Continuous Subcutaneous Hydrocortisone Infusion In Addison`s Disease and Type 1 Diabetes

This study is ongoing, but not recruiting participants.
Information provided by (Responsible Party):
Haukeland University Hospital Identifier:
First received: April 23, 2013
Last updated: November 30, 2015
Last verified: November 2015

The conventional glucocorticoid replacement therapy in primary adrenal insufficiency (Addison's disease) renders the cortisol levels unphysiological, which may cause symptoms and long-term complications.

The majority of Addison's patients have other organ-specific autoimmune disease, which poses challenges to the replacement therapy. Of particular interest is the combination of Addison`s disease and type 1 diabetes, since cortisol affects glucose homeostasis. The clinical experience is that this subgroup of patients is difficult to treat, but very little research has been done to understand and improve their situation.

Glucocorticoid replacement is technically feasible by continuous subcutaneous hydrocortisone infusion, and can mimic the normal diurnal cortisol rhythm. This pilot study aims to further evaluate continuous subcutaneous hydrocortisone infusion treatment in terms of metabolic effects especially glycemic control in patients with the combination of Addison`s disease and type 1 diabetes in an 5 months cross-over design open clinical pilot study.

Condition Intervention Phase
Addison Disease
Type 1 Diabetes
Other: Cortef
Other: Solu-cortef
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Crossover Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Continuous Subcutaneous Hydrocortisone Infusion In Addison`s Disease and Type 1 Diabetes

Resource links provided by NLM:

Further study details as provided by Haukeland University Hospital:

Primary Outcome Measures:
  • nocturnal hypoglycemic events [ Time Frame: 4 months ] [ Designated as safety issue: Yes ]
    severe hypoglycemia (needs for another person's assistance, blood glucose ≤ 3.1 mmol ⁄ L or prompt recovery after oral carbohydrate, i.v glucose or glucagon administration) and insulin requirement

Secondary Outcome Measures:
  • o Nocturnal glycemic variability [ Time Frame: 4 months ] [ Designated as safety issue: Yes ]
    monitored by continuous glucose monitor system

  • hormone and metabolic profile [ Time Frame: 4 months ] [ Designated as safety issue: No ]
    • Hormone levels : insulin like growth factor 1, growth hormone
    • Steroid metabolism: adrenocorticotropic hormone , cortisol
    • Metabolic profile: fructosamine, HBA1C, lipid levels, C reactive protein , homeostasis model assessment index

  • o Subjective health status [ Time Frame: 4 months ] [ Designated as safety issue: No ]
    Self administration of questionnaires

Estimated Enrollment: 10
Study Start Date: May 2013
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: December 2016 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Cortef
Treatment A is oral hydrocortisone replacement( Cortef 5 mg)with weight-adjusted doses as suggested by Mah et al , will take 2 months
Other: Solu-cortef

Treatment B is continuous subcutaneous hydrocortisone infusion with the initial standard dose of 10mg/m2/24hrs. Body surface area will be calculated according to the nomogram from the formula of Du Bois and Du Bois.

This part of the study will take 2 months.

Active Comparator: Solu-cortef
This is the treatment B by continuous subcutaneous hydrocortisone infusion. Solu-cortef infusion will be given as Solu-Cortef Act-o-Vial 50mg/ml, , produced by Pfizer. Pump designed for subcutaneous insulin infusion can be used for subcutaneous administration.
Other: Cortef
Treatment A is oral hydrocortisone replacement ( Cortef 5 mg) administered according to weight-adjusted doses for 2 months

  Show Detailed Description


Ages Eligible for Study:   18 Years to 70 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

- primary Addison`s disease in combination with long-standing Type 1 diabetes

Exclusion Criteria:

  • cardiovascular disease
  • active malignant disease
  • pregnant women
  • pharmacological treatment with glucocorticoids or drugs that interfere with cortisol metabolism (antiepileptics, rifampicin, St. Johns war, estrogens)
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01840189

Haukeland University Hospiatl
Bergen, Norway, 5021
Sponsors and Collaborators
Haukeland University Hospital
Study Director: Kristian Løvås, MD, PhD Haukeland University Hospital
Principal Investigator: Katerina Simunkova, PhD Haukeland University Hospital
  More Information

Additional Information:

Responsible Party: Haukeland University Hospital Identifier: NCT01840189     History of Changes
Other Study ID Numbers: 2012/2218  2012/005516-26 
Study First Received: April 23, 2013
Last Updated: November 30, 2015
Health Authority: Norway: Norwegian Medicines Agency
Norway: Regional Ethics Commitee

Keywords provided by Haukeland University Hospital:
Addison disease
Type 1 diabetes

Additional relevant MeSH terms:
Addison Disease
Diabetes Mellitus, Type 1
Adrenal Gland Diseases
Adrenal Insufficiency
Autoimmune Diseases
Diabetes Mellitus
Endocrine System Diseases
Glucose Metabolism Disorders
Immune System Diseases
Metabolic Diseases
Cortisol succinate
Hydrocortisone 17-butyrate 21-propionate
Hydrocortisone acetate
Anti-Inflammatory Agents
Dermatologic Agents processed this record on May 26, 2016