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Trial registered on ANZCTR
Registration number
ACTRN12616000525482
Ethics application status
Approved
Date submitted
19/04/2016
Date registered
22/04/2016
Date last updated
20/02/2017
Type of registration
Prospectively registered
Titles & IDs
Public title
A preliminary investigation on the effects of intermittent exposure to hypoxia on glucose homeostasis
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Scientific title
A preliminary investigation on the effects of intermittent exposure to hypoxia on glucose homeostasis in overweight adults with impaired fasting blood glucose
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Secondary ID [1]
289031
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Nil known
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Universal Trial Number (UTN)
U1111-1182-0446
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Impaired fasting blood glucose
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Pre-diabetes
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Overweight
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Type 2 diabetes
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Condition category
Condition code
Metabolic and Endocrine
298545
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0
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Diabetes
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Participants with impaired fasting blood glucose will be given intermittent exposure to hypoxic air from a hypoxicator via a breathing mask. The biofeedback mode of the hypoxicator will be used with the target hypoxia level set as blood oxygen saturation at 90% (corresponding oxygen level in the air at approximately 15%). The blood oxygen saturation is monitored by a pulse oximeter. Each intervention session is for 1 hour that includes four cycles of breathing hypoxic air for 10 minutes followed by normal air for 5 minutes. The intervention will be administered by research scientists and accredited exercise physiologists. Each intervention session will be delivered individually at the research laboratory in School of Health and Human Sciences, Lismore Campus of Southern Cross University.
The research has two phases. The first phase is a pilot investigation that will use a single system research design to examine the acute effects of 1 hour hypoxia or normoxia exposure on blood glucose. Each participant will be randomly allocated into two hypoxia and two normoxia sessions each is separated by one week. The phase two of the research will be a randomised controlled trial that uses a single-blind crossover design to investigate the effects of four weeks (three 1 hour sessions per week in non-consecutive days) hypoxia or placebo intervention on blood glucose homeostasis and insulin sensitivity. A 4-week wash-out period will be inserted between the two 4-week hypoxia or normoxia (placebo) intervention periods).
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Intervention code [1]
294513
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Treatment: Other
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Comparator / control treatment
Hypoxia group will be given normobaric hypoxic air and control group will be given normal air during the intervention sessions.
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Control group
Placebo
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Outcomes
Primary outcome [1]
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Phase 1: Acute changes in blood glucose (skin-puncture samples), assessed by a hand-hold glucometer..
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Assessment method [1]
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Timepoint [1]
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Phase 1: Pre, 30 min and 60 min during, and 30 min, 1 hour and 24 hour post an intervention trial.
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Primary outcome [2]
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Phase 2: Changes in fasting blood glucose (veni-puncture samples), assessed by serum assay at an accredited pathology lab..
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Assessment method [2]
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Timepoint [2]
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Pre and post four weeks hypoxia and four weeks placebo intervention periods.
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Primary outcome [3]
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Phase 2: Changes in glucose tolerance (veni-puncture samples), assessed by serum assay at an accredited pathology lab..
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Assessment method [3]
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Timepoint [3]
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Pre and post four weeks hypoxia and four weeks placebo intervention periods.
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Secondary outcome [1]
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Phase 2: Changes in blood insulin (veni-puncture samples), assessed by serum assay at an accredited pathology lab.
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Assessment method [1]
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Timepoint [1]
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Phase 2: Pre and post four weeks hypoxia and four weeks placebo intervention periods.
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Secondary outcome [2]
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Phase 2: Changes in HbA1c, assessed by ion-exchange high-performance liquid chromatography at an accredited pathology lab.
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Assessment method [2]
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Timepoint [2]
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Pre and post four weeks hypoxia and four weeks placebo intervention periods.
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Secondary outcome [3]
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Blood oxygen saturation (SpO2), monitored by a pulse oximeter in all intervention sessions.
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Assessment method [3]
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Timepoint [3]
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Monitored continuously during each intervention session to provide biofeedback to the hypoxicator.
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Secondary outcome [4]
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Heart rate, monitored by a pulse oximeter.
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Assessment method [4]
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Timepoint [4]
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Monitored continuously and recorded every 5 minutes during each intervention session.
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Secondary outcome [5]
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Blood pressure, monitored using a sphygmomanometer.
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Assessment method [5]
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Timepoint [5]
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Every 15 minutes during each intervention session.
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Eligibility
Key inclusion criteria
Fasting blood glucose greater than 6.0 mM
Body mass index >25 (i.e. overweight or obese);
No planned changes to medication regimen for hyperglycaemia (e.g. metformin, acarbose) or other metabolic diseases (e.g. lipid lowering drugs); and
No planned major lifestyle changes during the testing period (i.e. commencement/ceasing of exercise regimen, pregnancy, etc.)
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Minimum age
18
Years
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Maximum age
65
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Cardiovascular diseases;
Anemia or blood donation within past 3 months;
Severe chronic obstructive pulmonary disease;
Smoking;
Alcohol consumption for more than 3 standard drinks per day;
Obstructive sleep apnea;
Uncontrolled asthma;
Inflammatory and/or infectious diseases;
Intolerance to oxygen insufficiency;
Disease with symptoms of decompensation;
Terminal illness;
Cancer;
Pregnant;
Neurological diseases; or
Mental illness.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is not concealed.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
A restricted randomization (blocking) method will be used. Participants will be randomly given a code number among 1 to 4 in Phase 1, or 1 to 20 In Phase 2, then a random pick of odd (or even) number will determine whether those having an odd (or even) number will start with treatment A – hypoxia, or B - normoxia, then change over to the alternate treatment at the designed time point.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Crossover
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
Phase one of the trial is a pilot investigation that will use a single system research design. Each individual’s responses to 1 hour hypoxia or placebo treatment will be visually demonstrated and inspected. Four participants with impaired fasting blood glucose and one healthy participant will be recruited and are thought sufficient in validating intervention procedures.
The phase two of the trial is a randomised controlled trial that will use a single-blind crossover design to investigate the effects of four weeks (three 1 hour sessions per week) hypoxia or normoxia (as control) intervention. The number of participants is justified by a priori estimation. With assumptions of effect size of 0.4, power of 0.8, alpha level of 0.05, and two groups with three measures, the minimum number required is 12 (i.e. 6 in each group) for general linear model with repeated measures statistical analysis. Therefore, a total 20 participants (10 in each group) would be sufficient, with consideration of potential dropouts.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
27/04/2016
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Actual
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Date of last participant enrolment
Anticipated
22/12/2017
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Actual
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Date of last data collection
Anticipated
30/04/2018
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Actual
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Sample size
Target
25
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment postcode(s) [1]
13091
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2480 - Lismore
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Recruitment postcode(s) [2]
13092
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2478 - Ballina
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Recruitment postcode(s) [3]
13093
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2470 - Casino
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Funding & Sponsors
Funding source category [1]
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University
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Name [1]
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Southern Cross University
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Address [1]
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Military Road
Lismore, NSW 2480
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Country [1]
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Australia
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Primary sponsor type
University
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Name
Southern Cross University
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Address
Military Road
Lismore, NSW 2480
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Southern Cross University Human Research Ethics Committee
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Ethics committee address [1]
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Military Road Lismore, NSW 2480
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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09/02/2016
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Approval date [1]
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14/03/2016
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Ethics approval number [1]
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ECN-16-025
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Summary
Brief summary
Obesity and diabetes have become global epidemics. It is known that adequate physical activity and a healthy diet are among the key factors in weight control and management of type 2 diabetes. However, participation in regular exercise could be a challenge to some individuals with various capacities. There have been reports in the literature that hypoxia interventions, alone or combined with exercise, may have beneficial effects on weight control and blood glucose homeostasis in individuals with obesity and hyperglycaemia. With advancement of technology, hypoxia chambers and breathing devices (hypoxicators) have become available to provide air with various levels of oxygen. Whether hypoxia can be validated as an alternative or complementary intervention for obesity and diabetes requires further research. The aim of this research is to conduct a preliminary investigation on the effect of four weeks intermittent exposure to mild hypoxia (with the target blood oxygen saturation level at approximately 90%) on blood glucose homeostasis and insulin sensitivity in individuals with impaired fasting blood glucose. The participants’ responses (including blood oxygen saturation level, heart rate, and blood pressure) during the intervention sessions will be closely monitored, and their blood glucose, insulin and HbA1c levels, and glucose tolerance will be assessed pre and post the intervention period to determine the effects.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Prof Shi Zhou
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Address
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School of Health and Human Sciences
Southern Cross University
Military Road, Lismore NSW 2480
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Country
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Australia
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Phone
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+61 2 66203991
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Charl Neuhoff
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Address
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School of Health and Human Sciences
Southern Cross University
Military Road, Lismore NSW 2480
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Country
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Australia
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Phone
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+61 2 66203868
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Shi Zhou
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Address
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School of Health and Human Sciences
Southern Cross University
Military Road, Lismore NSW 2480
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Country
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Australia
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Phone
65240
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+61 2 66203991
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Fax
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Email
65240
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF