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Myocardial Dysfunction in Type 2 Diabetes Mellitus (T2DM)

Primary Purpose

Type 2 Diabetes, Coronary Heart Disease

Status
Completed
Phase
Phase 4
Locations
Study Type
Interventional
Intervention
pioglitazone
Sponsored by
The University of Texas Health Science Center at San Antonio
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Type 2 Diabetes focused on measuring diastolic function, mitochondria, pioglitazone, pericardial fat

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Patients must be able to communicate meaningfully with the investigator and must be legally competent to provide written informed consent.
  • Patients may be of either sex. Female patients must be non-lactating and must either be at least one year post-menopausal, or be using adequate contraceptive precautions (i.e. oral contraceptives, approved hormonal implant, intrauterine device, diaphragm with spermicide, condom with spermicide), or be surgically sterilized (i.e. bilateral tubal ligation, bilateral oophorectomy). Female patients who have undergone a hysterectomy are eligible for participation in the study. Female patients (except for those patients who have undergone a hysterectomy or a bilateral oophorectomy) are eligible only if they have a negative pregnancy test throughout the study period
  • Patients must range in age from 18 to 75 years, inclusive.
  • Patients with type 2 diabetes must be drug naïve, receiving monotherapy with metformin or with a sulfonylurea, or combination therapy with both: metformin & sulfonylurea.
  • Patients must have the following laboratory values:

    • Hematocrit ≥ 34 vol%
    • Serum creatinine ≤ 1.8 mg/dl
    • AST (SGOT) ≤ 2.5 times upper limit of normal
    • ALT (SGPT) ≤ 2.5 times upper limit of normal
    • Alkaline phosphatase ≤ 2 times upper limit of normal
  • Patients must have been on a stable dose of allowed chronic medications for 30 days prior to entering the study.
  • Only subjects whose body weight has been stable (±3-4 pounds) over the three months prior to study will be included.

Exclusion Criteria:

  • Patients must not have type 1 diabetes.
  • Patients must not be receiving any medications with known adverse effects on glucose tolerance (except metformin or a sulfonylurea) unless the patient has been on stable doses of such agents for the past three months before entry into the study. Patients may be taking stable doses of estrogens or other hormonal replacement therapy, if the patient has been on these agents for the prior three months. Patients taking systemic glucocorticoids are excluded.
  • Patients with a history of clinically significant heart disease (New York Heart Classification greater than class 2; more than non-specific ST-T wave changes on the EKG), peripheral vascular disease (history of claudication), or pulmonary disease (dyspnea on exertion of one flight or less; abnormal breath sounds on auscultation) will not be studied.
  • Patients with hematocrit < 34% will be excluded.
  • Patient who were exposed to any procedure involves radiation exposure and his total radiation dose equivalent exceeds 5 rem during the past year will be excluded from the study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm Type

    Experimental

    Arm Label

    Pioglitazone

    Arm Description

    Only subjects with T2DM or non-diabetic subjects with coronary heart disease will receive Pioglitazone

    Outcomes

    Primary Outcome Measures

    Change in E to A Ratio
    The E to A ratio is a marker of the function of the left ventricle of the heart. It represents the ratio of peak velocity flow in early diastole (the E wave) to peak velocity flow in late diastole caused by the atrial contraction (the A wave) This is measured using ultrasound-based cardiac imaging. In a healthy heart the E velocity is greater than the A velocity.
    Myocardial Glucose Uptake
    Measurement of change in myocardial glucose uptake from baseline to 6 months of treatment with pitoglitazone

    Secondary Outcome Measures

    Change in Hemoglobin A1c
    Change in hemoglobin A1c levels measured at 6 months

    Full Information

    First Posted
    March 19, 2012
    Last Updated
    October 31, 2017
    Sponsor
    The University of Texas Health Science Center at San Antonio
    Collaborators
    Takeda Pharmaceuticals North America, Inc.
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    1. Study Identification

    Unique Protocol Identification Number
    NCT01588470
    Brief Title
    Myocardial Dysfunction in Type 2 Diabetes Mellitus (T2DM)
    Official Title
    Myocardial Dysfunction in Type 2 Diabetes Mellitus (T2DM) - Role of Intramyocellular Lipid Content and Mitochondrial Dysfunction in Myocardial Insulin Resistance and Their Correction With Pioglitazone
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2017
    Overall Recruitment Status
    Completed
    Study Start Date
    June 2006 (undefined)
    Primary Completion Date
    December 2011 (Actual)
    Study Completion Date
    December 2011 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    The University of Texas Health Science Center at San Antonio
    Collaborators
    Takeda Pharmaceuticals North America, Inc.

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to examine the existence of heart abnormalities in patients with diabetes and the effect of pioglitazone in correcting these abnormalities.
    Detailed Description
    PRIMARY OBJECTIVES To quantitate myocardial insulin sensitivity using positron emission tomography (PET) with 18F-deoxyglucose in type 2 diabetes mellitus (T2DM) and control subjects. To quantitate pericardial fat using magnetic resonance spectroscopy in T2DM and control subjects. To quantitate cardiac function using magnetic resonance imaging and echocardiography in T2DM and control subjects. To examine the effect of pioglitazone on myocardial insulin sensitivity, pericardial fat content, and cardiac function. SECONDARY OBJECTIVES To examine the relationships between myocardial insulin sensitivity, pericardial fat content, and cardiac function.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Type 2 Diabetes, Coronary Heart Disease
    Keywords
    diastolic function, mitochondria, pioglitazone, pericardial fat

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Phase 4
    Interventional Study Model
    Single Group Assignment
    Model Description
    this study includes single arm intervention with pioglitazone. T2DM individuals will be studied at baseline and after 6 months treatment. as a reference group, healthy subjects will be studied in cross sectional fashion. Because healthy subjects will not be treated nor restudied at 6 months, they can not be considered a separate arm in the study but rather a reference group
    Masking
    None (Open Label)
    Allocation
    N/A
    Enrollment
    130 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Pioglitazone
    Arm Type
    Experimental
    Arm Description
    Only subjects with T2DM or non-diabetic subjects with coronary heart disease will receive Pioglitazone
    Intervention Type
    Drug
    Intervention Name(s)
    pioglitazone
    Other Intervention Name(s)
    Actos
    Intervention Description
    45 mg per day for 6 months
    Primary Outcome Measure Information:
    Title
    Change in E to A Ratio
    Description
    The E to A ratio is a marker of the function of the left ventricle of the heart. It represents the ratio of peak velocity flow in early diastole (the E wave) to peak velocity flow in late diastole caused by the atrial contraction (the A wave) This is measured using ultrasound-based cardiac imaging. In a healthy heart the E velocity is greater than the A velocity.
    Time Frame
    Baseline and 6-months Post Treatment
    Title
    Myocardial Glucose Uptake
    Description
    Measurement of change in myocardial glucose uptake from baseline to 6 months of treatment with pitoglitazone
    Time Frame
    Baseline and 6-months Post Treatment
    Secondary Outcome Measure Information:
    Title
    Change in Hemoglobin A1c
    Description
    Change in hemoglobin A1c levels measured at 6 months
    Time Frame
    Baseline and 6-months Post Treatment

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    75 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Patients must be able to communicate meaningfully with the investigator and must be legally competent to provide written informed consent. Patients may be of either sex. Female patients must be non-lactating and must either be at least one year post-menopausal, or be using adequate contraceptive precautions (i.e. oral contraceptives, approved hormonal implant, intrauterine device, diaphragm with spermicide, condom with spermicide), or be surgically sterilized (i.e. bilateral tubal ligation, bilateral oophorectomy). Female patients who have undergone a hysterectomy are eligible for participation in the study. Female patients (except for those patients who have undergone a hysterectomy or a bilateral oophorectomy) are eligible only if they have a negative pregnancy test throughout the study period Patients must range in age from 18 to 75 years, inclusive. Patients with type 2 diabetes must be drug naïve, receiving monotherapy with metformin or with a sulfonylurea, or combination therapy with both: metformin & sulfonylurea. Patients must have the following laboratory values: Hematocrit ≥ 34 vol% Serum creatinine ≤ 1.8 mg/dl AST (SGOT) ≤ 2.5 times upper limit of normal ALT (SGPT) ≤ 2.5 times upper limit of normal Alkaline phosphatase ≤ 2 times upper limit of normal Patients must have been on a stable dose of allowed chronic medications for 30 days prior to entering the study. Only subjects whose body weight has been stable (±3-4 pounds) over the three months prior to study will be included. Exclusion Criteria: Patients must not have type 1 diabetes. Patients must not be receiving any medications with known adverse effects on glucose tolerance (except metformin or a sulfonylurea) unless the patient has been on stable doses of such agents for the past three months before entry into the study. Patients may be taking stable doses of estrogens or other hormonal replacement therapy, if the patient has been on these agents for the prior three months. Patients taking systemic glucocorticoids are excluded. Patients with a history of clinically significant heart disease (New York Heart Classification greater than class 2; more than non-specific ST-T wave changes on the EKG), peripheral vascular disease (history of claudication), or pulmonary disease (dyspnea on exertion of one flight or less; abnormal breath sounds on auscultation) will not be studied. Patients with hematocrit < 34% will be excluded. Patient who were exposed to any procedure involves radiation exposure and his total radiation dose equivalent exceeds 5 rem during the past year will be excluded from the study.
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Ralph A DeFronzo, MD
    Organizational Affiliation
    University of Texas
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    IPD Sharing Plan Description
    IPD data will not be available for other researchers. However, a manuscript describing the study results is under review for publication in the medical literature
    Citations:
    PubMed Identifier
    28847910
    Citation
    Clarke GD, Solis-Herrera C, Molina-Wilkins M, Martinez S, Merovci A, Cersosimo E, Chilton RJ, Iozzo P, Gastaldelli A, Abdul-Ghani M, DeFronzo RA. Pioglitazone Improves Left Ventricular Diastolic Function in Subjects With Diabetes. Diabetes Care. 2017 Nov;40(11):1530-1536. doi: 10.2337/dc17-0078. Epub 2017 Aug 28.
    Results Reference
    derived

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    Myocardial Dysfunction in Type 2 Diabetes Mellitus (T2DM)

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