Combination of Metformine/Inulin Versus Metformin on Prostate Benign Hyperplasia in Metabolic Syndrome

Effect of Administration of Combination Metformine/Inulin Versus Metformine on Patients With Prostate Benign Hyperplasia and Metabolic Syndrome Syndrome

Type 2 diabetes mellitus, insulin resistance, visceral obesity and disorders of lipid metabolism, especially triglyceride and hypertension are metabolic disorders that play a central role in pathophysiology of metabolic syndrome, and ultimately, the cardiovascular morbidity and mortality associated with atherosclerosis, such as myocardial infarction, cerebral vascular events, vascular dementia, heart failure and end stage renal disease. Recently other complications related with hyperinsulinemia like the prostate benign hypertrophy (BPH). Metformin is the treatment of choice in patients with metabolic syndrome, given its low cost and comparable pharmacological effects to the tiazolinedionas (eg pioglitazone), decreasing hyperinsulinemia, insulin resistance, concentration of free fatty acids and triglycerides, also it produces moderate weight loss, improving the metabolic profile triglcerides atherogenic lipid and carbohydrate and delaying the onset of diabetes mellitus in individuals with impaired fasting glucose.

A second option for risk reduction would be the addition of inulin fiber type as it has been demonstrated some metabolic effects on benefices lipid metabolism and carbohydrate.

It is expected that combination of metformin with inulin produce a beneficial effect through farmacological synergism and the impact on fisiopatological changes of metabolic syndrome that potentially is considered as an important risk factor for prostate growth.

Study Overview

• Status: Completed
• Conditions: Metabolic Syndrome
• Intervention / Treatment: Other: Placebo of agave inulin; Other: Metformin placebo; Drug: Metformin; Dietary supplement: Agave inulin

Detailed Description

The main objective is to evaluate the effect of the combination of metformin / inulin on clinical, urodynamic parameters as well as metabolic and inflammatory profile in patients with benign prostate hypertrophy and metabolic syndrome.

The investigators conducted a double-blind trial, randomized, on 4 groups, each group with 15 male and female patients of 40 to 80 years of age with METS diagnosed by IDF criteria and clinical diagnose of HBP. Randomization will determine who will receive the intervention during 12 week trial, each group will be like:

Group (A) intervention with combination metformin/ inulin: 15 individuals recieved combination of metformin/ agave inulin in a dosis of 500 mg / 10 grs per 24hrs during 12 weeks.

Group (B) Metformin plus Placebo of agave inulin: 15 individuals recieved Metformin in a dosis of 500mg per day (with the first bite of the second meal) plus homologue placebo of agave inulin (calcinated magnesia) in a dosis of 10grs each 24 hrs during 12 weeks.

Group (C) agave inulin plus placebo of Metformin: 15 indivuduals recieved agave inulin in a dosis of 10grs per 24hrs plus homologate placebo of metformin (calcinated magnesia) in a dosis of 500 mg per day (with the first bite of the second meal) during 12 weeks.

Group (D) Placebo of agave inulin plus Placebo of Metformin: homologate placebo of agave inulin (calcinated magnesia) in a dosis of 10 grs each 24 hrs plus homologate placebo of metformin (calcinated magnesia capsules) in a dosis of 500 mg per day (with the first bite of the second meal) during 12 weeks.

The clinical findings and laboratory test include a metabolic profile and biosafety, will be baseline and at 12 weeks.

Clinical components of Mets like antropometrics parameters, fasting glucose, fasting insulin, blood lipids, clinical finding of HBP and inflammation parameters and adipocitocins, IGF-1, insulin, prostatic specific antigen. Adverse events and adherence to treatment will be documented. Statistical analysis: Mann-Whitney U Test and Wilcoxon exact test. It is considered with significance at p<0.05.

• Study Type: Interventional
• Enrollment (Actual): 40
• Phase: Phase 3

Contacts and Locations

Study Locations

• Mexico
  • Jalisco, México
    • Guadalajara, Jalisco, México, Mexico, 44100
      • Universidad de Guadalajara

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• Diagnosis of metabolic syndrome by IDF criteria

  • a person to be defined as having the metabolic syndrome they must have: Central obesity (defined as waist circumference* with ethnicity specific values) ≥80 cm in females and ≥90 cm in males; and plus any two of the following four factors:
  • Raised triglycerides ≥ 150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality Reduced HDL cholesterol
  • < 40 mg/dL (1.03 mmol/L) in males < 50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality
  • Raised blood pressure systolic BP ≥ 130 or diastolic BP ≥ 85 mm Hg or treatment of previously diagnosed hypertension
  • Raised fasting plasma glucose (FPG) ≥ 100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes
• Age ranging from 40 to 80 years old
• Male patients
• Informed written consent

Exclusion Criteria:

• Kidney disease
• Hepatic disease
• Thyroid disease
• Diabetes mellitus
• Ischemic heart disease
• Drug consumption
• Alcohol consumption of more than 2 ounces daily
• Consumption of drugs that intervene with lipid or glucose metabolism 2 months before
• Blood pressure >160/100mmHg.
• Lack of adherence to treatment (adherence <80%)

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
Active Comparator: Metformin + Placebo of agave inulin; 500 mg tablet of metformin every 24 hrs + 5 g every 12 hrs of calcinated magnesia powder	Other: Placebo of agave inulin; Calcinated magnesia powder; Drug: Metformin; Metfomin in tablet presentation of 500 mg; Other Names: GLUCOPHAGE
Active Comparator: Agave Inulin+Placebo of Metformin; 5 g of agave inulin powder every 12 hrs + 500 mg tablet of calcinated magnesia as metformin placebo every 24 hrs	Other: Metformin placebo; Calcinated magnesia tablet; Dietary supplement: Agave inulin; Oligofructan in powder obtained from agave plant, it was given to each patient a full 10 mg container.
Placebo Comparator: Placebo of Inulin + Placebo of Metformin; 5 g of calcinated magnesia powder every 12 hrs + 500 mg tablet of calcinated magnesia every 24 hrs	Other: Placebo of agave inulin; Calcinated magnesia powder; Other: Metformin placebo; Calcinated magnesia tablet
Experimental: Agave inulin + Metfomin; 5 g of Agave inulin powder every 12 hrs + 500 mg tablet of metformin every 24 hrs	Drug: Metformin; Metfomin in tablet presentation of 500 mg; Other Names: GLUCOPHAGE; Dietary supplement: Agave inulin; Oligofructan in powder obtained from agave plant, it was given to each patient a full 10 mg container.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
International Prostate Symptom Score (I-PSS)	before and after intervention questionnaire	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Fasting plasma glucose at 12 weeks	Before and after intervention by glucose oxidase	12 weeks
Change from Baseline in Total cholesterol at 12 weeks	Before and after intervention by spectrophotometry	12 weeks
Change from Baseline in Triglycerides at 12 weeks	Before and after intervention by spectrophotometry	12 weeks
Change from baseline in High-density lipoprotein cholesterol at 12 weeks	Before and after intervention by spectrophotometry	12 weeks
Change of waist circumference	Measured with a non elastic tape at baseline and after intervention	12 weeks
Change from baseline in Peripheral systolic blood pressure	Before and after intervention using a digital sphygmomanometer	12 weeks
Change from baseline in Peripheral diastolic blood pressure	Before and after intervention using a digital sphygmomanometer	12 weeks
Change of body mass index	before and after intervention using a tetrapolar bioelectrical impedance analyzer (body composition analyzer TBF-215 - Tanita)	12 weeks
Change of HOMA-IR from base line to 12 weeks	Before and after intervention by using the formula for the homeostasis model assessment β-cell function index: 20 x fasting insulin (µU/Ml)/fasting glucose (mmol/L) - 3.5.	12 weeks
qmax urine flow rate	before and after intervention by uroflowmetry	12 weeks
prostate serum antigen	before and after intervention by colorimetry	12 weeks

Collaborators and Investigators

• Sponsor: Centro Universitario de Ciencias de la Salud, Mexico
• Investigators: Principal Investigator: FERNANDO GROVER, PhD, Institute of Experimental and Clinical Therapeutics (INTEC), CUCS, University of Guadalajara

Study record dates

Study Major Dates

• Study Start: January 1, 2013
• Primary Completion (Actual): June 1, 2015
• Study Completion (Actual): June 1, 2015

Study Registration Dates

• First Submitted: May 18, 2016
• First Submitted That Met QC Criteria: May 19, 2016
• First Posted (Estimate): May 20, 2016

Study Record Updates

• Last Update Posted (Estimate): May 20, 2016
• Last Update Submitted That Met QC Criteria: May 19, 2016
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Keywords: Metformin; METS; Agave Inulin; Inflammation parameters; Urodynamic parameters; Prostate hyperplasia
• Additional Relevant MeSH Terms: Pathologic Processes; Glucose Metabolism Disorders; Metabolic Diseases; Disease; Insulin Resistance; Hyperinsulinism; Syndrome; Metabolic Syndrome; Hyperplasia; Hypoglycemic Agents; Physiological Effects of Drugs; Metformin
• Other Study ID Numbers: CUCS-INTEC-MV-HBP-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No