Targeting Beta-cell Failure in Lean Patients With Type 2 Diabetes
试验速览
- 阶段
- 4 期
- 状态
- 已完成
- 入组人数
- 57
- 试验地点
- 1
- 主要终点
- Change in myocardial perfusion after treatment
研究概览
简要总结
The majority of people with type 2 diabetes (T2D) are overweight, and while weight gain is a major contributor to diabetes, a minority of patients with T2D are not overweight or obese. The reasons why lean or normal body weight individuals develop T2D (lean-T2D) are not yet understood. T2D occurs when the body does not produce enough insulin, or becomes less sensitive to its effects. Insulin acts like a key to allow sugar into cells and if someone is overweight that key works less well. Recent research suggests that T2D in lean people should be considered a different disease from the diabetes associated with obesity and the main problem in lean-T2D patients may be a reduced capacity of insulin secretion. However, some researchers argue that many seemingly thin people carry more fat than muscle, making them trim on the outside, but fat on the inside, and they are in fact not truly lean. This implies that just like overweight diabetics, lean diabetics also have high resistance to insulin. The main aim of this research is to better understand the main driver of T2D in lean individuals, as this will determine how best to treat these individuals.
There are many different types of drugs for treating T2D. Liraglutide improves insulin secretion capacity of the pancreas. Pioglitazone reduces resistance to insulin action. The investigators will compare the actions of these diabetes drugs on the blood supply and the heart's energy levels in lean-T2D and obese-T2D patients. This will allow the investigators to determine the ideal treatment strategies for improving cardiovascular health in lean-T2D patients, and better understand the role of impaired insulin secretory capacity, insulin resistance and excess fat deposition specifically in this group.
详细描述
This is a single centre, open-label, randomized, cross-over study. Participants will attend 4 visits in total over the course of approximately 40 weeks. Two cohorts of patients will be recruited: 28 lean-T2D patients and 28 obese-T2D patients.
Potential participants will be invited to the research centre for a screening/ baseline visit (Visit 1). At this visit, the participants will be given the Participant Information Sheet (PIS) to read through, and given the opportunity to ask questions. If they are interested in participating, their consent will be taken in written form. Each participant will then have a series of non-invasive tests. At this baseline visit, the following assessments will be done:
- Review of medical history and concomitant medications;
- Review of history of diabetes and complications;
- Review of inclusion/exclusion criteria;
- Collection of demographic data;
- Vital signs;
- Physical examination;
- Height and weight;
- Blood pressure;
- Urine pregnancy test in women of childbearing potential;
- Venepuncture (fasting sample): 20mls;
- Multiparametric MRI;
- EndoPAT testing;
- 6 minute walk test;
- 12-lead ECG;
- Randomization;
- Dispense study medication and issue patient diary; and
- Urine sample collection.
At this visit, participants will be randomized to receive either liraglutide or pioglitazone first. Participants that are already taking certain classes of glucose-lowering medications may be excluded from the study (see exclusion criteria for more detail). Participants will continue to take their previously prescribed medications throughout the study.
After 16 weeks of treatment (Visit 2), participants will return to the research centre and have the following assessments:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Lean cohort
- •Men and women>18 years of age;
- •Normal body weight (18.5 ≤ BMI ≤25 kg/m2);
- •T2D patients can be on treatment with oral glucose lowering therapies, and if they are, they must have been on these treatments for at least 12 weeks prior to screening;
- •6.5≤HBA1c≤10% at screening;
- •Agreement to maintain prior diet and exercise habits for the duration of the study.
- •Overweight cohort
- •Men and women>18 years of age;
- •Increased body weight (BMI >27 kg/m2);
- •T2D patients can be on treatment with oral glucose lowering therapies, and must have been on these treatments for at least 12 weeks prior to screening;
- •6.5≤HBA1c≤10% at screening;
- •Agreement to maintain prior diet and exercise habits for the duration of the study.
排除标准
- •Any type of diabetes other than T2D;
- •Past history of significant CAD;
- •Significant renal impairment (eGFR<30ml/min/m2);
- •Participation in a clinical trial of an investigational medicinal product (CTIMP) in the preceding 12 weeks;
- •Known hypersensitivity to dobutamine or gadolinium or any other contra-indications to MRI;
- •Participants with obesity where their girth exceeds the scanner bore;
- •History of pancreatitis;
- •Any history of liver disease;
- •Patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2);
- •Prior or current use of thiazolidinediones (aka PPAR-γ agonists), fibrates, GLP-1RA or insulin;
- •Patients that are pregnant (female participants only);
- •Inflammatory bowel disease
- •Diabetic gastroparesis
研究组 & 干预措施
Liraglutide-Pioglitazone
Participants randomised to receive liraglutide treatment for 16 weeks, followed by an 8 week washout then commencing 16 weeks of treatment with pioglitazone.
干预措施: Liraglutide (Drug)
Liraglutide-Pioglitazone
Participants randomised to receive liraglutide treatment for 16 weeks, followed by an 8 week washout then commencing 16 weeks of treatment with pioglitazone.
干预措施: Pioglitazone (Drug)
Pioglitazone-Liraglutide
Participants randomised to receive pioglitazone treatment for 16 weeks, followed by an 8 week washout then commencing 16 weeks of treatment with liraglutide.
干预措施: Liraglutide (Drug)
Pioglitazone-Liraglutide
Participants randomised to receive pioglitazone treatment for 16 weeks, followed by an 8 week washout then commencing 16 weeks of treatment with liraglutide.
干预措施: Pioglitazone (Drug)
结局指标
主要结局
Change in myocardial perfusion after treatment
时间窗: 40 weeks
Measured changes in myocardial perfusion by Magnetic Resonance Imaging (MRI) after treatment with liraglutide and pioglitazone.
次要结局
- Myocardial steatosis (myocardial triglyceride content)(40 weeks)
- Myocardial function(40 weeks)
- Insulin resistance (HOMA-IR)(40 weeks)
- Myocardial energetics (PCr/ATP ratio)(40 weeks)
- Peripheral endothelial function(40 weeks)
- Physical performance(40 weeks)
- Hepatic steatosis (hepatic triglyceride content)(40 weeks)
研究者
Eylem Levelt
Principal Investigator
University of Leeds