Effects of Metformin Hydrochloride (HCl) in Combination With Colesevelam HCl, Compared to Metformin HCl Alone, in Patients With Type 2 Diabetes Mellitus and the Effects of Colesevelam HCl on Lipids and Glucose on Pre-diabetic Patients.

Effects of Metformin HCl in Combination With Colesevelam HCl, Compared to Metformin HCl Alone, as Initial Therapy in Drug naïve Subjects With Type 2 Diabetes Mellitus, and the Effects of Colesevelam HCl on the Lipid Profile in Subjects With Pre Diabetes

This is a 16-week double-blind, placebo-controlled (for colesevelam hydrochloride (HCl)) study in the type 2 diabetic subjects and pre-diabetic subjects. Diabetic participants will also be treated with open label, background,metformin HCl. Two-hundred sixty subjects with type 2 diabetes (T2DM) and 200 pre-diabetic subjects are planned to be be enrolled. Qualified subjects with T2DM will be randomized 1:1 to receive metformin HCl plus colesevelam HCl or metformin HCl plus placebo matching colesevelam HCl. Qualified pre-diabetic subjects will be randomized 1:1 to receive colesevelam HCl or matching placebo.

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes Mellitus; Hypercholesterolemia; Pre-diabetes
• Intervention / Treatment: Drug: Metformin HCl and Colesevelam Placebo; Drug: Metformin HCl tablets and Colesevelam tablets; Drug: Colesevelam placebo; Drug: Colesevelam

• Study Type: Interventional
• Enrollment (Actual): 502
• Phase: Phase 3

Contacts and Locations

Study Locations

• Colombia
  • Atlántico
    • Barranquilla, Atlántico, Colombia
  • Cundinamarca
    • Bogota, Cundinamarca, Colombia
  • Santander
    • Bucaramanga, Santander, Colombia
• India
  • Dadar
    • Mumbai, Dadar, India
  • Jaipur
    • Durgapura, Jaipur, India
  • Karnataka
    • Bangalore, Karnataka, India
  • Kerala
    • Cochin, Kerala, India
  • Mahārāshtra
    • Nasik, Mahārāshtra, India
• Mexico
  • Chihuahua
    • Las Palmas, Chihuahua, Mexico
  • Cuauhtemoc
    • Delegacion, Cuauhtemoc, Mexico
  • Jalisco
    • Guadalajara, Jalisco, Mexico
  • Nuevo Leon
    • Monterrey, Nuevo Leon, Mexico
  • Sonora
    • Hermosillo, Sonora, Mexico
  • Yucatan
    • Merida, Yucatan, Mexico
• United States
  • Alabama
    • Birmingham, Alabama, United States
  • California
    • Los Gatos, California, United States
    • Tarzana, California, United States
  • Florida
    • Ocala, Florida, United States
  • Idaho
    • Pocatello, Idaho, United States
  • Indiana
    • Gary, Indiana, United States
  • Louisiana
    • New Orleans, Louisiana, United States, 70112
  • Mississippi
    • Olive Branch, Mississippi, United States
  • New York
    • Dundee, New York, United States
    • West Seneca, New York, United States
  • North Carolina
    • Statesville, North Carolina, United States
  • Ohio
    • Kent, Ohio, United States
    • Marion, Ohio, United States
  • Oregon
    • Portland, Oregon, United States
  • Texas
    • Corpus Christi, Texas, United States
    • Dallas, Texas, United States
    • San Antonio, Texas, United States

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 79 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Age 18 to 79 years, inclusive.
• HbA1C in the range of greater than or equal to 6.5 percent to small than or equal to 10.0 percent, to be enrolled in the T2DM cohort.

• 2-hour post 75 g OGTT glucose levels in the range of:

  • greater than or equal to 200 mg/dL to be enrolled in the T2DM cohort, or
  • greater than or equal to 140 to 200 mg/dL to be enrolled in the pre-diabetes cohort.

• FPG levels in the range of:

  • greater than or equal to 126 mg/dL to be enrolled in the T2DM cohort, or
  • greater than or equal to 110 to smaller than or equal to 125 mg/dL to be enrolled in the pre-diabetes cohort.
• LDL-C levels greater than or equal to 100 mg/dL.
• Drug-naïve, defined as having never received treatment for T2DM or not having received antidiabetic drug therapy during the 3 months prior to screening visit.

• Previous diagnosis of:

  • T2DM or prediabetes, to be enrolled in the respective cohorts, or
  • CHD, CVD, and/or primary hypercholesterolemia + BMI greater than or equal to 25 mg/kg2 to be screened for T2DM or pre-diabetes.
• Understanding of the study procedures and agreement to participate in the study by giving written informed consent at screening visit.

• Women may be enrolled if all 3 of the following criteria (in addition to the above criteria)are met:

  • They are not pregnant (women of childbearing potential must have a negative serum pregnancy test [serum beta human chorionic gonadotropin )] at screening visit);
  • They are not breast-feeding; and
  • They do not plan to become pregnant during the study.

• In addition to all of the above criteria, women must also meet 1 of the following 3 criteria to be enrolled:

  • They have been post-menopausal for at least 1 year; or
  • They are of childbearing potential and will practice 1 of the following methods of birth control throughout the study: oral, injectable, or implantable hormonal contraceptives; intrauterine device; diaphragm plus spermicide; or female condom plus spermicide. Methods of contraception that are not acceptable are partner's use of condoms or partner's vasectomy.

Exclusion Criteria:

• History of type 1 diabetes and/or history of acute or chronic metabolic acidosis, including diabetic ketoacidosis.
• History of chronic (requiring daily for greater than 2 months) use of insulin therapy, except for the treatment of gestational diabetes.
• Current or prior (within the past 3 months) treatment with an oral antidiabetic drug.
• Current or prior (within the past 3 months) treatment with colesevelam HCl (WelChol), colestipol, colestimide, or cholestyramine.
• History of dysphagia, swallowing disorders, or intestinal motility disorder.
• Any serious disorder, including pulmonary, hepatic, gastrointestinal (including clinically significant malabsorption), uncontrolled endocrine/metabolic, hematologic/oncologic (within the last 5 years), neurologic, and psychiatric diseases, that would interfere with the conduct of the study or interpretation of the data.
• Acute coronary syndrome (eg, myocardial infarction or unstable angina), coronary intervention (coronary artery bypass graft or percutaneous transluminal coronary angioplasty or similar procedure), congestive heart failure (requiring pharmacological treatment), or transient ischemic attack within 3 months of screening visit.
• History of pancreatitis.
• History of acquired immune deficiency syndrome or human immunodeficiency virus.
• History of drug or alcohol abuse within the past 2 years.
• Hospitalization for any cause within 14 days prior to screening visit.
• History of an allergic or toxic response to colesevelam HCl or any of its components.
• Known hypersensitivity to metformin HCl.
• Serum TG greater than or equal to 500 mg/dL.
• Body mass index (BMI) greater than 40 kg/m2 .

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Diabetic Participants: Metformin HCl+Placebo for Colesevelam; Participants will receive either 850 mg or 1700 mg of metformin HCl, depending on tolerability + 6 placebo tablets matching colesevelam 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Metformin HCl and Colesevelam Placebo; One or two Metformin HCl tablets 850 mg (depending on tolerability) and 6 colesevelam 625 mg placebo tablets once daily for 16 weeks
Experimental: Diabetic participants: Metformin HCl + Colesevelam; Participants will receive either 850 mg or 1700 mg of metformin HCl, depending on tolerability + 6 colesevelam tablets, 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Metformin HCl tablets and Colesevelam tablets; One or two Metformin HCl tablets 850 mg (depending on tolerability) and 6 colesevelam 625 mg tablets once daily for 16 weeks
Placebo Comparator: Pre-diabetic Participants: Colesevelam Placebo; Participants will receive 6 placebo tablets matching colesevelam 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Colesevelam placebo; Six colesevelam 625 mg placebo tablets will be given once a day for 16 weeks
Experimental: Pre-diabetes Participants: Colesevelam; Participants will receive 6 colesevelam tablets, 625 mg. Study medication is to be administered once daily for 16 weeks.	Drug: Colesevelam; Six colesevelam 625 mg tablets will be given once a day for 16 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Percent Change of Hemoglobin A1C (HbA1C) From Baseline to 16 Weeks When Given as Initial Therapy to Drug-naïve, Diabetic Subjects.	Baseline to 16 weeks
Percent Change in Low Density Lipoprotein-Cholesterol (LDL-C) in Pre-Diabetic Subjects From Baseline to 16 Weeks	Baseline to 16 Weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent Change in Hemoglobin A1C (HbA1C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12 and 16 Weeks.		Baseline to 4, 8, 12, and 16 weeks
Fasting Plasma Glucose When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 weeks
Fasting Insulin When Given to Drug-naïve, Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 weeks
Fasting C-Peptide Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
30 Minute Post-Meal Glucose Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
1 Hour Post-Meal Glucose Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
2 Hour Post-Meal Glucose Levels to in Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
2 Hour Post-Meal Insulin Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
2 Hour Post-Meal C-Peptide Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
The Percent Change of Low Density Lipoprotein Cholesterol (LDL-C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Non-High Density Lipoprotein (Non-HDL) Levels When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of High Density Lipoprotein Cholesterol(HDL-C) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Total Cholesterol (TC) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Triglycerides (TG)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Apolipoprotein A-1 (Apo A-1) When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Apolipoprotein B (Apo B)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Percent Change of Apolipoprotein C3 (Apo C3)When Given to Drug-naïve, Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 weeks
Change in the Levels of Various Lipoprotein Particles When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 weeks
Change in the Size of Various Lipoprotein Particles When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change in the Calculated Total Triglycerides When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change in the Calculated Very Low Density Lipoprotein Triglycerides When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks	These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.	Baseline to 16 Weeks
Change in the Calculated High Density Lipoprotein Cholesterol When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks	These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.	Baseline to 16 Weeks
Percent of Subjects Achieving HbA1c Goal of <7.0% at Weeks 4, 8, 12, and 16 if Baseline HbA1c Was > or = to 7.0% When Given to Drug-naïve, Diabetics		Baseline to 4, 8, 12, and 16 Weeks
Percent of Subject Achieving HbA1c Goal of <6.5% at Weeks 4, 8, 12, and 16 When Given to Drug-naïve, Diabetic Subjects		Baseline to 4, 8, 12 and 16 weeks
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <100 mg/dL at Weeks 8, 16 When Given to Drug-naïve, Diabetic Subjects		Baseline to Weeks 8, and 16
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol Goal of <70 mg/dL at Weeks 8, 16 When Given as to Drug-naïve, Diabetics		Baseline to Weeks 8, and 16
Change in Body Weight When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change in Waist-to-Hip Ratio When Given to Drug-Naive Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change in Plasma Glucose Area Under the Curve (0 to 120 Minutes) From the Baseline Glucose Tolerance Test (GTT) to the 16 Week GTT		Baseline vs. 16 Weeks
Percent Change of Various Calculated Lipid Parameters When Given as Initial Therapy to Drug-naïve, Diabetic From Baseline to 16 Weeks Subjects	These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.	Baseline to 16 Weeks
Percent of Subjects Achieving 2-Hr. Post Meal Glucose Goal of <180 mg/dL When Given to Drug-naïve, Diabetic Subjects From Baseline to Week 16		Baseline to Week 16
Percent of Subjects Achieving Hs-C-Reactive Protein Goal of <2.0 mg/L When Given to Drug-naïve, Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent Change in Low Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Non-High Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in High Density Lipoprotein-Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Total Cholesterol in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Apolipoprotein A-1 in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Apolipoprotein B in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Apolipoprotein CIII in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Triglycerides in Pre-Diabetic Subjects From Baseline to 8, and 16 Weeks		Baseline to 8, and 16 Weeks
Percent Change in Hs-C-Reactive Protein in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline 16 Weeks
Level of Various Lipoprotein Particles in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Particle Size of Various Lipoprotein Particles in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of Various Calculated Lipid Parameters in Pre-Diabetic Subjects From Baseline to 16 Weeks	These calculated values are reported as part of an NMR analysis. The calculations are done by LipoScience, Inc., and are proprietary.	Baseline to 16 Weeks
Percent Change of HbA1c in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 Weeks
Percent Change of Fasting Plasma Glucose in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 weeks
Percent Change of Fasting Insulin in Pre-Diabetic Subjects From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 Weeks
Change of Fasting C-peptide Levels in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of Glucose Levels 30 Minutes Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of Glucose Levels 1 Hour Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of Glucose Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of Insulin Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change of C-Peptide Levels 2 Hours Post Oral Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <100 mg/dL at Weeks 8, 16 in Pre-Diabetic Subjects		Baseline to 8, and 16 Weeks
Percent of Subjects Achieving Low Density Lipoprotein-Cholesterol of <70 mg/dL at Weeks 8, 16 in Pre-Diabetic Subjects		Baseline to 8, and 16 Weeks
Change in Body Weight in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Change in Waist-to-Hip Ratio in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Area Under the Curve for Plasma Glucose From 0 to 120 Minutes During the Oral Glucose Tolerance Tests in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent Achievement of <140 mg/dL Plasma Glucose 2 Hours Post the Oral Glucose Tolerance Test in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was >or= to 140 mg/dL From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent Achievement of <110 mg/dL Fasting Plasma Glucose in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 110 mg/dL From Baseline to 4, 8, 12, and 16 Weeks		Baseline to 4, 8, 12, and 16 Weeks
Percent Achievement of <100 mg/dL Fasting Plasma Glucose in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 100 mg/dL From Baseline to 4, 8, 12 and 16 Weeks		Baseline to 4, 8, 12 and 16 weeks
Percent Achievement of <140 mg/dL Plasma Glucose Post 2 Hour Glucose Tolerance Test and Fasting Plasma Glucose <110 mg/dL in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent Achievement of Hs-C-Reactive Protein <2.0 mg/L in Pre-Diabetic Subjects Whose Corresponding Baseline Value Was > or = to 2.0 mg/L From Baseline to 16 Weeks		Baseline to 16 Weeks
Percent of Subjects Meeting Type 2 Diabetes Criteria (Fasting Plasma Glucose >or= to 126 mg/dL or Plasma Glucose >or= to 200 mg/dL Post 2 Hr Glucose Tolerance Test in Pre-Diabetic Subjects From Baseline to 16 Weeks		Baseline to 16 Weeks

Collaborators and Investigators

• Sponsor: Daiichi Sankyo, Inc.
• Investigators: Study Director: Michael Jones, DSI

Publications and helpful links

General Publications

• Rosenstock J, Hernandez-Triana E, Handelsman Y, Misir S, Jones MR. Clinical effects of colesevelam in Hispanic subjects with primary hyperlipidemia and prediabetes. Postgrad Med. 2012 Jul;124(4):14-20. doi: 10.3810/pgm.2012.07.2564.
• Goldberg RB, Rosenson RS, Hernandez-Triana E, Misir S, Jones MR. Initial combination therapy with metformin plus colesevelam improves lipoprotein particles in patients with early type 2 diabetes mellitus. J Clin Lipidol. 2012 Jul-Aug;6(4):318-24. doi: 10.1016/j.jacl.2012.05.005. Epub 2012 May 29.
• Handelsman Y, Goldberg RB, Garvey WT, Fonseca VA, Rosenstock J, Jones MR, Lai YL, Jin X, Misir S, Nagendran S, Abby SL. Colesevelam hydrochloride to treat hypercholesterolemia and improve glycemia in prediabetes: a randomized, prospective study. Endocr Pract. 2010 Jul-Aug;16(4):617-28. doi: 10.4158/EP10129.OR.
• Rosenstock J, Fonseca VA, Garvey WT, Goldberg RB, Handelsman Y, Abby SL, Lai YL, Jin X, Misir S, Nagendran S, Jones MR. Initial combination therapy with metformin and colesevelam for achievement of glycemic and lipid goals in early type 2 diabetes. Endocr Pract. 2010 Jul-Aug;16(4):629-40. doi: 10.4158/EP10130.OR.

Study record dates

Study Major Dates

• Study Start: November 1, 2007
• Primary Completion (Actual): April 1, 2009
• Study Completion (Actual): May 1, 2009

Study Registration Dates

• First Submitted: December 10, 2007
• First Submitted That Met QC Criteria: December 10, 2007
• First Posted (Estimate): December 11, 2007

Study Record Updates

• Last Update Posted (Estimate): July 27, 2010
• Last Update Submitted That Met QC Criteria: July 19, 2010
• Last Verified: July 1, 2010

More Information

Terms related to this study

• Keywords: Metformin; Type 2 Diabetes Mellitus; Colesevelam; Pre-diabetes
• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Hyperglycemia; Lipid Metabolism Disorders; Hyperlipidemias; Dyslipidemias; Diabetes Mellitus; Diabetes Mellitus, Type 2; Prediabetic State; Glucose Intolerance; Hypercholesterolemia; Hypoglycemic Agents; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Antimetabolites; Anticholesteremic Agents; Hypolipidemic Agents; Lipid Regulating Agents; Metformin; Colesevelam Hydrochloride
• Other Study ID Numbers: WEL-411; IND 68,466

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No