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Interleukin-1 Receptor Antagonist and Insulin Sensitivity

Primary Purpose

Diabetes Mellitus, Type 2, Insulin Resistance

Status
Unknown status
Phase
Phase 2
Locations
Netherlands
Study Type
Interventional
Intervention
Anakinra (Kineret)
Placebo
Sponsored by
Radboud University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2 focused on measuring anakinra, Diabetes mellitus, type 2, Insulin resistance, Interleukin-1beta

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • adult subjects with a BMI > 30 kg/m2
  • 3 or more characteristics of the metabolic syndrome

Exclusion Criteria:

  • inability to give informed consent
  • age < 18 years
  • known diabetes mellitus
  • fasting plasma glucose > 7,0 mmol/l or HbA1c > 6,2%
  • presence of any medical condition that might interfere with the current study protocol
  • immunodeficiency of immunosuppressive treatment
  • anti-inflammatory drugs (100 mg of aspirin/day is allowed)
  • signs of current infection
  • history of recurrent infections
  • pregnancy or breast feeding
  • liver disease
  • renal disease
  • neutropenia

Sites / Locations

  • Rabdoud University Nijmegen Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Placebo Comparator

Arm Label

Anakinra group

Placebo

Arm Description

Anakinra 150 mg/day during four weeks

Placebo during four weeks

Outcomes

Primary Outcome Measures

to determine the effect of Interleukin-1 receptor antagonist on insulin sensitivity, as derived from glucose infusion rate measured by euglycemic hyperinsulinemic clamp

Secondary Outcome Measures

pancreatic beta cell function als tested by oral glucose tolerance test, pro-insulin/insulin ratio
lipid profile
systemic inflammation

Full Information

First Posted
June 25, 2009
Last Updated
December 16, 2010
Sponsor
Radboud University Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT00928876
Brief Title
Interleukin-1 Receptor Antagonist and Insulin Sensitivity
Official Title
Effect of Interleukin-1 Receptor Antagonist on Insulin Sensitivity in Obese, Insulin Resistant Individuals
Study Type
Interventional

2. Study Status

Record Verification Date
June 2009
Overall Recruitment Status
Unknown status
Study Start Date
June 2009 (undefined)
Primary Completion Date
March 2010 (Anticipated)
Study Completion Date
July 2010 (Anticipated)

3. Sponsor/Collaborators

Name of the Sponsor
Radboud University Medical Center

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
Obesity is characterized by continuous low-grade inflammation. This is an important link between obesity and insulin resistance. Results from the investigators' own group of in vitro and in vivo research on mice show that Interleukin-1 is involved in the process of developing insulin resistance. Earlier it has been shown that interleukin-1 receptor antagonist in human subjects improves glycemic control. The investigators' hypothesis is that this is due to improved insulin sensitivity.
Detailed Description
The prevalence of obesity is increasing fast. Obesity is one of the most common acquired risk factors for insulin resistance. As a consequence the prevalence of type 2 diabetes mellitus is rising fast as well. Interleukin 6 and Tumor Necrosis Factor alfa are well known pro-inflammatory cytokines that have been linked to insulin resistance. Results from our own group show that interleukin-1 is also involved in the process of developing insulin resistance. Earlier research projects studied the effect of Interleukin-1 receptor antagonist (Anakinra) on glycemic control in subjects with type 2 diabetes mellitus. It was shown that glycemic control was improved. The authors conclude that this is the result of improved function of pancreatic beta cells. These results are in contrast to our results of in vitro en in vivo research on mice, which show improved insulin sensitivity by Interleukin-1 receptor antagonist. A possible explanation for not finding an effect on insulin sensitivity by earlier research projects may be that it is difficult to reliable quantify insulin sensitivity in this group of patients with concurrent changes in glycemic control, extensive co-morbidity and medication use, who might be at the rather extreme end of insulin resistance. Furthermore a relatively low dose of Anakinra was used. Altogether we hypothesize that the effect of Interleukin-1 is not only mediated through better pancreatic beta-cell function, but that Interleukin-1 blocking by recombinant Interleukin-1 receptor antagonist will also diminish insulin resistance.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2, Insulin Resistance
Keywords
anakinra, Diabetes mellitus, type 2, Insulin resistance, Interleukin-1beta

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
12 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Anakinra group
Arm Type
Experimental
Arm Description
Anakinra 150 mg/day during four weeks
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo during four weeks
Intervention Type
Drug
Intervention Name(s)
Anakinra (Kineret)
Other Intervention Name(s)
kineret
Intervention Description
anakinra 150 mg s/c. daily for four weeks
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
placebo s/c daily for four weeks
Primary Outcome Measure Information:
Title
to determine the effect of Interleukin-1 receptor antagonist on insulin sensitivity, as derived from glucose infusion rate measured by euglycemic hyperinsulinemic clamp
Time Frame
after four weeks of treatment
Secondary Outcome Measure Information:
Title
pancreatic beta cell function als tested by oral glucose tolerance test, pro-insulin/insulin ratio
Time Frame
after four weeks of treatment
Title
lipid profile
Time Frame
after four weeks of treatment
Title
systemic inflammation
Time Frame
after four weeks of treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: adult subjects with a BMI > 30 kg/m2 3 or more characteristics of the metabolic syndrome Exclusion Criteria: inability to give informed consent age < 18 years known diabetes mellitus fasting plasma glucose > 7,0 mmol/l or HbA1c > 6,2% presence of any medical condition that might interfere with the current study protocol immunodeficiency of immunosuppressive treatment anti-inflammatory drugs (100 mg of aspirin/day is allowed) signs of current infection history of recurrent infections pregnancy or breast feeding liver disease renal disease neutropenia
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
C J Tack, Prof Dr
Organizational Affiliation
Radboud University Medical Center
Official's Role
Study Chair
Facility Information:
Facility Name
Rabdoud University Nijmegen Medical Centre
City
Nijmegen
ZIP/Postal Code
6500 HB
Country
Netherlands

12. IPD Sharing Statement

Citations:
PubMed Identifier
17429083
Citation
Larsen CM, Faulenbach M, Vaag A, Volund A, Ehses JA, Seifert B, Mandrup-Poulsen T, Donath MY. Interleukin-1-receptor antagonist in type 2 diabetes mellitus. N Engl J Med. 2007 Apr 12;356(15):1517-26. doi: 10.1056/NEJMoa065213.
Results Reference
background
PubMed Identifier
21508140
Citation
van Asseldonk EJ, Stienstra R, Koenen TB, Joosten LA, Netea MG, Tack CJ. Treatment with Anakinra improves disposition index but not insulin sensitivity in nondiabetic subjects with the metabolic syndrome: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2011 Jul;96(7):2119-26. doi: 10.1210/jc.2010-2992. Epub 2011 Apr 20.
Results Reference
derived

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Interleukin-1 Receptor Antagonist and Insulin Sensitivity

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