- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03733132
Metformin Effect on Brain Function in Insulin Resistant Elderly People
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Insulin resistance is highly prevalent with advancing age. Metformin is an insulin sensitizer and is currently being extensively investigated for its potential anti-aging effect. However, only very limited information is available on metformin effect on brain, which is a major organ affected by aging. With appropriate experimental design, the investigators are attempting to understand the mechanism of metformin treatment on the physiology of the brain as well as cognitive effects. These studies may uncover relationships that could be favorably manipulated to decrease health risks associated with insulin sensitivity and the effect on the brain.
The study results may lead to a breakthrough in providing either definitive data or sufficiently strong preliminary data regarding metformin's effect on elderly people with insulin resistance, on whether the drug enhances brain mitochondrial function in conjunction with improvement of brain functional network and cognitive function.
The overall hypothesis is that metformin administration to elderly people with insulin resistance enhances brain mitochondrial function in conjunction with improvement of brain function. To test this hypothesis, the investigators will address the following Specific Aims:
- Determine whether 40 weeks of metformin administration in elderly people (> 65 years) with insulin resistance enhances brain mitochondrial ATP production. The investigators will measure brain ATP production by 31P-MRS.
- Determine the effect of 40 weeks of metformin administration in elderly people (> 65 years) with insulin resistance on blood flow and functional network in different areas of brain. As a secondary outcome, the investigators will measure structural changes in white and grey matter areas of brain to determine whether metformin has any effect on brain structure.
- Determine the effect of 40 weeks of metformin administration in elderly people (> 65 years) with insulin resistance on cognitive function. The investigators will utilize the computerized NIH Toolbox to measure cognitive outcomes.
The investigators will also associate outcomes from our specific aims with improvements in whole-body insulin sensitivity and skeletal muscle mitochondrial function.
The investigators propose to complete 40 weeks of study in 40 elderly (> 65 years) participants with fasting glucose between 100 to 140 mg/dl and abdominal girth of >102 cm in men and > 88 cm in women. All participants will be those who are not oral hypoglycemic agents including metformin. In this double-blind placebo trial, the investigators will randomly assign the participants to placebo or metformin in an escalated dose to reach a maximum of 2500 mg per day.
Study Type
Enrollment (Actual)
Phase
- Phase 2
Contacts and Locations
Study Locations
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Mayo Clinic in Rochester
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age >/= 65 years
- Abdominal girth > 102 cm in men and > 88 cm in women-
- Fasting glucose >/= 100-140 mg/dL
- Non-smoker
- English language proficiency
Exclusion Criteria:
- Coronary artery disease or heart failure
- A known medical condition that in the judgment of the investigator might interfere with the completion of the protocol such as the following examples:
Inpatient psychiatric treatment in the past 6 months
- Presence of a known adrenal disorder
- Abnormal liver function test results (Transaminase >2 times the upper limit of normal); testing required for subjects taking medications known to affect liver function or with diseases known to affect liver function
- Abnormal renal function tests results (calculated GFR <60 mL/min/1.73m2); testing required for subjects with diabetes duration of greater than 5 years post onset of puberty
- Active gastroparesis
- If on antihypertensive, thyroid, anti-depressant or lipid lowering medication, lack of stability on the medication for the past 2 months prior to enrollment in the study
- Uncontrolled thyroid disease (TSH undetectable or >10 mlU/L): testing required within here months prior to admission for subjects with a goiter, positive antibodies, or who are on thyroid hormone replacement, and within one year otherwise
- Abuse of alcohol or recreational drugs
- Infectious process not anticipated to resolve prior to study procedures (e.g. meningitis, pneumonia, osteomyelitis)
- Uncontrolled arterial hypertension (Resting diastolic blood pressure >90 mmHg and/or systolic blood pressure >160 mmHg) at the time of screening
- Oral steroids
- A recent injury to body or limb, muscular disorder, use of any medication, any carcinogenic disease, or other significant medical disorder if that injury, medication or disease in the judgment of the investigator will affect the completion of the protocol
- Any metal in the body that could interfere with magnetic resonance imaging (MRI) including pacemaker or implanted defibrillator, neurostimulators, ear implants, metal fragments within the body, metal joints, rods, pins, plates or screws
- Medications that may impact study end points such as mitochondrial biology eg. beta blockers
- Anti-hyperglycemic drugs including metformin
- Any other medication that the investigator believes is a contraindication to the subject's participation
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Placebo Comparator: Placebo
Participants in placebo group will receive Placebo Oral Tablets identical to the metformin tablets for 10 months.
|
Placebo treatment of identical tablets to metformin group
Other Names:
|
Active Comparator: Metformin
Participants in placebo group will receive an escalating dose of Metformin hydrochloride tablets up to a dose of 2500mg for 10 months.
|
Metformin treatment of 2500mg for 10 months in the Metformin group
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in brain functional connectivity as measured by fMRI after 10 months of metformin administration
Time Frame: Baseline, 10 months
|
To measure global brain functional network information, an axial 2D echo-planar imaging sequence with 3mm isotropic voxels (FA=90, TE=30, TR=2000, # slices=50) will be used to acquire resting state functional MRI data throughout the brain.
|
Baseline, 10 months
|
Change from baseline in cognitive function as measured by NIH Toolbox after 10 months of metformin administration
Time Frame: Baseline, 10 months
|
The NIH Toolbox will be utilized to measure cognitive outcomes.
The NIH Toolbox-Cognition Battery is composed of 7 tests (~30 minutes) including the Dimensional Change Card Sort (DCCS) Test (executive function), the Flanker Inhibitory Control Test (executive function), the Picture Sequence Memory Test (episodic memory), the Picture Vocabulary Test (vocabulary), the Oral Reading Recognition Test (reading), the List Sorting Working Memory Test (working memory), and the Pattern Comparison Processing Speed Test (processing speed.
Our primary outcome measure will be the Total Cognition Composite score.
|
Baseline, 10 months
|
Change from baseline in brain PCr/ATP ratio as measured by phosphorus Magnetic Spectroscopy (31P-MRS) after 10 months of metformin administration
Time Frame: Baseline, 10 months
|
Multivoxel spectroscopic imaging of the brain will be performed using our dual-tuned single-channel-proton eight-channel-phosphorus head coil.
A single 2.5 cm thick slice will be prescribed to encompass the temporal and occipital lobes, and weighted MRSI will be performed using a 16x16 matrix to acquire nominal 2.5 cm3 voxels.
|
Baseline, 10 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change from baseline in brain structure as measured by MRI after 10 months of metformin administration
Time Frame: Baseline, 10 months
|
AA sagittal 3D MPRAGE sequence with 0.7mm isotropic voxels (TR=2400, TE=2.57,
TI=1100, FA=8) will be used to acquire high-resolution structural data for volumetric analysis of brain region changes related to metformin.
To measure white matter information: An axial 2D symmetric multi-slice (SMS) diffusion tensor imaging (DTI) sequence with 60 diffusion directions, 5 B0 acquisitions and 2mm isotropic voxels (TR=3000, TE=73, FA=90, ETL 43, both A-P and P-A phase encoding for B0 images) will be used to acquire white matter integrity data related to metformin.
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Baseline, 10 months
|
Change from baseline in muscle mitochondrial respiration as measured by high-resolution respirometry following 10 months of metformin administration
Time Frame: Baseline, 10 months
|
High-resolution respirometry will be used to analyze oxygen consumption in isolated mitochondria from skeletal muscle biopsy samples while simultaneously quantifying reactive oxygen species (ROS) production using amplex red.
ATP production rates will be concurrently measured using high sensitivity fluorometry.
|
Baseline, 10 months
|
Change from baseline in muscle mitochondrial ATP production as measured by fluorometry following 10 months of metformin administration
Time Frame: Baseline, 10 months
|
Concurrent to mitochondrial respiration, muscle mitochondrial ATP production will be measured using high-sensitivity fluorometry.
|
Baseline, 10 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: K Sreekumaran Nair, M.D., Ph.D., Mayo Clinic
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18-004012
- 1R21AG060139-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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