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
About this trial
This is an interventional treatment trial for Type 2 Diabetes focused on measuring diastolic function, mitochondria, pioglitazone, pericardial fat
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.
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
NCT ID
NCT01588470
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.
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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