TAKE TIME Pioglitazone Reverses Defects in Mitochondrial Biogenesis in Patients With T2DM

Study Overview
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Brief Summary
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This study is designed to look at the effect of Pioglitazone treatment on the body's ability to burn food in order to produce energy.

Detailed Description
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Skeletal muscle mitochondrial defects are a sine qua non of insulin resistance in patients with T2DM. Pioglitazone decreases free fatty acid levels and restores mitochondria number in adipose tissue whereas high fat diet and lipid infusion decreases genes involved in mitochondrial biogenesis. Increased lipid flux from diet or adipose tissue into skeletal muscle might be the cause of decreased mitochondrial biogenesis. The purpose of this study is to determine if 22 weeks treatment with Pioglitazone can increase mitochondrial biogenesis in muscle in 30 uncomplicated T2DM patients that were previously not taking TZD's. This Phase IV, randomized, double-blind, placebo controlled, clinical trial will consist of 3 phases: a screening, a placebo / Pioglitazone phase (12 weeks) and a weight loss period (6-10 weeks). The primary endpoint is to identify the changes in skeletal muscle mitochondria number and gene expression. Secondary endpoints include MRS measured mitochondrial capacity, insulin sensitivity for glucose disposal and insulin suppression of free fatty acids, electron transport chain activity, mitochondrial content and intra hepatic and intra myocellular lipid. Metformin and Sulfonylurea will be used as standardized oral therapy to maintain HbA1C < 7.0. After completing the protocol, patients will be offered a very low calorie liquid diet (800kcal/d) to assist them in losing weight. During this period they will continue on their previously randomized treatment. When patients lose 10% of their body weight, patients will be switched to a weight maintenance diet (meal replacement with 1 can of glucerna at breakfast and lunch with a healthy dinner) for 10 days. MRS measured mitochondrial capacity will again be determined to see if weight loss + pioglitazone has more effect on mitochondrial function than pioglitazone alone.

Official Title
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Pioglitazone Reverses Defects in Mitochondrial Biogenesis in Patients With T2DM

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Drug: Pioglitazone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Men and women aged 18-70 with Type 2 diabetes as defined by: Fasting plasma glucose > 126 mg/dL at entry Or a two-hour OGTT glucose > 200mg/dL Or current treatment with one or two oral anti-diabetic drugs, except TZD Or currently using insulin Fasting plasma glucose < 200mg/dL at entry BMI >27.0 and <45.0kg/m2 Adequate contraception for women (including, but not limited to: oral contraception, hysterectomy, tubal ligation, or post-menopausal as defined by > 6 months without a menstrual cycle and FSH > 40 mIU/ml). Exclusion Criteria: Significant renal, cardiac, liver, lung, or neurological disease (controlled hypertension is acceptable if baseline bp < 140/90 on medications). Prior use of other thiazolidinediones (rosiglitazone [AVANDIATM], pioglitazone [ACTOSTM]) Use of drugs known to affect energy metabolism or body weight: including, but not limited to: orlistat, sibutramine, ephedrine, phenylpropanolamine, corticosterone, etc. Pregnancy Alcohol or other drug abuse Unwilling or unable to abstain from caffeine (48h) and tobacco (24h) prior to metabolic rate measurements Increased liver function tests at baseline (AST/ALT/GGT/or alkaline phosphatase greater than 2.5 times the upper limit of normal) Metal objects that would interfere with the measurement of body composition /MRS such as implanted rods, surgical clips, etc. HbA1C of > 10%. NYHA class III/IV CHF is an exclusionary cardiac condition. history of deep vein thrombosis (DVT) or pulmonary embolism (PE) varicose veins major surgery on the abdomen, pelvis, or lower extremities within previous 3 months cancer (active malignancy with or without concurrent chemotherapy) rheumatoid disease bypass graft in limb known genetic factor (Factor V Leiden, etc) or hypercoagulable state diagnosed peripheral arterial or vascular disease, or intermittent claudication family history of primary DVT or PE (pulmonary embolism) peripheral neuropathy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: 1<br> | |
| Experimental: 2<br> | Drug: Pioglitazone<br>* During the double-blind, 12 weeks treatment period, subjects will self-administer study medication (pioglitazone or equivalent volume of placebo) 30 mg/day each morning. The dose of pioglitazone will be increased to 45 mg/day after 4 weeks if the fasting plasma glucose is higher than 100mg/dl or the HbA1C is higher than 7%. This dose has proven tolerability, safety and efficacy for type 2 diabetes and has previously been used at the Pennington Center in studies on pioglitazone.<br>* Other names: TZD;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in skeletal muscle mitochondrial number (electron microscopy + qPCR of mtDNA) and mitochondrial gene expression in T2DM patients treated with pioglitazone (vs. placebo) |  | baseline and after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| insulin sensitivity for insulin suppression of free fatty acid and glucose disposal |  | baseline and after intervention | 
| electron transport chain activity; mitochondrial content by MRS (ATP max) |  | baseline and after intervention | 
| intra hepatic and intra myocellular lipid by MRS; mitochondrial content by MRS (ATP max) post weight loss period |  | baseline ,after treatment and after weight loss | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diabetes Mellitus, Type 2