informed consent b Eligibility criteria form c Physician interview and examination d Demographic and medical information e Medical History and recent blood work
Visits 2 - 5 After being allocated to the two study arms 4 additional measurement visits will be booked 1 baseline - week 0 visit 2 2 week 8 visit 3 3 week 16 visit 4 and 4 end of treatment - week 26 visit 5 The following information will be collected on each visit a Anthropometric measurements including waist and hip circumference waist to hip ratio weight height and body mass index BMI calculated in kgm2 b Body composition measured with Magnetic Resonance Imaging MRI and Dual-energy X-ray Absorptiometry DXA c Functional and strength assessments including balance aerobic capacity gait speed and strength tests d Blood pressure BP and heart rate HR e lipid profile and hemoglobin A1C test HbA1C only on visits 2 and 5 f frailty assessment only on visits 2 and 5 g Distribution of Semaglutide usage and titration guidance only visits 2-4 h Documentation of 2-day self-reported food diary for MDIG only on visits 3-5 i Nutritional counseling for MDIG jcollection and recording of partly used and full pens for estimation of Semaglutide adherence only on visits 3-5 k Documentation of exercise adherence through self-reported exercise diary only on visits 3-5 l Target Physical Examination m Adverse events collection only on visits 3-5 All baseline measurements will be conducted within one week before the trial commences
Measures of complianceadherence Compliance to the drug would be monitored in both arms Consumption of 80 or 120 of study background medication Semaglutide would be considered poor adherence to therapy Patients will be instructed to bring back all empty partly used and full Semaglutide pens at each site visit and all pens will be counted and estimation of Semaglutide adherent will be recorded In the MDIG the subjects adherence to the exercise regimen will be assessed during weekly phone calls based on subject reporting and by documentation in a personal diary they will bring to each visit Good complianceadherence would be considered as performing 2 of the exercise sessions In order to perform a protein consumption evaluation the nutritional sessions will be recorded and the patients will be asked to fill out a 2-day food diary before each visit
Glucagon-like Peptide-1 Receptor Agonist GLP-1-RA treatment All patients will receive Semaglutide 24 mg once a week for 26 weeks Semaglutide will start at 025 mg per week and escalate in a fixed-dose regimen every 4 weeks until the target dose is reached ie 24 mg by week 16 until the end of trial If a participant will not be able to tolerate Semaglutide 24 mg SC QW dose the highest tolerable dose of Semaglutide will be used and further attempts to increase Semaglutide dose will continue
Changes in body composition will be carried out using whole-body MRI DXA and body composition measures
Functional assessments will include the following tests
1 Timed up and Go TUG test which examines dynamic balance and mobility skills The participant is asked to get up from a chair with handles walk three meters turn walk back and sit down in the shortest possible time Data suggests that the TUG test is a reliable and valid test for quantifying functional mobility and risk for falls that may also be useful in following clinical change over time
2 Short Physical Performance Battery SPPB The SPPB is an objective assessment tool for evaluating three domains of lower extremity physical function in older adults balance repeated chair stands and gait speed It is associated with various adverse health outcomes in older adults including mobility impairments difficulties performing basic activities of daily living ADL or instrumental activities of daily living IADL and falls Poor performance on the SPPB and its components independently predict higher fall risk over 1 and 4 years of follow-up
3 The 6-minute walk test 6MWT The 6MWT assesses aerobic capacity The test measures the distance walked over six minutes on a hard flat surface The goal is for the individual to walk as far as possible in six minutes The 6MWT has been linked to frailty and mortality in older adults
410-meter walk 10MW The 10MW determines gait speed The participant is asked to walk at a comfortable pace for 14 meters The score achieved is determined by the walking time of the central 10 meters Studies have shown that better gait speed is associated with a lower risk for functional decline hospitalization and mortality
Strength tests
1 30 second chair stand STS The purpose of this test is to evaluate lower limb muscle strength The instructions are to get up from sitting to standing as many times as possible without the assistance of the arms for 30 seconds The number of times within 30 seconds that the participant succeeds to rise from a seated position is counted The strength of the lower limb muscles has a crucial impact on daily function Failure to perform STS movements efficiently and smoothly may lead to falls
2 Hand grip strength test The maximum grip strength test evaluates upper limb strength using the Jamar dynamometer The test is conducted in a neutral hand position and repeated 3 times Grip strength assessment has been shown to have predictive validity and low values are associated with falls disability impaired health-related quality of life and prolonged length of stay in hospital as well as increased mortality
Screening for frailty will be performed using the Fried scale The scale includes five criteria and pre-frailty is defined as the presence of two components while frailty is defined as the presence of at least three of the following components 1 unintentional weight loss - loss of 10 lbs45 kg or more in 1 year 2 self-reported exhaustion fatigue 3 low physical activity level as assessed by a modified Baecke questionnaire 4 slow gait speed - less than 08 ms with or without a walking aid 5 low grip strength relative to gender and body weight
Anthropometric measurements Weight and height with body mass index BMI calculated as kgm2 and waist and hip circumference measured and waist to hip ratio calculated
Glycemic control GC Hba1c will be collected at baseline and at the end of trial
Socio-demographic questionnaire Socio-demographic characteristics including age gender education marital status employment status ethnicity and smoking status will be collected at visit 1
Discontinuation Participants may withdraw consent for any reason at any time or be discontinued from the trial by the investigator if based upon his clinical judgment continuation in the trial is deemed inappropriate In addition the investigator may discontinue a subject if enrollment into the trial is inappropriate the trial plan is violated or for administrative andor any other safety reasons or if the trial is terminated early for any reason
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
False
Is an FDA AA801 Violation?:
None