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Latent Autoimmune Diabetes in AdultsPhase 2GADinLADANCT04262479

Injections of Glutamic Acid Decarboxylase (GAD) for LADA Type of Diabetes

A Phase 2 study testing recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogel and Vitamin D in people with Latent Autoimmune Diabetes in Adults, run by Norwegian University of Science and Technology at 2 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study will evaluate the effects of 3 intra-nodal injections of GAD-alum (Diamyd), together with oral vitamin D supplementation. Safety and feasibility of the treatment will be evaluated and also effects on the immune system and on the preservation of endogenous insulin production. Read more about this study

Who is it for?
Ages 30 to 70 years
Conditions the study is for
Latent Autoimmune Diabetes in Adults
What is being tested?
recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogel and Vitamin D
Could I receive a placebo?
No, everyone receives an active treatment
How many people
14 participants
Where
2 sitesin 2 countries
Study dates
2 Mar 2020to 5 May 2022
Phase
Phase 2
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 30 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Signed informed consent by the patient.
  • Diagnosis of LADA and diabetes debut within the last 18 months before inclusion. LADA should be defined by the criteria of age ≥30 years at the onset of diabetes, anti-GAD positivity and no clinical need for permanent insulin treatment during the first 3 months after the diagnosis of diabetes.
  • Fasting C-peptid levels ≥ 0.3 nmol/l
  • High GADA titers (>190 U/ml)
  • Patients must be insulin independent at baseline by clinical judgement and C-peptide criteria
  • Antidiabetic medication in the form of metformin is acceptable for inclusion as well as medications not mentioned under exclusion criteria
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  • Females must agree to avoid pregnancy, and must have a negative urine pregnancy test.
  • Patients of childbearing potential must agree to use adequate contraception, until one (1) year after the last administration of GAD-alum. Adequate contraception is as follows:
  • For females of childbearing potential:
  • oral (except low-dose gestagen (lynestrenol and norestisteron)), injectable, or implanted hormonal contraceptives
  • combined (estrogen and progestogen containing)
  • oral, intravaginal or transdermal progesterone hormonal contraception associated with inhibition of ovulation
  • intrauterine device
  • intrauterine hormone-releasing system (for example, progestin-releasing coil)
  • bilateral tubal occlusion
  • vasectomized male (with appropriate post vasectomy documentation of the absence of sperm in the ejaculate)
  • male partner using condom
  • abstinence from heterosexual intercourse
  • For males of childbearing potential:
  • condom (male)
  • abstinence from heterosexual intercourse

Who cannot join

  • Current or previous treatment with immunosuppressant therapy (topical or inhaled steroids are accepted)
  • Continuous treatment with anti-inflammatory drug (sporadic treatment e.g. because of headache or in connection with fever a few days will be accepted)
  • Systemic treatment with glucocorticoids
  • Treatment with any vaccine, including influenza vaccine, within 1 month prior to planned first study drug dose or planned treatment with any vaccine up to 1 month after the last injection with study drug
  • Antidiabetic medication (metformin excepted)
  • Significantly abnormal hematology results at screening (i.e. anemia with hemoglobin < 12 g/L).
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  • A history of epilepsy, head trauma or cerebrovascular accident, or clinical features of continuous motor unit activity in proximal muscles
  • Clinically significant history of acute reaction to vaccines in the past.
  • Renal disease (as defined by serum creatinine >150 µmol/l)
  • Serious cardiovascular events (myocardial infarction, stroke) within the last year preceding recruitment.
  • Participation in other clinical trials with a new chemical entity within the previous 3 months
  • A history of alcohol or drug abuse
  • Known HIV or hepatitis
  • Presence of associated serious disease or condition, including active skin infections that preclude intralymphatic injection, which in the opinion of the investigator makes the patient non-eligible for the study
  • Other serious chronic disease as judged by investigator.
  • Females who are lactating, are pregnant or intend to become pregnant.
  • Inability or unwillingness to comply with the provisions of this protocol
  • Deemed by the investigator not being able to follow instructions and/or follow the study protocol
  • Treatment any other supplementation of with vitamin D, marketed or not, or unwilling to abstain from such medication during the trial 120 days daily intake of Divisun (non-investigational medicinal product)

Trial locations and contacts

2 sites in 2 countries.

2 sites in 2 countries

Norway1 site
  • Department of Endocrinology, St Olavs Hospital

    Trondheim

Other trials in Norway

Sweden1 site
  • Akademiskt Specialistcentrum, Centrum for Diabetes, and Karolinska Institute

    Stockholm

Other trials in Sweden

About this study

Official title: A Pilot Study on Safety, Feasibility and Insulin-promotion by Intra-inguinal Lymph Node Injections of Glutamic Acid Decarboxylase (GAD) in Patients With LADA Type of Diabetes

This study will evaluate the effects of 3 intra-nodal injections of GAD-alum (Diamyd), together with oral vitamin D supplementation. Safety and feasibility of the treatment will be evaluated and also effects on the immune system and on the preservation of endogenous insulin production.

Read the detailed description

The purpose of the trial is to evaluate the effects of 3 intra-nodal injections of GAD-alum, together with oral vitamin D supplementation, in a population of LADA patients with high GADA titers. Effects will be summarized at 5 and 12 months after the first injection.

  • The primary objective is to evaluate safety and feasibility of this treatment regimen.
  • Secondary objectives are to test if the treatment induces a strong GAD-specific immune response similar to what has previously been observed in type 1 diabetes patients and to test for indications of preservation of endogenous insulin production.

The study is an open label Phase IIa feasibility trial. It is a pilot study that does not include a placebo arm.

Antidiabetic medication in the form of metformin is acceptable before and during the trial. Study participants must be insulin independent at baseline, but if the need for insulin treatment develops during the trial, such treatment will be given.

GAD-alum will be injected directly into an inguinal lymph node by a qualified radiologist.

Patients will be followed for a total of 12 months during which their endogenous insulin production and immune response will be evaluated at regular intervals throughout the study period. Urine and blood samples will be taken for safety, diabetes status assessments, vitamin D levels and immunological assessments. Concomitant medication and demographics will be collected.

Being tested
recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogel, Vitamin D
Keywords
Glutamic Acid Decarboxylase, Alum Compounds, Injections, Inguinal Canal, Diamyd, rhGAD65, Vitamin D
Medical subject headings
Latent Autoimmune Diabetes in Adults

What participants receive

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

  • recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogelDrug

    Also called GAD-alum (Diamyd(R))

    3 intra-inguinal injections (into the lymph nodes) of GAD-alum one month apart. Supplier Diamyd Medical AB in Stockholm, Sweden

  • Vitamin DDrug

    Also called Divisun 2000 IE

    1 tablet/day, total daily dose of 2000 IE given per os from day -30 through day 90. Supplier Meda, Solna, Sweden

Study groups in NCT04262479
Study groupRoleWhat they receive
GAD-vaccination with vitamin D suppletionExperimentalEach study participant will receive 3 injections of 4 µg GAD-alum (Diamyd). The first, second and third injection will be one month apart. Vitamin D (Divisun 2000 IE) will be given from one month before the first injection of GAD-alum until one month after the third injection (120 days in total).
Receives: Drug: recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogel; Drug: Vitamin D

What is being measured

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

  1. Injection Site Skin Reactions

    Injection site skin reactions 1 hour post injection, i.e., erythema, oedema, haematoa, tenderness, pain, itching or other finding.

    Measured: 1 hour

  2. Occurrence of Adverse Events (AEs) During 5 Months From Baseline.

    AEs were continuously monitored and registered from the baseline visit (first injection of GAD-alum) to the end of study (12 months after the baseline visit). The total number of AEs registered for all 14 participants during the first 5 months from baseline was summarized when all 14 participants had completed their 5 months study visit (i.e., 5 months after the baseline visit). At the end of study, when all 14 participants had completed their 12 months study visit, the total number of AEs registered for all 14 participants during the 12 months from baseline was summarized.

    Measured: From baseline (first injection of GAD-alum) to 5 months after baseline.

  3. Occurrence of Adverse Events (AEs) During the Study.

    AEs were continuously monitored and registered from the baseline visit (first injection of GAD-alum) to the end of study (12 months after the baseline visit/first injection of GAD-alum). The total number of AEs registered for all 14 participants during the first 5 months from baseline was summarized when all 14 participants had completed their 5 months study visit (i.e., 5 months after the baseline visit). At the end of study, when all 14 participants had completed their 12 months study visit, the total number of AEs registered for all 14 participants during the 12 months from baseline was summarized.

    Measured: From baseline (first injection of GAD-alum) to 12 months after baseline.

  4. Serum GAD65A Titers, Change From Baseline at 5 Months After Baseline.

    Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 5 months after baseline.

    Calculation: Value at 5 months minus value at baseline.

    Measured: Baseline (first injection of GAD-alum) and 5 months after baseline.

  5. Serum GAD65A Titers, Change From Baseline at 12 Months After Baseline.

    Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 12 months after baseline.

    Calculation: Value at 12 months minus value at baseline.

    Measured: Baseline and 12 months after baseline.

  6. Serum GAD65A Titers, Change From Baseline at 12 Months After Baseline.

    Values present changes in serum GAD65A titers from baseline (first injection of GAD-alum) to 12 months after baseline.

    Calculation: Value at 12 months minus value at baseline.

    Measured: Baseline (first injection of GAD-alum) and 12 months after baseline.

Secondary outcomes (6)
  1. Insulin Secretion, Change From Baseline to 5 Months After Baseline.

    Values present changes in serum values of glucagon-stimulated C-peptide from baseline (first injection of GAD-alum) to 5 months after baseline.

    Calculation: Value at 5 months minus value at baseline.

    Measured: Baseline (first injection of GAD-alum) and 5 months after baseline.

  2. Insulin Secretion, Change From Baseline to 12 Months After Baseline.

    Values present changes in serum values of glucagon-stimulated C-peptide from baseline (first injection of GAD-alum) to 12 months after baseline.

    Calculation: Value at 12 months minus value at baseline.

    Measured: Baseline (first injection of GAD-alum) and 12 months after baseline.

  3. Change in HbA1c

    HbA1c at 12 months vs. baseline (first injection)

    Measured: from baseline to 12 months after the first injection

  4. Change in Fasting Glucose

    Change in fasting glucose at 12 months vs baseline (first injection)

    Measured: From baseline to 12 months after the first injection

  5. Change in Fasting C-peptide

    Change in fasting glucose at 12 months vs baseline (first injection)

    Measured: Between baseline and 12 months after the first injection

  6. Change in Maximum C-peptide During Mixed Meal Tolerance Test (MMTT)

    Change in maximum C-peptide value at 12 months vs baseline (first injection)

    Measured: between baseline 12 months after the first injection

Timeline

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

  1. First posted10 Feb 2020
  2. Study start2 Mar 2020
  3. Primary completion5 May 2022
  4. Study completion5 May 2022

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
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
14 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04262479
Sponsor's protocol ID
GADinLADA
Other IDs
2019-002692-34, 2019
Acronym
GADinLADA
Status last verified
Jun 2025
First submitted
5 Feb 2020
Last updated
8 Jun 2025
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: There is not a plan to make IPD available.

Publications

  • Hals IK, Fiskvik Fleiner H, Reimers N, Astor MC, Filipsson K, Ma Z, Grill V, Bjorklund A. Investigating optimal beta-cell-preserving treatment in latent autoimmune diabetes in adults: Results from a 21-month randomized trial. Diabetes Obes Metab. 2019 Oct;21(10):2219-2227. doi: 10.1111/dom.13797. Epub 2019 Jun 19.

    PubMed 31148332

Questions about this trial

What is this clinical trial studying?

A Phase 2 study testing recombinant human glutamic acid dehydrogenase (rhGAD65), formulated in aluminium hydrogel and Vitamin D in people with Latent Autoimmune Diabetes in Adults, run by Norwegian University of Science and Technology at 2 sites in 2 countries.

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 21 inclusion and 19 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: finished, as of the sponsor's last update on 8 Jun 2025. 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 Norway, Sweden. 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. 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?

Yes. Results are posted in the registry (first posted 8 Jun 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Injection Site Skin Reactions (time frame: 1 hour). 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 NCT04262479, which also lists 1 linked publication.

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 8 Jun 2025.

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