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Pioglitazone Influence of triglyceride Accumulation in the Myocardium in Diabetes.


- candidate number1309
- NTR NumberNTR180
- ISRCTNISRCTN53177482
- Date ISRCTN created20-dec-2005
- date ISRCTN requested18-okt-2005
- Date Registered NTR5-sep-2005
- Secondary IDsN/A 
- Public TitlePioglitazone Influence of triglyceride Accumulation in the Myocardium in Diabetes.
- Scientific TitlePathophysiological significance of myocardial triglyceride accumulation in type 2 diabetes mellitus related heart disease: the effect of pioglitazone versus metformin on myocardial metabolism and function.
- ACRONYMThe PIRAMID study
- hypothesisLipotoxicity-related cardiac abnormalities can be reversed by PPAR g agonist therapy in type 2 diabetes patients.
- Healt Condition(s) or Problem(s) studiedDiabetes Mellitus Type 2 (DM type II), Heart diseases
- Inclusion criteriaType 2 Diabetes PatientsMales, 45-65 years, DM2 (diagnosed according to WHO criteria, treated by monotherapy of sulfanylurea (i.e. unchanged during >30 days prior to inclusion).
At least three month stable HbA1c (<8.5%) under this therapy.
Sitting blood pressure <150/85 mmHg with or without antihypertensive drugs, BMI<32 kg/m2.Healthy volunteers, Healthy male subjects, 45-65 years, Normal sitting blood pressure <150/85 mmHg, BMI<32 kg/m2. Normal glucose tolerance as assessed by 75-g oral glucose tolerance test.
- Exclusion criteriaType 2 Diabetes Patients, CAD, Active malignant disease, Impaired renal function (serum creatinine > 176 mmol/L), Weight >/= 45 kg (because of 11C-palmitate tracer), Anti-coagulant therapy, Severe obstructive lung disease; hereditary lipoprotein disease, Impaired hepatic function (defined as ALT > 3 ULN) or a history of liver disease, Inability to understand study information, inability / unwillingness to sign informed consent, Substance abuse, Familial polyposis coli, <3 months after participation in other clinical trials.
Other research projects, whereby radiation is used. Hemoglobin <8 mmol/l, Metal implants and claustrophobia, incompatible with CMR.
Congestive heart failure (NYHA functional score > I), atrial fibrillation or history of sustained ventricular tachycardia.
Stroke within 6 months prior to enrollment.
Microvascular complications, including:
diabetic nephropathy, proliferative retinopathy, symptomatic macrovascular complications and/or (autonomic) neuropathy, except for background diabetic retinopathy.
Leg ulcers, gangrene. Hyper sensibility to study medication.
Current use of TZD/fibrates Healthy volunteersHistory or current cardiovascular diseaseDyslipidemia, requiring pharmacological treatment according to the Dutch Cholesterol Consensus 1998
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingDouble
- controlActive
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-sep-2004
- planned closingdate15-jan-2007
- Target number of participants90
- Interventions80 subjects on monotherapy sulfanylurea for at least 10 weeks will be enrolled. Following, participants will be randomised to Metformin or Pioglitazone for 24 weeks.
Group 1: Metformin;
Group 2: Pioglitazone
10 healthy subject will only undergo baseline measurements.
- Primary outcomeChanges in cardiac function and metabolism following treatment with PPARg agonist versus current state of the art therapy, metformin.
- Secondary outcomeGlucose and FFA uptake by adipose tissue and skeletal muscle Cardiac high-energy-phosphate (HEP) metabolism.
Hemodynamic and vascular parametersBody composition (body mass index (BMI), waist, adipose tissue distribution, including liver fat content, body fat percentage and fluid retention) Plasma parameters of glycemic control and lipoprotein metabolism Circulating levels of markers of inflammation, coagulation activation, fibrinolysis and endothelial functions Whole-body insulin sensitivity (by clamp).
- TimepointsN/A
- Trial web siteN/A
- statusinclusion stopped: follow-up
- CONTACT FOR PUBLIC QUERIESDrs. L.J. Rijzewijk
- CONTACT for SCIENTIFIC QUERIESDr. M. Diamant
- Sponsor/Initiator VU University Medical Center
- Funding
(Source(s) of Monetary or Material Support)
Eli Lilly Nederland B.V.
- PublicationsN/A
- Brief summaryBackground/hypothesis:
Patients with type 2 diabetes mellitus (DM2) have a considerably higher risk to develop cardiac disease with a poorer outcome. Ectopic triglyceride (TG) accumulation underlies diabetic cardiomyopathy. These cardiac abnormalities can be reversed by lowering myocardial TG using a peroxisome proliferator-activated receptor (PPAR) g agonist. Metformin, the present gold standard treatment for type 2 diabetes, might also have cardioprotective properties due to its recently proposed mechanism of action.
- Main changes (audit trail)
- RECORD29-aug-2005 - 15-nov-2009


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