Lovaza® and Microvascular Function in Type 2 Diabetes
28 de marzo de 2017 actualizado por: Aaron I. Vinik, MD, PhD, Eastern Virginia Medical School
The Role of Lovaza® on Microvascular Function and Lipoprotein Profile in Type 2 Diabetes
The objective of this study is to determine the efficacy of 6 months of 4 g/day oral Lovaza® on endothelial-dependent and heat-induced vasodilation in type 2 diabetics with neuropathy and elevated triglyceride levels.
Omega-3 fatty acids appear to exert beneficial effects on vascular function that are independent of the changes in serum triglycerides.
The efficacy will be compared with a placebo given at the same duration.
Efficacy of the drug will be evaluated after 3 and 6 months of treatment.
This timeline should be adequate for evaluation of the primary neurophysiological endpoints.
Previously, the investigators have demonstrated that it is feasible to pharmacologically alter nerve fiber density in as little as 18 weeks and that this correlates with subjective and objective measures of neurovascular function.
The investigators are predicting an enhancement of post-ischemic hyperemia of the foot dorsum, where the dilative mechanism is primarily endothelium-dependent and a similar improvement in heat-induced hyperemia.
Descripción general del estudio
Estado
Terminado
Condiciones
Intervención / Tratamiento
Descripción detallada
This pilot study is a within-subject repeated measures design. This study will compare the neurophysiological and vascular responses to placebo and treatment with Lovaza® (omega-3-acid ethyl esters, Reliant Pharmaceuticals, Inc.) in subjects with type 2 diabetes, neuropathy, and dyslipidemia.
Lovaza's potential mechanism of action is the inhibition of acyl Coenzyme A:1, 2-diacylglycerol acyltransferase and increased peroxisomal β-oxidation in the liver.
Subjects will be recruited and a baseline of physiological, neurological and hematological profile established for each patient. Forty-four subjects (20 in the active arm, 20 in the placebo arm, and 2 replacements for each arm) will receive 4 g/day Lovaza® tablets or placebo for a period of 6 months. All subjects will receive a physical and neurological exam as well as neurovascular function testing. This includes nerve conduction studies, quantitative sensory testing, quantitative autonomic testing, and skin blood flow testing, which includes, ischemia reperfusion. Lab tests include an insulin resistance profile, hepatic and renal function profiles, lipid profile, C-reactive protein, thyroid stimulating hormone, and fatty acids. Other tests include inflammatory markers such as adiponectin and tumor necrosis factor-α. The study is powered to detect differences in microvascular function after 6 months of Lovaza® and differences in ethnic responses.
Tipo de estudio
Intervencionista
Inscripción (Actual)
44
Fase
- Fase 4
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Ubicaciones de estudio
-
-
Virginia
-
Norfolk, Virginia, Estados Unidos, 23510
- Strelitz Diabetes Center
-
-
Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
18 años a 80 años (Adulto, Adulto Mayor)
Acepta Voluntarios Saludables
No
Géneros elegibles para el estudio
Todos
Descripción
Inclusion Criteria:
- Subjects may be males or non-pregnant, non-lactating females age 18-80 years.
- Subjects must have been diagnosed with type 2 diabetes mellitus according to the current ADA criteria.
- Triglyceride levels above 149 mg/dL
- Minimum of 2 years after diagnosis of type 2 diabetes
- Prior to participation in this study, each subject must sign an informed consent document.
Exclusion Criteria:
- Presence of type 1 diabetes mellitus (defined as C-peptide < 1 ng/ml or diabetes onset at < 35 years of age in a non-obese patient).
- Presence of diabetic retinopathy that is more severe than "background" level.
- Presence of diabetic nephropathy, defined by urine dipstick results greater than 300 mg/100 mL for protein (proteinuria).
- Presence of clinically significant neuropathy that is clearly of non-diabetic origin, e.g. alcoholic or autoimmune.
- Bilateral amputation of lower extremities or foot ulcers involving the great toes. Presence of neuroarthropathy (Charcot deformity) is allowable.
- History of major macrovascular events such as myocardial infarction or stroke.
- Participation in another clinical trial concurrently or within 30 days prior to entry into this study.
- The use of ACE-inhibiting agents or angiotensin receptor blockade therapy (ARB) is allowed but must have been stable for at least 30 days prior to study entry and may not change during the course of the study. This is prudent due to their potential effects on blood flow.
- Patients with moderate or severe hepatic insufficiency or abnormalities of liver function defined as any liver enzymes (aspartate aminotransferase,alanine transaminase, alkaline phosphatase) greater than 3 times the upper limit of normal.
- Presence of pedal edema.
- Presence or history of heart failure New York Heart Association Class II or greater.
- Other serious medical conditions that in the opinion of the investigator, would compromise the subject's participation in the study.
- Concomitant use of medications known to exacerbate triglyceride levels, such as estrogens.
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Triple
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Comparador de placebos: Placebo
Subjects are males or non-pregnant, non-lactating females age 18-80 years.
All subjects must have been diagnosed with type 2 diabetes mellitus a minimum of two years according to the current ADA criteria and triglyceride levels above 149 mg/dL.
Subjects in this arm will be taking placebo for 6 months.
|
Subjects are males or non-pregnant, non-lactating females age 18-80 years.
All subjects must have been diagnosed with type 2 diabetes mellitus a minimum of two years according to the current ADA criteria and triglyceride levels above 149 mg/dL.
Subjects in this arm will be taking placebo for 6 months.
|
|
Comparador activo: omega-3-ethyl esters 4g
Subjects are males or non-pregnant, non-lactating females age 18-80 years.
All subjects must have been diagnosed with type 2 diabetes mellitus a minimum of two years according to the current ADA criteria and triglyceride levels above 149 mg/dL.
Subjects in this arm will be taking 4 g of Lovaza per day for 6 months.
|
Lovaza (TM) (omega-3-ethyl esters) 1 gram Capsules are indicated as an adjunct to diet to reduce very high (>500 mg/dL) triglyceride (TG) levels in adult patients.
Otros nombres:
|
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Efficacy Measures Are Nerve Conduction Studies, Specifically Changes in Conduction Amplitude.
Periodo de tiempo: One year
|
19 participants in each arm( placebo or omega-3-ethyl esters 4g) were analyzed .
Conduction velocities and amplitude of the following nerves were compared between each arm: Tibial Nerve Ankle Amplitude, Tibial Nerve Popliteal Amplitude, Median Nerve Wrist Amplitude, Median Nerve Elbow Amplitude, Peroneal Motor Nerve Ankle Amplitude, Peroneal Motor Nerve Below Fibular Amplitude, Peroneal Motor Nerve Above Fibular Amplitude, Sensory Median Nerve Wrist Amplitude, Sensory Ulnar, Sensory Sural Ankle Ampltiude Wrist Ampltiude
|
One year
|
|
Measurements of Indices of Large and Small Fiber Nerve Function Including Heart Rate Variation Measures.
Periodo de tiempo: One year
|
Quantitative Autonomic Function Tests (QAFTs) were performed.
Primarily, power spectral analysis of heart rate variability (HRV) and time- and frequency-domain analyses, including measures of the sympathetic and parasympathetic control of the heart beat (R-R interval), were recorded with deep breathing, Valsalva, and standing from the sitting position maneuvers.
Additionally, the sample difference of the beat to beat (NN) intervals and the TSP was calculated as well as the standard deviation of all normal R-R intervals (sdNN).
|
One year
|
|
Measurements of Indices of Large and Small Fiber Nerve Function Using Vibration and Thermal Thresholds.
Periodo de tiempo: One year
|
Quantitative Sensory Tests (QSTs), including, cold sensation threshold, cold pain threshold and vibration detection threshold, were used to evaluate peripheral sensory perception.
|
One year
|
|
Percent Change in Measurements of Indices of Large and Small Fiber Nerve Function Including Vibration Thresholds
Periodo de tiempo: One year
|
Quantitative Sensory Tests (QSTs), including vibration detection threshold, were used to evaluate peripheral sensory perception.
Mean represents percent change of total group.
Measurements taken at baseline and at one year.
|
One year
|
|
Measurements of Indices of Large and Small Fiber Nerve Function Including Markers of Inflammation and Oxidative Stress.
Periodo de tiempo: One year
|
Oxidative stress/inflammatory markers (IL1β, IKKβ, TLR4, TNF-α, JNK1, toll-like receptor 2) were assessed through a meal challenge.
|
One year
|
|
Efficacy Measures Are Nerve Conduction Studies; Specifically, Increases in Conduction Velocity.
Periodo de tiempo: One Year
|
One Year
|
|
|
Efficacy Measures Are Nerve Conduction Studies, Specifically Changes in Latency.
Periodo de tiempo: One Year
|
One Year
|
|
|
Efficacy Measures Are Nerve Conduction Studies, Specifically Changes in F-wave Conduction
Periodo de tiempo: One Year
|
One Year
|
|
|
Efficacy Measures Examining Increased Vascular Response to Ischemic Block and to Local Warming at the Dorsum of the Foot.
Periodo de tiempo: One Year
|
One Year
|
Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Aaron I Vinik, MD, PhD, Eastern Virginia Medical School
- Director de estudio: Henri K Parson, PhD, Eastern Virgina Medical School
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio
1 de octubre de 2009
Finalización primaria (Actual)
1 de julio de 2012
Finalización del estudio (Actual)
1 de julio de 2012
Fechas de registro del estudio
Enviado por primera vez
17 de junio de 2009
Primero enviado que cumplió con los criterios de control de calidad
30 de junio de 2009
Publicado por primera vez (Estimar)
2 de julio de 2009
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
9 de mayo de 2017
Última actualización enviada que cumplió con los criterios de control de calidad
28 de marzo de 2017
Última verificación
1 de marzo de 2017
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
- Enfermedades metabólicas
- Enfermedades del Sistema Nervioso
- Enfermedades del sistema endocrino
- Complicaciones de la diabetes
- Diabetes mellitus
- Enfermedades Neuromusculares
- Enfermedades del Sistema Nervioso Periférico
- Trastornos del metabolismo de los lípidos
- Hiperlipidemias
- Dislipidemias
- Neuropatías diabéticas
- Hipertrigliceridemia
Otros números de identificación del estudio
- LVZ111903
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
No
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
No
producto fabricado y exportado desde los EE. UU.
No
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .