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The Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases (J-DOIT3)

Primary Purpose

Cardiovascular Diseases, Diabetes Mellitus, Type 2

Status
Unknown status
Phase
Not Applicable
Locations
Japan
Study Type
Interventional
Intervention
Lifestyle consultation: weight control, diet, exercise
Lifestyle consultation: weight control, diet, exercise
Sponsored by
Japan Foundation for the Promotion of International Medical Research Cooperation
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Cardiovascular Diseases focused on measuring Blood glucose, Blood pressure, Lipids

Eligibility Criteria

45 Years - 69 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

(Intervention study) Inclusion Criteria: Subjects were considered eligible if they were 45 years old or older but younger than 70 years old at study entry, had type 2 diabetes and met both "(1) and (2)" or both "(1) and (3)" described below. [Note: Those who met all three "(1), (2) and (3)" were also considered eligible for inclusion.](1) Glycemic control Those with HbA1c 6.9% or greater despite treatment with any of the three regimens given below. Diet and exercise therapy alone, Diet and exercise therapy plus 1 oral anti-diabetic drug, Diet and exercise therapy plus, GI and 1 other oral anti-anti-diabetic drug (2) Blood pressure control Those with the following casual blood pressure (BP) level as measured on an outpatient basis, Systolic BP 140 mmHg or diastolic BP 90 mmHg while not on an antihypertensive agent, Systolic BP 130 mmHg or diastolic BP 80 mmHg while on 1 or 2 ARB, ACEI or long-acting CCB Those receiving antihypertensive agents other than ARB, ACEI or long-acting CCB were not eligible for study entry, with the exception of those who were receiving these agents for other purposes than blood pressure lowering. (3) Lipid metabolism Those with the following fasting lipid levels while not on a lipid-lowering agent LDL-cholesterol, 120 mg/dL (as calculated by using the Friedewald formula) Triglycerides, 150 mg/dL HDL-cholesterol, < 40 mg/dL Subjects receiving 1 lipid-lowering agent were judged eligible for study entry if they met any of the above criteria. However, care needs to be taken to ensure that those on fibrates discontinue the fibrate treatment at the start of the study when they are assigned to the intensive therapy arm. Exclusion Criteria: 1. Those with poorly controlled hypertension despite pharmacological therapy (systolic BP 200 mmHg or diastolic BP 120 mmHg) 2. Those on insulin therapy 3. Those with non-diabetic renal disease 4. Those in whom type 1 and other diabetes due to pathogenic mechanisms other than those associated with type 2 diabetes is strongly suspected 5. Those who tested anti-GAD antibody*-positive 6. Those with LDL-cholesterol 200 mg/dL 7. Those suspected of having secondary hypertension other than renal parenchymal hypertension 8. Those suspected of having hereditary lipid disorder with a strong family history of lipid metabolic disorder 9. Those who were receiving antihypertensive agents other than ARB, ACEI, long-acting CCB, except where they were receiving these agents for other purposes than blood pressure lowering 10. Those who were receiving 3 or more antihypertensive agents (i.e., ARB, ACEI, and long-acting CCB), except where they were receiving these agents for other purposes than blood pressure lowering 11. Those with more serious retinopathy than proliferative retinopathy 12. Renal failure (serum Cr: 2.0 mg/dL in men; 1.5 mg/dL in women) 13. Those with a history of cardiac failure or those with cardiac failure 14. Those who were pregnant or potentially pregnant 15. Those who met any of the following criteria and who had BNP 100 pg/mL, Myocardial infarction, Angina pectoris (or a history of disease), History of coronary artery bypass graft (CABG), History of percutaneous coronary angioplasty (PTCA), Other cardiac disease, ECG findings of left ventricular hyperplasia, Abnormal ECG findings (excluding isolated extrasystole or right bundle branch block [RBBB]) 16. Those judged by the physician in charge to be ineligible for study entry (Follow-up study) Inclusion criteria: Of the subjects in the randomized controlled study comparing intensive therapy and conventional therapy in type 2 diabetic patients (J-DOIT3), those who provide written informed consent to participate in the follow-up study will be enrolled regardless of completion or discontinuation from the randomized controlled study (If the subject is unable to provide informed consent for any reason, consent from his/her legal representative is allowed). Exclusion criteria: A subject who is assessed as ineligible by the investigator will be excluded from the follow-up study

Sites / Locations

  • The University of Tokyo

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Intensive therapy

Conventional therapy

Arm Description

Outcomes

Primary Outcome Measures

The occurrence of myocardial infarction, coronary bypass surgery, percutaneous transluminal coronary angioplasty, stroke, carotid endarterectomy, percutaneous transluminal cerebral angioplasty, carotid artery stenting, or death

Secondary Outcome Measures

Occurrence of myocardial infarction, stroke or death
Onset or progression of nephropathy
Lower limb vascular events (amputation or revascularization of lower limb)
Onset or progression of retinopathy
All-cause mortality (deaths due to any cause)
This measure is only evaluated with follow-up study.

Full Information

First Posted
March 8, 2006
Last Updated
August 2, 2017
Sponsor
Japan Foundation for the Promotion of International Medical Research Cooperation
Collaborators
Japan Diabetes Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT00300976
Brief Title
The Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases
Acronym
J-DOIT3
Official Title
(Intervention Study) A Randomized Controlled Study of the Intensive Therapy and the Conventional Therapy for the Suppression of the Vascular Complications in the Type 2 Diabetic Patients (Follow-up Study) A Randomized Controlled Study Comparing Intensive Therapy and Conventional Therapy in the Reduction of Vascular Complications in Type 2 Diabetic Patients: A Follow-up Study After Intervention
Study Type
Interventional

2. Study Status

Record Verification Date
August 2017
Overall Recruitment Status
Unknown status
Study Start Date
May 2006 (Actual)
Primary Completion Date
March 2016 (Actual)
Study Completion Date
June 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Japan Foundation for the Promotion of International Medical Research Cooperation
Collaborators
Japan Diabetes Foundation

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
(Intervention study) The objective of the study is to confirm the superiority of the intensive therapy to the conventional therapy concerning the prevention of the incidence or exacerbation of vascular complications caused by diabetes mellitus (DM) by a randomized controlled study in patients with type 2 DM. (Follow-up study) The objective of the follow-up study is to evaluate the long-term efficacy of intensive versus conventional therapy in the effect on mortality and the prevention of the incidence or exacerbation of vascular complications caused by diabetes mellitus through a post-intervention follow-up research conducted after the multi-center, open-label, randomized parallel-group study comparing the efficacy of intensive versus conventional therapy in type 2 diabetic patients.
Detailed Description
(Intervention study) The objective of the study is to confirm the superiority of the intensive therapy to the conventional therapy concerning the prevention of the incidence or exacerbation of vascular complications caused by diabetes mellitus by a randomized controlled study in patients with type 2 DM. The primary outcome measure is occurrence of myocardial infarction, coronary bypass surgery, percutaneous transluminal coronary angioplasty, stroke, carotid endarterectomy, percutaneous transluminal cerebral angioplasty, carotid artery stenting, or death. (Follow-up study) The objective of the follow-up study is to evaluate the long-term efficacy of intensive versus conventional therapy in the effect on mortality and the prevention of the incidence or exacerbation of vascular complications caused by diabetes mellitus through a post-intervention follow-up research conducted after the multi-center, open-label, randomized parallel-group study comparing the efficacy of intensive versus conventional therapy in type 2 diabetic patients. The primary endpoint is identical to that in the intervention study. In addition, overall survivalall-cause mortality will be evaluated as a key secondary endpoint.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Cardiovascular Diseases, Diabetes Mellitus, Type 2
Keywords
Blood glucose, Blood pressure, Lipids

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
(Intervention study) A multi-center, open-label, randomized controlled study, which compared the efficacy of intensive therapy and conventional therapy in type 2 diabetic patients (Follow-up study) A prospective cohort study with a 5-year long-term follow-up period
Masking
None (Open Label)
Allocation
Randomized
Enrollment
2542 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intensive therapy
Arm Type
Experimental
Arm Title
Conventional therapy
Arm Type
Active Comparator
Intervention Type
Behavioral
Intervention Name(s)
Lifestyle consultation: weight control, diet, exercise
Intervention Description
Behavioral: Lifestyle modification including weight control, with the goal of BMI 22. Drug: Drugs are added in a stepwise manner to control blood glucose, blood pressure and lipid metabolism, using mainly hypoglycemic drugs, ACEI/ARB and statins, respectively. Management goals are: HbA1c < 6.2%, BP < 120/75 mmHg, HDL-C 40 mg/dL , LDL-C < 80 mg/dL, TG < 120 mg/dL. Follow-up study (Not provided)
Intervention Type
Behavioral
Intervention Name(s)
Lifestyle consultation: weight control, diet, exercise
Intervention Description
Behavioral and Drug: The physician in charge is to administer appropriate therapy in accordance with the Guidelines. Follow-up study (Not provided)
Primary Outcome Measure Information:
Title
The occurrence of myocardial infarction, coronary bypass surgery, percutaneous transluminal coronary angioplasty, stroke, carotid endarterectomy, percutaneous transluminal cerebral angioplasty, carotid artery stenting, or death
Time Frame
Every 12 months, at the end of the study.
Secondary Outcome Measure Information:
Title
Occurrence of myocardial infarction, stroke or death
Time Frame
Every 12 months, at the end of the study.
Title
Onset or progression of nephropathy
Time Frame
Every 6 months, at the end of the study.
Title
Lower limb vascular events (amputation or revascularization of lower limb)
Time Frame
Every 12 months, at the end of the study.
Title
Onset or progression of retinopathy
Time Frame
Every 12 months, at the end of the study.
Title
All-cause mortality (deaths due to any cause)
Description
This measure is only evaluated with follow-up study.
Time Frame
Every 12 months, at the end of the study.
Other Pre-specified Outcome Measures:
Title
Development of severe hypoglycemia (requiring assistance from another person and/or hospitalization)
Description
This measure is only evaluated with follow-up study.
Time Frame
Every 12 months, at the end of the study.
Title
Hospitalization for heart failure
Description
This measure is only evaluated with follow-up study.
Time Frame
Every 12 months, at the end of the study.
Title
Development of malignant neoplasms
Description
This measure is only evaluated with follow-up study.
Time Frame
Every 12 months, at the end of the study.
Title
Occurrence of fractures
Description
This measure is only evaluated with follow-up study.
Time Frame
Every 12 months, at the end of the study.
Title
Changes in cognitive function (MMSE)
Description
This measure is only evaluated with follow-up study.
Time Frame
At the end of the study.
Title
Changes in QOL (EQ-5D)
Description
This measure is only evaluated with follow-up study.
Time Frame
At the enrollment, at the end of the study.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
45 Years
Maximum Age & Unit of Time
69 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
(Intervention study) Inclusion Criteria: Subjects were considered eligible if they were 45 years old or older but younger than 70 years old at study entry, had type 2 diabetes and met both "(1) and (2)" or both "(1) and (3)" described below. [Note: Those who met all three "(1), (2) and (3)" were also considered eligible for inclusion.](1) Glycemic control Those with HbA1c 6.9% or greater despite treatment with any of the three regimens given below. Diet and exercise therapy alone, Diet and exercise therapy plus 1 oral anti-diabetic drug, Diet and exercise therapy plus, GI and 1 other oral anti-anti-diabetic drug (2) Blood pressure control Those with the following casual blood pressure (BP) level as measured on an outpatient basis, Systolic BP 140 mmHg or diastolic BP 90 mmHg while not on an antihypertensive agent, Systolic BP 130 mmHg or diastolic BP 80 mmHg while on 1 or 2 ARB, ACEI or long-acting CCB Those receiving antihypertensive agents other than ARB, ACEI or long-acting CCB were not eligible for study entry, with the exception of those who were receiving these agents for other purposes than blood pressure lowering. (3) Lipid metabolism Those with the following fasting lipid levels while not on a lipid-lowering agent LDL-cholesterol, 120 mg/dL (as calculated by using the Friedewald formula) Triglycerides, 150 mg/dL HDL-cholesterol, < 40 mg/dL Subjects receiving 1 lipid-lowering agent were judged eligible for study entry if they met any of the above criteria. However, care needs to be taken to ensure that those on fibrates discontinue the fibrate treatment at the start of the study when they are assigned to the intensive therapy arm. Exclusion Criteria: 1. Those with poorly controlled hypertension despite pharmacological therapy (systolic BP 200 mmHg or diastolic BP 120 mmHg) 2. Those on insulin therapy 3. Those with non-diabetic renal disease 4. Those in whom type 1 and other diabetes due to pathogenic mechanisms other than those associated with type 2 diabetes is strongly suspected 5. Those who tested anti-GAD antibody*-positive 6. Those with LDL-cholesterol 200 mg/dL 7. Those suspected of having secondary hypertension other than renal parenchymal hypertension 8. Those suspected of having hereditary lipid disorder with a strong family history of lipid metabolic disorder 9. Those who were receiving antihypertensive agents other than ARB, ACEI, long-acting CCB, except where they were receiving these agents for other purposes than blood pressure lowering 10. Those who were receiving 3 or more antihypertensive agents (i.e., ARB, ACEI, and long-acting CCB), except where they were receiving these agents for other purposes than blood pressure lowering 11. Those with more serious retinopathy than proliferative retinopathy 12. Renal failure (serum Cr: 2.0 mg/dL in men; 1.5 mg/dL in women) 13. Those with a history of cardiac failure or those with cardiac failure 14. Those who were pregnant or potentially pregnant 15. Those who met any of the following criteria and who had BNP 100 pg/mL, Myocardial infarction, Angina pectoris (or a history of disease), History of coronary artery bypass graft (CABG), History of percutaneous coronary angioplasty (PTCA), Other cardiac disease, ECG findings of left ventricular hyperplasia, Abnormal ECG findings (excluding isolated extrasystole or right bundle branch block [RBBB]) 16. Those judged by the physician in charge to be ineligible for study entry (Follow-up study) Inclusion criteria: Of the subjects in the randomized controlled study comparing intensive therapy and conventional therapy in type 2 diabetic patients (J-DOIT3), those who provide written informed consent to participate in the follow-up study will be enrolled regardless of completion or discontinuation from the randomized controlled study (If the subject is unable to provide informed consent for any reason, consent from his/her legal representative is allowed). Exclusion criteria: A subject who is assessed as ineligible by the investigator will be excluded from the follow-up study
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Takashi Kadowaki
Organizational Affiliation
Tokyo University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The University of Tokyo
City
Tokyo
ZIP/Postal Code
113-8655
Country
Japan

12. IPD Sharing Statement

Citations:
PubMed Identifier
33491087
Citation
Sasako T, Ueki K, Miyake K, Okazaki Y, Takeuchi Y, Ohashi Y, Noda M, Kadowaki T. Effect of a Multifactorial Intervention on Fracture in Patients With Type 2 Diabetes: Subanalysis of the J-DOIT3 Study. J Clin Endocrinol Metab. 2021 Apr 23;106(5):e2116-e2128. doi: 10.1210/clinem/dgab013.
Results Reference
derived
PubMed Identifier
29079252
Citation
Ueki K, Sasako T, Okazaki Y, Kato M, Okahata S, Katsuyama H, Haraguchi M, Morita A, Ohashi K, Hara K, Morise A, Izumi K, Ishizuka N, Ohashi Y, Noda M, Kadowaki T; J-DOIT3 Study Group. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017 Dec;5(12):951-964. doi: 10.1016/S2213-8587(17)30327-3. Epub 2017 Oct 24.
Results Reference
derived
PubMed Identifier
26843962
Citation
Ueki K, Sasako T, Kato M, Okazaki Y, Okahata S, Katsuyama H, Haraguchi M, Morita A, Ohashi K, Hara K, Morise A, Izumi K, Ohashi Y, Noda M, Kadowaki T; J-DOIT3 Study Group. Design of and rationale for the Japan Diabetes Optimal Integrated Treatment study for 3 major risk factors of cardiovascular diseases (J-DOIT3): a multicenter, open-label, randomized, parallel-group trial. BMJ Open Diabetes Res Care. 2016 Jan 25;4(1):e000123. doi: 10.1136/bmjdrc-2015-000123. eCollection 2016. Erratum In: BMJ Open Diabetes Res Care. 2016;4(1):e000123corr1.
Results Reference
derived

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The Japan Diabetes Optimal Integrated Treatment Study for 3 Major Risk Factors of Cardiovascular Diseases

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