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Hypoglycemia UnawarenessPhase 2NCT03970720

Restoration of Hypoglycemia Awareness With Metoclopramide

A Phase 2 study testing Metoclopramide in people with Hypoglycemia Unawareness, run by Simon Fisher at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

Metoclopramide is a drug approved by the FDA for gastroesophageal reflux and to relieve symptoms in adults with acute and recurrent diabetic gastroparesis. The objective of this study is to determine whether metoclopramide can improve hypoglycemia awareness and decrease the incidence of hypoglycemia in type 1 diabetes… Read more about this study

Who is it for?
Ages 20 to 60 years
Conditions the study is for
Hypoglycemia Unawareness
What is being tested?
Metoclopramide
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
36 participants
Where
2 sitesUnited States
Study dates
28 May 2019to 31 Dec 2027
Phase
Phase 2
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Subjects with Type 1 Diabetes Mellitus
  • Diabetes duration > 5 years
  • Hemoglobin A1c ≤ 9%
  • Able to provide informed consent and willing to sign an approved consent form that conforms to federal and institutional guidelines

Who cannot join

  • History of myocardial infarction, cardiac arrhythmia, congestive heart failure and coronary artery insufficiency
  • History of stroke or brain disease
  • History of genitourinary obstruction or urinary retention
  • Advanced liver disease
  • Active anemia with hemoglobin less than 11 g/dL
  • Female in pregnancy or breastfeeding, or not able to practice effective contraception during the study period
Show all 12Show fewer
  • Uncontrolled mania or active major depressive disorder
  • Previous allergic reaction or side effect to heparin use
  • Contraindications to metoclopramide or conditions raising the risk for complication development to metoclopramide, such as hypersensitivity to metoclopramide, ongoing mechanical gastrointestinal obstruction, uncontrolled hypertension, pheochromocytoma, seizure disorders, Parkinson's disease, use of neuroleptics or antipsychotics within 6 months, use of benzodiazepines within the last month, active or recent (last 14 days) use of monoamine oxidase inhibitors or opioids, active alcohol or drug abuse, or other sedatives
  • Participation in another study evaluating treatment for impaired awareness of hypoglycemia or hypoglycemia-associated autonomic failure in the last 30 days
  • Current use of unblinded real-time Continuous Glucose Monitoring System
  • Frequent need of acetaminophen administration

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Simon Fisher, MD, PhD contact

859-562-0473

sjfi230@uky.edu

Karen M Shearer contact

859-323-7778

Karen.Shearer@uky.edu

United States2 sites, 1 recruiting
  • University of Kentucky

    Lexington, Kentucky, 40516

    Simon Fisher, MD, PhD, 859-562-0473, Simon.Fisher@uky.edu

    Karen Shearer, HIT, 8593237778, Karen.Shearer@uky.edu

    Recruiting
  • University of Utah

    Salt Lake City, Utah, 84132

    Completed

Other trials in United States

About this study

Metoclopramide is a drug approved by the FDA for gastroesophageal reflux and to relieve symptoms in adults with acute and recurrent diabetic gastroparesis. The objective of this study is to determine whether metoclopramide can improve hypoglycemia awareness and decrease the incidence of hypoglycemia in type 1 diabetes patients with hypoglycemia unawareness.

Read the detailed description

Hypoglycemia is the most prevalent clinical complication in the daily management of diabetes and is the major obstacle to normalizing blood sugar. For people with Type 1 diabetes mellitus (T1DM), hypoglycemia associated autonomic failure (HAAF) increases the risk for severe hypoglycemia by a factor of 25 or more. A major component of HAAF is hypoglycemia unawareness (perhaps more accurately defined as impaired awareness of hypoglycemia), which involves in the loss/diminution of warning symptoms to hypoglycemia that would normally prompt a corrective behavioral response (e.g., eating food). Approximately 25-40% of people with T1DM report hypoglycemia unawareness. This value is most certainly an underestimation, as even people with diabetes who report having intact hypoglycemia, demonstrate impaired awareness of biochemically confirmed hypoglycemia. Although a major clinical problem for people with T1DM, it remains largely unknown what therapeutic agents could possibly be used to treat hypoglycemia unawareness.

With a goal of identifying existing biological compounds that could restore hypoglycemia awareness, laboratory drug screens were conducted using animal models. It was postulated that an ideal drug would markedly enhance the ability to sense hypoglycemia and trigger a potentially life-saving behavioral response (ie, alert the subject to increase food consumption). The vast majority of tested drugs did not restore hypoglycemia awareness (ie, did not restore blunted food intake response to hypoglycemia). Interestingly, of all the drugs tested, the dopamine antagonist metoclopramide consistently restored hypoglycemia awareness in several preclinical experiments. Additionally, metoclopramide also restored the impaired counterregulatory response to hypoglycemia in the animal model of HAAF.

This pilot phase II clinical trial (with placebo control) will be conducted to determine if FDA approved doses of Metaclopramdide can restore both, 1) hypoglycemia awareness, and 2) the sympathoadrenal response to hypoglycemia in patients with T1DM and hypoglycemia unawareness.

Being tested
Metoclopramide, Placebo
Keywords
Type 1 Diabetes Mellitus
Medical subject headings
Diabetes Mellitus, Type 1

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MetoclopramideDrug

    10 mg metoclopramide four times a day

  • PlaceboDrug

    10 mg matching placebo capsules four times a day

Study groups in NCT03970720
Study groupRoleWhat they receive
T1DM - Unaware: MetoclopramideExperimentalT1DM participants with hypoglycemia unawareness determined by a hypoglycemic clamp study will receive 10 mg metoclopramide four times a day during the four-week intervention period.
Receives: Drug: Metoclopramide
T1DM - Unaware: PlaceboPlacebo comparatorT1DM participants with hypoglycemia unawareness determined by a hypoglycemic clamp study will receive 10 mg matching placebo capsules four times a day during the four-week intervention period.
Receives: Drug: Placebo
T1DM - Aware: PlaceboPlacebo comparatorT1DM participants with hypoglycemia awareness determined by a hypoglycemic clamp study will receive 10 mg matching placebo capsules four times a day during the four-week intervention period.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Blood Glucagon

    Blood samples will be drawn from study participants during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period. The average change in blood glucagon level will be compared between the study arms.

    Measured: 4 weeks

  2. Change in Blood Epinephrine

    Blood samples will be drawn from study participants during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period. The average change in blood epinephrine level will be compared between the study arms.

    Measured: 4 weeks

  3. Change in Blood Norepinephrine

    Blood samples will be drawn from study participants during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period. The average change in blood norepinephrine level will be compared between the study arms.

    Measured: 4 weeks

  4. Change in Blood Cortisol

    Blood samples will be drawn from study participants during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period. The average change in blood cortisol level will be compared between the study arms.

    Measured: 4 weeks

  5. Change in Blood Pancreatic Polypeptide

    Blood samples will be drawn from study participants during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period. The average change in blood pancreatic polypeptide level will be compared between the study arms.

    Measured: 4 weeks

  6. Change in Hypoglycemia Symptom Recognition

    Participant's self-reported symptoms of hypoglycemia will be obtained during the initial hypoglycemic clamp study (Day 0) and during the second hypoglycemic clamp study (Day 28) following the 4-week intervention period.

    Measured: 4 weeks

Secondary outcomes (1)
  1. Ratio of Self-Reported Hypoglycemic Episodes to Total Hypoglycemic Episodes

    Participants will complete a report of all hypoglycemic events during the study surveillance periods. The average ratio of self-reported hypoglycemic episodes to total hypoglycemic episodes recorded by Continuous Glucose Monitoring (CGM) during these periods will be compared between the study arms.

    Measured: 6 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted31 May 2019
  2. Study start28 May 2019
  3. Primary completion30 Jun 2027 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
36 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03970720
Sponsor's protocol ID
IRB_00118549
Other IDs
1R01DK118082-01A1
Status last verified
Mar 2026
First submitted
29 May 2019
Last updated
20 Mar 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Cryer PE. Hypoglycemia-associated autonomic failure in diabetes. Handb Clin Neurol. 2013;117:295-307. doi: 10.1016/B978-0-444-53491-0.00023-7.

    PubMed 24095133
  • Cryer PE. Mechanisms of hypoglycemia-associated autonomic failure in diabetes. N Engl J Med. 2013 Jul 25;369(4):362-72. doi: 10.1056/NEJMra1215228. No abstract available.

    PubMed 23883381
  • Heller SR, Cryer PE. Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia after 1 episode of hypoglycemia in nondiabetic humans. Diabetes. 1991 Feb;40(2):223-6. doi: 10.2337/diab.40.2.223.

    PubMed 1991573
  • Schultes B, Schmid SM, Wilms B, Jauch-Chara K, Oltmanns KM, Hallschmid M. Lactate infusion during euglycemia but not hypoglycemia reduces subsequent food intake in healthy men. Appetite. 2012 Jun;58(3):818-21. doi: 10.1016/j.appet.2012.01.022. Epub 2012 Jan 28.

    PubMed 22314041
  • Schmid SM, Jauch-Chara K, Hallschmid M, Oltmanns KM, Born J, Schultes B. Short-term nocturnal hypoglycaemia increases morning food intake in healthy humans. Diabet Med. 2008 Feb;25(2):232-5. doi: 10.1111/j.1464-5491.2007.02347.x.

    PubMed 18290864
  • Dewan S, Gillett A, Mugarza JA, Dovey TM, Halford JC, Wilding JP. Effects of insulin-induced hypoglycaemia on energy intake and food choice at a subsequent test meal. Diabetes Metab Res Rev. 2004 Sep-Oct;20(5):405-10. doi: 10.1002/dmrr.471.

    PubMed 15343587
  • Towler DA, Havlin CE, Craft S, Cryer P. Mechanism of awareness of hypoglycemia. Perception of neurogenic (predominantly cholinergic) rather than neuroglycopenic symptoms. Diabetes. 1993 Dec;42(12):1791-8. doi: 10.2337/diab.42.12.1791.

    PubMed 8243825
  • Geddes J, Schopman JE, Zammitt NN, Frier BM. Prevalence of impaired awareness of hypoglycaemia in adults with Type 1 diabetes. Diabet Med. 2008 Apr;25(4):501-4. doi: 10.1111/j.1464-5491.2008.02413.x.

    PubMed 18387080
  • Kubiak T, Hermanns N, Schreckling HJ, Kulzer B, Haak T. Assessment of hypoglycaemia awareness using continuous glucose monitoring. Diabet Med. 2004 May;21(5):487-90. doi: 10.1111/j.1464-5491.2004.1136.x.

    PubMed 15089796

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing Metoclopramide in people with Hypoglycemia Unawareness, run by Simon Fisher at 2 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 20 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Simon Fisher, MD, PhD (859-562-0473, sjfi230@uky.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Blood Glucagon (time frame: 4 weeks). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03970720, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Mar 2026.

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