Cardiovascular safety study of linagliptin versus glimepiride in patients with Type 2 Diabetes Mellitus at high cardiovascular risk.
- Conditions
- Health Condition 1: null- Patients with type 2 diabetes mellitus at high cardiovascular risk
- Registration Number
- CTRI/2011/10/002038
- Lead Sponsor
- Boehringer Ingelheim Pharmaceuticals
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Completed
- Sex
- Not specified
- Target Recruitment
- 6000
Documented diagnosis of T2DM and concurrently 1) insufficient glycaemic control and 2) a high risk of CV events prior to informed consent
1) Insufficient glycaemic control (at Visit 1a) defined as:
a) HbA1c 6.5 - 8.5% (48 - 69 mmol/mol) while patient is treatment naïve or treated with:
- metformin monotherapy, or
- alpha-glucosidase inhibitor monotherapy (e.g. acarbose, voglibose), or
- metformin + alpha-glucosidase inhibitor (e.g. acarbose, voglibose), or
b) HbA1c 6.5 - 7.5% (48 - 58 mmol/mol) while patient is treated with
- sulphonylurea (SU) monotherapy, or
- glinide monotherapy (e.g. repaglinide, nateglinide), or
- metformin + sulphonylurea (combination maximal up to 5 years), or
- metformin + glinide (combination maximal up to 5 years)
2) High risk of CV events defined as any one (or more) of A), B), C) or D):
A) Previous Vascular Disease:
- Myocardial infarction ( > 6 weeks prior to informed consent)
- Documented coronary artery disease (≥50% luminal diameter narrowing of left main coronary artery or in at least two major coronary arteries in angiogram)
- Percutaneous Coronary Intervention (PCI) > 6 weeks prior informed consent
- Coronary Artery By-pass Grafting (CABG) > 4 years prior to informed consent or with recurrent angina following surgery
- Ischemic or hemorrhagic stroke ( > 3 months prior to informed consent)
- Peripheral occlusive arterial disease (previous limb bypass surgery or percutaneous transluminal angioplasty; previous limb or foot amputation due to circulatory insufficiency, angiographic or ultrasound detected significant vessel stenosis ( >50%) of major limb arteries (common iliac artery, internal iliac artery, external iliac artery, femoral artery, popliteal
artery), history of intermittent claudication, with an ankle: arm blood pressure ratio < 0.90 on at least one side).
B) Evidence of vascular related end-organ damage:
- Moderately impaired renal function (as defined by modified diet of renal disease (MDRD) formula) with estimated glomerular filtration rate [eGFRF]) 30-59 mL/min/1.73 m2
- Random spot urinary albumin:creatinine ratio ≥ 30 μg/mg in two of three unrelated specimens in previous 12 months prior Visit 1a
- Proliferative retinopathy defined as retinal neovascularisation or previous retinal laser coagulation therapy.
D) At least two of the following CV risk factors:
- Type 2 diabetes mellitus duration > 10 years at Visit 1a.
- Systolic blood pressure (SBP) > 140 mmHg (or on at least one blood pressure lowering treatment at Visit 1a)
- Current daily cigarette smoking
- LDL cholesterol ≥ 135 mg/dL (3.5 mmol/l) (or specific current treatment for this lipid abnormality) at Visit 1a
3) Body Mass Index (BMI) ≤ 45 kg/m2 at Visit 1a
4) Age ≥ 40 and ≤ 65 years at Visit 1a
5) Signed and dated written informed consent at the latest by the date of Visit 1a, in
accordance with GCP and local legislation
1) Type 1 diabetes mellitus
2) Treatment with other antidiabetic drugs (e.g. rosiglitazone, pioglitazone, GLP-1 analogue/agonists, DPP-IV inhibitors or any insulin) prior to informed consent. Note:
previous short term use of insulin (up to two weeks) is allowed (e.g. during hospitalisation) if taken at least 8 weeks prior informed consent.
3) Treatment with anti-obesity drugs (e.g. sibutramine, orlistat) 3 months prior to
informed consent
4) Uncontrolled hyperglycaemia with a glucose level greater than 240 mg/dl (greater than 13.3 mmol/L) after an overnight fast during placebo run-in and confirmed by a second measurement(not on the same day).
5) Active liver disease or impaired hepatic function, defined by serum levels of either ALT (SGPT), AST (SGOT), or alkaline phosphatase above 3 x upper limit of normal (ULN) as determined at Visit 1a.
6) Any previous (or planned within next 12 months) bariatric surgery (open or laparascopic) or intervention (gastric sleeve)
7) Pre-planned coronary artery re-vascularization (PCI, CABG) within next 6 months
8) Known hypersensitivity or allergy to the investigational product or its excipients,
metformin or glimepiride
9) Inappropriateness of glimepiride treatment for renal safety issues according to local
prescribing information
10) Congestive heart failure of NYHA class III or IV
11) Acute or chronic metabolic acidosis (present condition in patient history)
12) Hereditary galactose intolerance
13) Alcohol or drug abuse within the 3 months prior to informed consent that would interfere with trial participation
14) Current treatment with systemic steroids at time of informed consent or pre-planned
initiation of such therapy. Note: inhaled use of steroids (e.g. for asthma/COPD) is no exclusion criterion, as this does not cause systemic steroid action.
15) Change in dose of thyroid hormones within 6 weeks prior informed consent
16) Participation in another trial with an investigational drug given within 2 months prior
to informed consent
17) Pre-menopausal women (last menstruation less than or equal to 1 year prior to informed consent) who:
- are nursing or pregnant,
- or are of child-bearing potential and are not practicing an acceptable method of birth
control (acceptable methods of birth control include tubal ligation, transdermal patch,
intra uterine devices/systems (IUDs/IUSs), oral, implantable or injectable contraceptives and vasectomised partner) or do not plan to continue using acceptable method of birth control throughout the study and do not agree to submit to periodic pregnancy testing during participation in the trial.
18) Patients considered unreliable by the investigator concerning the requirements for
follow-up during the study and/or compliance with study drug administration, has a life expectancy less than 5 years for non-CV causes, or has cancer other than nonmelanoma skin cancer within last 3 years, or has any other condition than mentioned which in the opinion of the investigator, would not allow safe participation in the study
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method - cardiovascular death <br/ ><br>- non fatal myocardial infarction <br/ ><br>- non fatal stroke (ischemic/hemorrhagic/etiology unknown) <br/ ><br>- hospitalisation for unstable anginaTimepoint: From patients randomization until final visit (end of study visit) + 30 days.
- Secondary Outcome Measures
Name Time Method