- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02132442
Hepatic Dysfunction, Vitamin D Status, and Glycemic Control in Diabetes (VDLS)
Study Overview
Status
Intervention / Treatment
Detailed Description
The prevalence of significantly poor glycemic control marked by a hemoglobin A1c (HbA1c) level of ≥ 9.5% in youth with type 2 diabetes (T2D) is 27% 1 and 24.2% in young adults2. Strategies to improve glycemic control in patients with T2D include lifestyle modification, optimization of therapeutic regimens, and correction of comorbid states that impair glycemic control. However, the role of comorbid states on glycemic control in T2D has not been adequately studied. For example, 70% of patients with T2D have nonalcoholic fatty liver disease (NAFLD)3, a potentially serious form of chronic liver disease 4 in which the triad of the development of lipotoxicity-induced mitochondrial dysfunction, activation of inflammatory pathways, and cytokine generation lead to progressive liver damage5. NAFLD is the leading cause of elevated liver enzymes in the US6, and is diagnosed by either liver biopsy or the detection of a hepatic triglyceride content (HTGC) of >5.6% by proton magnetic resonance spectroscopy (1H MRS)2. Despite the high prevalence of NAFLD in T2D, its potential impact on glycemic control through the impairment of hepatic metabolic processes is unclear. This is important because a crucial step in vitamin D metabolism, the hydroxylation of vitamin D at the 25 position, occurs in the liver. The consequence of NAFLD on this critical step in vitamin D metabolism in patients with T2D, and the impact of the resultant 25-hydroxyvitamin D [25(OH)D] deficiency on glycemic control are not well understood. The rationale for this study is that a clear understanding of the role of vitamin D on the pathogenesis of NAFLD is crucial because vitamin D is a prohormone with potent anti-inflammatory properties that inhibit pro-inflammatory cytokines such as tumor necrosis factor- α (TNF-α), interleukin-6, and the activity of macrophages 2 while upregulating the production of anti-inflammatory cytokine, interleukin-10 2which could potentially reverse the effects of insulin resistance (IR) and oxidative stress, the two key components of the 'double hit model' of the pathogenesis of NAFLD. The 'first hit' involves IR-induced hepatocyte lipid accumulation which increases hepatic vulnerability to the components of the 'second hit': oxidative stress and proinflammatory cytokines, leading to mitochondrial dysfunction, inflammation and fibrosis.
The investigators7 previously showed that mild hepatic dysfunction in patients with T2D was associated with a high prevalence (47.5%) of vitamin D deficiency as defined by 25(OH)D level of < 20 ng/mL, as well as poor glycemic control. The investigators further reported a significant inverse relationship between HbA1c and 25(OH)D, and also between 25(OH)D and alanine transaminase. These data suggest that mild hepatic dysfunction could impair vitamin D metabolism and negatively impact glycemic control in patients with T2D. The investigators have also accumulated data 8 to show that 25(OH)D supplementation was associated with a significant reduction in HbA1c in T2D without a significant change in insulin or metformin dose. Histologically, a recent animal study reported significant hepatic steatosis in vitamin D-deficient mice compared to vitamin D-sufficient mice 2.
Study Type
Enrollment (Actual)
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
Massachusetts
-
Worcester, Massachusetts, United States, 01609
- University of Massachusetts Medical School
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Children: 10 - 17 years
- Adults: 18 - 50 years
- Type 2 diabetes > 6 mo duration
- 25-hydroxyvitamin D [25(OH)D] level of <20 ng/mL
- Hepatic triglyceride content (HTGC) value of >5.6%
- HbA1c of > 8%;
- Ability to take medication by mouth.
Exclusion Criteria:
- Pregnant or lactating women
- Mental deficiency (IQ <70)
- Chronic liver disease
- Disorders of vitamin D metabolism, kidney, or parathyroid disease;
- Calcium and/or vitamin D supplementation
- Mauriac syndrome
- Malabsorption of fat soluble vitamins
- Drug toxicity and alcoholism
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Vitamin D supplementation
Ergocalciferol 50,000 IU per week for 6 weeks, then bi-weekly for 6 mo
|
Ergocalciferol 50000 IU capsules Microcrystalline cellulose
Other Names:
|
Placebo Comparator: Placebo
Placebo capsules, on capsule per week for 6 weeks, then bi-weekly for 6 mo.
|
Ergocalciferol 50000 IU capsules Microcrystalline cellulose
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in hepatic triglyceride content (HTGC)
Time Frame: 6 months
|
Change in hepatic triglyceride content (HTGC) as measured by proton magnetic resonance spectroscopy (1H MRS)
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin A1c
Time Frame: 6 months
|
Change in glycemic control as measured by HbA1c.
|
6 months
|
Collaborators and Investigators
Investigators
- Principal Investigator: Benjamin U Nwosu, MD, University of Massachusetts, Worcester
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Digestive System Diseases
- Glucose Metabolism Disorders
- Metabolic Diseases
- Endocrine System Diseases
- Nutrition Disorders
- Avitaminosis
- Deficiency Diseases
- Malnutrition
- Liver Diseases
- Diabetes Mellitus
- Diabetes Mellitus, Type 2
- Fatty Liver
- Vitamin D Deficiency
- Non-alcoholic Fatty Liver Disease
- Physiological Effects of Drugs
- Micronutrients
- Vitamins
- Bone Density Conservation Agents
- Calcium-Regulating Hormones and Agents
- Vitamin D
- Ergocalciferols
Other Study ID Numbers
- HSC Docket # H00002866
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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