Efficacy of Pioglitazone and Insulin in Treating Subjects With Type 2 Diabetes Mellitus and Renal Failure.

The purpose of this study is to determine the metabolic and cardiovascular effects of pioglitazone, once daily (QD), and insulin combination therapy in subjects with Type 2 Diabetes and Renal Failure.

Patients with type 2 diabetes mellitus and clinically significant kidney disease presenting with contra-indications for metformin and sulfonylurea drugs are usually treated with insulin therapy only. While the prolonged pharmacokinetic insulin profile due to delayed renal insulin elimination already is a hurdle for a successful therapy, impaired kidney function results in increased oxidative stress and cardiovascular risk, especially in patients requiring dialysis. Several potential mechanisms may explain this increased cardiovascular risk, and one, frequent finding is coexistence of several other independent cardiovascular risk factors including dyslipidemia, hypertension and smoking. In addition, impaired kidney function is associated with elevated markers of inflammation and other putative risk factors for cardiovascular events.

The focus of this study is to investigate whether pioglitazone may help improve overall metabolic and cardiovascular risks in patients with end stage renal disease, and if pioglitazone can potentially exert positive effects on kidney function in patients with renal failure requiring dialysis.

The duration of treatment for patients completing the study is approximately 26 weeks.

Eligibility Criteria:
Inclusion Criteria:

* Has Type 2 Diabetes Mellitus, and is a patient on insulin treatment for at least 3 months.
* Has a body mass index less than 36 kg/m²
* Has a glycosylated hemoglobin level greater than or equal to 6.0% and less than 10%.
* Patient is on hemo-dialysis with or without residual excretion
* An insulin dose greater than 20 IE/day

Exclusion Criteria:

* Has a history of type 1 diabetes.
* Has acute infections.
* History of hypersensitivity to the study drugs or to drugs with similar chemical structures.
* History of severe or multiple allergies.
* Has a progressive fatal disease other than kidney failure.
* Has a history of drug or alcohol abuse within the last 5 years.
* A history of significant cardiovascular (e.g. Coronary heart failure based on New York Heart Association stage III - IV), respiratory, gastrointestinal, hepatic (e.g. alanine aminotransferase greater than 2.5 times the normal reference range) or hematological disease.
* History of primary hyperaldosteronism
* Acute myocardial infarction, open heart surgery or cerebral event (stroke/transient ischemic attack) within the last year prior to study start.
* Any further antidiabetic treatment except pioglitazone and insulin.
* History of macular edema.
* Is required to take or intends to continue taking any disallowed medication, any prescription medication, herbal treatment or over-the counter medication that may interfere with evaluation of the study medication, including:

  * Treatment with any other investigational drug within 3 months before trial entry.
  * Treatment with steroids within 3 months before trial entry.
  * Treatment with thiazolidinediones within the past 3 months.
  * If statin therapy applicable: Change of medication within the last 4 weeks.
  * Pre-treatment with gemfibrozil within the last 12 weeks.
  * Pre-treatment with rifampicin within the last 12 weeks.
* Has uncontrolled unstable angina.