Metformin in Obese Children and Adolescents (MetVoorMin)
An Efficacy, Safety and Pharmacokinetic Study on the Short-term and Long-term Use of Metformin in Obese Children and Adolescents
調査の概要
詳細な説明
The prevalence of obesity in children and adolescents is increasing rapidly and is associated with significant medical and psychosocial consequences persisting into adulthood.
Obesity may lead to metabolic complications, such as insulin resistance, which can progress via impaired fasted glucose and impaired glucose tolerance to type 2 diabetes mellitus (T2DM) and to the development of micro- and macro-vascular complications.
Metformin, an oral anti-diabetic licensed for T2DM for adults and children from 10 years onwards, is already used off label in obese children and adolescents with insulin resistance, even though the specific effects of metformin in these obese children and adolescents have not been elucidated, particularly upon long-term use.
The rationale for this study is based on the hypothesis that metformin may reduce body mass index (BMI), insulin resistance and percentage of body-fat in obese children and adolescents with insulin resistance. Further more it is anticipated that metformin may delay the progression to T2DM and thereby micro- and macro-vascular complications in obese children and adolescents with insulin resistance.
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
研究場所
-
-
-
's Hertogenbosch、オランダ
- Jeroen Bosch Hospital
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Nieuwegein、オランダ、3430EM
- St. Antonius Hospital
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-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Age ≥ 10 and ≤ 16 years at study entry
- Caucasian descent
- Obesity defined as BMI-SDS > 2.3
- Insulin resistance defined as HOMA-IR ≥ 3.4.
- An obtained informed consent from subjects and parents/caregivers.
Exclusion Criteria:
- Presence of T2DM (American Diabetes Association criteria)
- Presence of endocrine disorders with steroid therapy
- Suspicion of polycystic ovarium syndrome;
- Height < -1.3 SD of target height;
- Syndrome disorders with or without mental retardation;
- Use of anti-hyperglycaemic drugs;
- Pregnancy (pregnancy test will be performed, if applicable);
- (History of) alcohol abuse;
- Impaired renal and/or hepatic function (defined as GFR < 80 ml/min. GFR=40 x length (cm) / serumcreatinin (μmol/l and ALAT >150% of normal value for age);
- Use of ritonavir; use of ACE inhibitors;
- Insufficient knowledge of the Dutch language.
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:トリプル
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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アクティブコンパレータ:Metformin
Metformin with lifestyle intervention during 18 months
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Oral administration, 500 mg daily at week 1.
Every week metformin dosage increases with 500 mg, to a maximum dose of 1000 mg bid.
This maximum dose will be administered till the end of the study.
他の名前:
Lifestyle intervention: 18 months physical therapy and dietary advice
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プラセボコンパレーター:Placebo
Placebo and lifestyle intervention during 18 months
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Lifestyle intervention: 18 months physical therapy and dietary advice
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Change in BMI from baseline
時間枠:18 months and 36 months
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Change in BMI after part 1 (double blind) and part 2 ( follow-up)
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18 months and 36 months
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Change in Insulin resistance from baseline
時間枠:3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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calculated by the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR).
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Renal and hepatic function
時間枠:3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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creatinine and alat
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
|
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Tolerability
時間枠:3; 6; 9; 12; 15; 18; 24; 30 and 36 months
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The amount of reported adverse effects, in relation to the achieved dose level.
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3; 6; 9; 12; 15; 18; 24; 30 and 36 months
|
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Pharmacokinetics (PK)-parameters: clearance (ml/min)
時間枠:9 months
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Clearance where applicable expressed per body weight, age category, Tanner Stage and gender, clearance will be determined with a two-compartment pharmacokinetic model using non linear mixed effect modelling.
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9 months
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Body fat percentage
時間枠:0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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Physical fitness
時間枠:0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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Quality of life
時間枠:0, 9, 18 and 36 months
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0, 9, 18 and 36 months
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|
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Long term efficacy
時間枠:36 months
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Based on BMI and HOMA-IR values
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36 months
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Long-term safety
時間枠:36 months
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Renal and hepatic function after 36 months of metformin use
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36 months
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Long-term tolerability
時間枠:36 months
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The amount of adverse effects after 36 months
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36 months
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Microvascular complications
時間枠:36 months
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Measured as micro-albuminuria
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36 months
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Macrovascular complications
時間枠:36 monthts
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Measured with Pulse Wave Velocity and Augmentation Index.
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36 monthts
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Development of T2DM
時間枠:36 months
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36 months
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PK-parameters: volume of distribution (liters)
時間枠:9 months
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Volume of distribution, where applicable expressed per body weight, age category, Tanner Stage and gender, volume of distribution will be determined with a two-compartment pharmacokinetic model using non linear mixed effect modelling.
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9 months
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Marja MJ van der Vorst, MD, PhD、St. Antonius Hospital
出版物と役立つリンク
一般刊行物
- van Rongen A, van der Aa MP, Matic M, van Schaik RHN, Deneer VHM, van der Vorst MM, Knibbe CAJ. Increased Metformin Clearance in Overweight and Obese Adolescents: A Pharmacokinetic Substudy of a Randomized Controlled Trial. Paediatr Drugs. 2018 Aug;20(4):365-374. doi: 10.1007/s40272-018-0293-1.
- van der Aa MP, Hoving V, van de Garde EM, de Boer A, Knibbe CA, van der Vorst MM. The Effect of Eighteen-Month Metformin Treatment in Obese Adolescents: Comparison of Results Obtained in Daily Practice with Results from a Clinical Trial. J Obes. 2016;2016:7852648. doi: 10.1155/2016/7852648. Epub 2016 Dec 22.
- van der Aa MP, Elst MA, van Mil EG, Knibbe CA, van der Vorst MM. METFORMIN: an efficacy, safety and pharmacokinetic study on the short-term and long-term use in obese children and adolescents - study protocol of a randomized controlled study. Trials. 2014 Jun 5;15:207. doi: 10.1186/1745-6215-15-207.
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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