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
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
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
NCT ID
NCT00928876
First Posted
June 25, 2009
Last Updated
December 16, 2010
Sponsor
Radboud University Medical Center
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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