Insulin Resistance, Prediabetic State
Conditions
Keywords
prediabetes
Brief summary
Type 2 diabetes is a worldwide epidemic disease, and preventive strategies are needed to face this health problem. The goal of this clinical trial is to evaluate the effect of linagliptin + metformin vs metformin alone on physiopathological parameters, such as glucose metabolism, insulin resistance, insulin secretion and pancreatic beta cell function in patients with impaired fasting glucose plus impaired glucose tolerance, during 24 months.
Detailed description
The main goal of this clinical trial is to compare the effect of two different treatments during 24 months: 1. Lifestyle modification program + metformin 850mg twice daily 2. Lifestyle modification program + linagliptin (2.5mg) and metformin (850mg) twice daily on the following parameters, after 24 months of treatment: 1. Glucose metabolism, evaluated by the oral glucose tolerance 2. Insulin resistance, evaluated by the oral glucose tolerance in 100% of the patients and by hyperglycemic clamp in 10 % of the patients 3. Insulin secretion, evaluated by the oral glucose tolerance in 100% of the patients and by hyperglycemic clamp in 10 % of the patients 4. Pancreatic beta cell function, evaluated by the oral glucose tolerance in 100% of the patients and by hyperglycemic clamp in 10 % of the patients 5. Systemic inflammation and cardiovascular risk factors, evaluated by cytokines interlelukin-6 (IL6), C-reactive protein (PCR), and measurement of the intima media thickness by ultrasound. All the patients will have a basal evaluation with an oral glucose tolerance test, lipid profile, body composition, and IMT measurement by ultrasonography; and 10 % will be invited for the hyperglycemic clamp. After the basal evaluation, if the patients result with IMPAIRED GLUCOSE TOLERANCE and have at least 2 risk factors, they will be invited to the intervention phase where they will be randomized to one of the two treatment groups. Patients will have a follow-up visit every month to review the adherence to the lifestyle modification program and to the medication. Every 6 months OGTT will be performed on all the patients, and in a subset of patients hyperglycemic clamp will be performed at 0, 6 and 12 months. After 18 and 24 months, patients will repeat the same evaluation performed as the basal evaluation.
Interventions
COMBINATION_PRODUCTLinagliptin + metformin
Linagliptin-Metformin 2.5/850mg twice daily plus a lifestyle modification program based on nutritional assesment, physical activity prescription and general counseling
DRUGMetformin
Metformin 850mg twice daily plus a lifestyle modification program based on nutritional assesment, physical activity prescription and general counseling
Sponsors
Hospital Regional de Alta Especialidad del Bajio
Universidad de Guanajuato
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Patients with prediabetes, defined for the existence impaired glucose tolerance (Glucose between 140 and 199 mg/dL at the 2 hours of the Oral Glucose Tolerance test (OGTT) ) with or without impaired fasting glucose (Fasting glucose between 100 and 125 mg/dL) * Patients who accept to participate in the study and sign the informed consent letter.
Exclusion criteria
* Patients with diagnosed Type 2 Diabetes Mellitus previously or detected during the OGTT * Patients in actual treatment or during the last 3 months with metformin, pioglitazone or another antidiabetic drug, including insulin. * Serum creatinine \> 1.6 mg/dL * Hypertriglyceridemia very high (\>500 mg/dL) * Pregnant women * Altered arterial hypertension (Systolic \> 180 mmHg or Diastolic \>105 mmHg) * Excessive alcohol intake, acute or chronic * Medications or medical conditions that affect glucose homeostasis (thiazides, beta blockers, glucocorticoids for systemic use, weight-reducing drugs or anorexigenics, Cushing's syndrome, Thyrotoxicosis.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from basal fasting and post2h OGTT glucose levels at 12 and 24 months | 12 and 24 months | Fasting and post-2h OGTT glucose values (mg/dl) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from basal pancreatic beta cell function at 12 and 24 months | 12 and 24 months | Evaluated with the measurements of glucose and insulin during the oral glucose tolerance test; as well as with the glucose and insulin measurements from the hyperglycemic clamp, as the Disposition index. |
| Change from basal insulin sensitivity at 12 and 24 months | 12 and 24 months | Insulin sensitivity evaluated during the oral glucose tolerance test by the Matsuda index, and reported as an arbitrary units. |
| Change from basal Weight at 12 and 24 months | 12 and 24 months | Weight measurement during the study, in kg |
| Incidence of type 2 diabetes | 24 months | New reported cases with T2D according the the ADA diagnostic criteria |
Countries
Mexico
Outcome results
None listed