Metformin Withdrawal In Metabolic Syndrome (METMS)
Effects of 14-Day Metformin Withdrawal on OGTT-Derived Insulin Sensitivity in Adults With Metabolic Syndrome: A Randomized Controlled Trial
The goal of this clinical trial is to investigate how a short-term interruption of metformin treatment affects insulin sensitivity, glucose control, and metabolic flexibility in adults with metabolic syndrome who are taking metformin as part of their usual medical treatment. Temporary interruptions in metformin treatment may occur in real-life situations, such as missed doses, medication access problems, travel, or planned short-term discontinuation for clinical reasons. This study aims to understand whether stopping metformin for 14 days leads to rapid changes in glucose metabolism or whether the effects of previous metformin treatment may persist during a short period without the medication.
The main questions it aims to answer are:
Does stopping metformin for 14 days worsen glucose control or insulin sensitivity measured by oral glucose tolerance tests, HbA1c, and continuous glucose monitoring?
Does stopping metformin for 14 days affect metabolic flexibility, measured by indirect calorimetry during the oral glucose tolerance test?
Does stopping metformin for 14 days affect blood lipids, liver and inflammatory markers, red blood cell parameters, kidney function markers, fasting lactate levels, blood pressure, or heart rate?
Researchers will compare participants who stop metformin for 14 days with participants who continue their usual metformin treatment to see whether temporary metformin discontinuation affects insulin sensitivity, glucose control, metabolic flexibility, and other cardiometabolic markers.
Participants in the metformin discontinuation group will stop taking metformin for 14 days. They will attend study visits on day 0, day 4, day 7, and day 14. At each visit, they will complete an oral glucose tolerance test, have blood samples taken, and undergo indirect calorimetry measurements before and after the glucose drink. Blood pressure and heart rate will also be measured during the test. Participants will wear a continuous glucose monitor throughout the 14-day period to track glucose levels and help detect any potentially unsafe increase in blood glucose.
Participants in the usual-treatment group will continue taking metformin as prescribed. They will attend study visits on day 0 and day 14. At each visit, they will complete an oral glucose tolerance test, have blood samples taken, and undergo indirect calorimetry, blood pressure, and heart rate measurements during the test.
At the study visits, researchers will assess glucose and insulin responses, HbA1c, continuous glucose monitoring data, metabolic flexibility, blood lipid profile, liver and inflammatory markers, red blood cell parameters, kidney function markers, fasting lactate levels, blood pressure, and heart rate.
調査の概要
研究の種類
入学 (推定)
段階
- 適用できない
連絡先と場所
研究連絡先
- 名前：Ricardo Mora-Rodriguez, Prof.
- 電話番号：+34 675424515
- メール：Ricardo.Mora@uclm.es
研究連絡先のバックアップ
- 名前：Diego Mora-Gonzalez, Msc.
- 電話番号：+34 634596243
- メール：Diego.Mora@uclm.es
研究場所
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Toledo
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Toledo、Toledo、スペイン、45071
- 募集
- University of Castilla-La Mancha
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コンタクト：
- University Castilla-La Mancha
- 電話番号：+34 925 26 88 00
- メール：fisioterapiayenfermeria.to@uclm.es
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-
参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
説明
Inclusion Criteria:
- Currently treated with metformin as part of their usual medical care for at least 12 months before enrolment.
- Diagnosis of metabolic syndrome according to established clinical criteria, based on the presence of at least three of the following components: increased waist circumference, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure or antihypertensive treatment, and elevated fasting glucose or treatment for dysglycemia.
- Stable metformin dose for at least 3 months before enrolment.
- Willing and medically able to temporarily discontinue metformin for 14 days if assigned to the metformin discontinuation group.
- Able and willing to undergo repeated oral glucose tolerance tests, venous catheter placement, repeated blood sampling, indirect calorimetry measurements, blood pressure measurements, and heart rate measurements.
- willing to wear a continuous glucose monitoring device during the study period.
- Preserved kidney function at baseline, defined as estimated glomerular filtration rate ≥60 mL/min/1.75 m² and urine albumin-to-creatinine ratio <30 mg/g, or values considered clinically acceptable by the study physician.
- No previous history of clinically significant diabetes-related complications, including diabetic retinopathy, diabetic foot disease, severe peripheral neuropathy, or diabetic kidney disease.
Exclusion Criteria:
- Diagnosis of type 1 diabetes.
- Current treatment with insulin or other glucose-lowering medications.
- Previous history of severe hypoglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state, or other acute diabetes-related metabolic complications.
- Uncontrolled diabetes or clinically unsafe glycemic status at screening, defined as HbA1c above 8.0 %, fasting plasma glucose above 160 mg/dl, or any other glycemic value considered unsafe by the study physician.
- Known allergy or intolerance to materials used in the continuous glucose monitoring device, adhesive patches, venous catheter, or study procedures.
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：基礎科学
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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実験的：METFOR WITHDRAW
Participants in this arm will stop their Metformin treatment for 14 days.
|
Participants assigned to this intervention will temporarily stop taking their usual metformin treatment for 14 days.
During this period, participants will undergo oral glucose tolerance tests and blood sampling on day 0, day 4, day 7, and day 14.
They will also wear a continuous glucose monitoring device throughout the 14-day period to monitor glucose levels during metformin discontinuation.
|
|
アクティブコンパレータ：CONTROL
Participants in this arm will continue with their Metformin treatment for 14 days.
|
Participants assigned to this intervention will temporarily stop taking their usual metformin treatment for 14 days.
During this period, participants will undergo oral glucose tolerance tests and blood sampling on day 0, day 4, day 7, and day 14.
They will also wear a continuous glucose monitoring device throughout the 14-day period to monitor glucose levels during metformin discontinuation.
|
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 Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)
時間枠：From enrolment to the end of the intervention, 14 days.
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HOMA-IR will be calculated from fasting plasma glucose and fasting insulin concentrations.
Higher values indicate greater insulin resistance.
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From enrolment to the end of the intervention, 14 days.
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Change in Matsuda Insulin Sensitivity Index
時間枠：From enrolment to the end of the intervention, 14 days.
|
The Matsuda Insulin Sensitivity Index will be calculated from glucose and insulin concentrations obtained during the oral glucose tolerance test.
Higher values indicate greater whole-body insulin sensitivity.
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From enrolment to the end of the intervention, 14 days.
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Mean sensor glucose during the intervention period
時間枠：From enrolment to the end of the intervention, 14 days.
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Mean glucose concentration will be assessed using continuous glucose monitoring (CGM) during the 14-day intervention period.
|
From enrolment to the end of the intervention, 14 days.
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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 |
|---|---|---|
|
Change in glycated hemoglobin
時間枠：From enrolment to the end of the intervention, 14 days.
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HbA1c will be measured in blood and reported as percentage of total hemoglobin.
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From enrolment to the end of the intervention, 14 days.
|
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Percentage of time in range assessed by continuous glucose monitoring
時間枠：From enrolment to the end of the intervention, 14 days.
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Time in range will be defined as the percentage of time with sensor glucose between 70 and 180 mg/dL during the 14-day intervention period.
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From enrolment to the end of the intervention, 14 days.
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Change in respiratory exchange ratio response during the oral glucose tolerance test
時間枠：From enrolment to the end of the intervention, 14 days.
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Respiratory exchange ratio (RER) will be assessed by indirect calorimetry during the oral glucose tolerance test.
The response will be calculated using the pre-specified respiratory exchange ratio values obtained during the test.
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From enrolment to the end of the intervention, 14 days.
|
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Change in plasma triglycerides
時間枠：From enrolment to the end of the intervention, 14 days.
|
Plasma triglyceride concentration will be measured in blood before each OGTT.
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From enrolment to the end of the intervention, 14 days.
|
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Change in total cholesterol
時間枠：From enrolment to the end of the intervention, 14 days.
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Total cholesterol concentration will be measured in blood before each OGTT.
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From enrolment to the end of the intervention, 14 days.
|
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Change in HDL-cholesterol
時間枠：From enrolment to the end of the intervention, 14 days.
|
HDL-cholesterol concentration will be measured in blood before each OGTT.
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From enrolment to the end of the intervention, 14 days.
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Change in LDL-cholesterol
時間枠：From enrolment to the end of the intervention, 14 days.
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LDL-cholesterol concentration will be measured in blood before each OGTT.
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From enrolment to the end of the intervention, 14 days.
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Change in estimated glomerular filtration rate
時間枠：From enrolment to the end of the intervention, 14 days.
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The estimated glomerular filtration rate will be calculated from serum creatinine and reported in mL/min/1.73
m².
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From enrolment to the end of the intervention, 14 days.
|
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Change in serum creatinine
時間枠：From enrolment to the end of the intervention, 14 days.
|
Serum creatinine concentration will be measured in blood before each OGTT.
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From enrolment to the end of the intervention, 14 days.
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Change in urinary albumin-to-creatinine ratio
時間枠：From enrolment to the end of the intervention, 14 days.
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The urinary albumin-to-creatinine ratio will be measured in urine before each OGTT.
|
From enrolment to the end of the intervention, 14 days.
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協力者と研究者
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (推定)
研究の完了 (推定)
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 (実際)
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
本研究に関する用語
その他の研究ID番号
- METMS
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IPD プランの説明
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