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Impact of Liraglutide on Endothelial Function and Microvascular Blood Flow in Type 2 Diabetes Mellitus

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01208012
Recruitment Status : Completed
First Posted : September 23, 2010
Last Update Posted : March 15, 2011
Novo Nordisk A/S
IKFE Institute for Clinical Research and Development
Information provided by:
ikfe-CRO GmbH

Brief Summary:
The trial is a phase IV clinical trial investigating the impact of Liraglutide on endothelial function and microvascular blood flow in 44 patients with type 2 diabetes mellitus aged 30-65 and HbA1c ranging from ≥ 5.5% ≤ 7.0%. The patients will be randomized into two study arms, one arm will be treated with Metformin monotherapy, the second arm will be treated with Metformin and Liraglutide at an increasing dose (0.6 mg/day to 1.8 mg/day.)

Condition or disease Intervention/treatment Phase
Diabetes Mellitus, Type 2 Drug: Victoza® Phase 4

Detailed Description:

Type 2 Diabetes Mellitus (DM) is associated with increased cardiovascular risk and the majority of type 2 diabetic patients die due to the vascular complications of Diabetes Mellitus. In type 2 diabetic patients, an early marker in the biogenesis of atherosclerosis and cardiovascular disease is the occurrence of endothelial dysfunction with subsequent deterioration in micro- and macrovascular blood flow and tissue supply. Also several mechanistic pathways linking Diabetes Mellitus with endothelial dysfunction and cardiovascular complications are postulated. Recent studies aimed to investigate the vasoprotective effect of strict glycaemic control using conventional treatment algorithms failed to reduce cardiovascular risk in patients with Diabetes Mellitus type 2. Numerous pharmacological drugs are available to reduce blood glucose levels in type 2 diabetic patients. Beside comparable glucose lowering efficacy, some of them evolve limited or even adverse effects on vascular function and cardiovascular risk. Therefore, ideally new treatments in Diabetes Mellitus type 2 provide more than just reducing blood glucose values. Future treatments in type 2 Diabetes Mellitus will be judged on their potency to affect the cardiovascular risk profile in patients with Diabetes Mellitus type 2.

Liraglutide is a Glucagon-like peptide-1 (GLP-1) analogue shown to be effective in the treatment of type 2 Diabetes Mellitus. Liraglutide was shown to improve blood glucose levels not only by stimulating insulin secretion from the β cell, but also by improving the conversion of intact proinsulin into insulin and C-peptide in the granula of the β cell. While in rodents, GLP-1 and its analogues showed an increase in β cell regeneration and an inhibitory effect on β cell apoptosis, the effect of GLP-1 analogues on β cell mass in humans is less clear. Beyond its effects on β cells, Liraglutide and other GLP1 analogues were shown to suppress the glucagon release from α cells and to evolve a supportive effect on weight reduction by central and probably peripheral effects.

Beside these effects of GLP-1-analogues on β cell physiology and glucose metabolism, recent studies suggested several pleiotrophic effects of GLP-1 treatment which go beyond glycaemic control. Receptors for GLP-1 have been located in myocardial and endothelial cells, and GLP-1 supplementation was found to improve myocardial and endothelial function in diabetic and in non-diabetic subjects. In endothelial cells, isolated from human coronary arteries, GLP-1 rapidly activates endothelial nitric oxide synthase (eNOS) and stimulates nitric oxide (NO) production, promotes cell proliferation and inhibits glucolipoapoptosis. In addition, in transformed vascular endothelial cells, GLP-1 protects endothelial dysfunction incurred by tumor necrosis factor-α (TNF-α) through the modulation of the expression of vascular adhesion molecules and plasminogen activator inhibitor-1 (PAI-1). Chronic administration of GLP-1 analogues is associated with a significant reduction in blood pressure. Therefore it seems conceivable, that in patients with Diabetes Mellitus type 2, treatment with the GLP-1 analog Liraglutide might improve the cardiovascular risk profile beyond glucose control by stimulating endothelial NO release and by improving endothelial function.

The goal of our study is to investigate the vascular and endothelial effects of adding Liraglutide treatment to type 2 diabetic patients previously treated with Metformin.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 44 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Impact of Liraglutide on Endothelial Function and Microvascular Blood Flow in Type 2 Diabetes Mellitus
Study Start Date : April 2010
Actual Primary Completion Date : November 2010
Actual Study Completion Date : November 2010

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
No Intervention: Metformin
Patients taking Metformin at individual dose
Experimental: Metformin and Liraglutide
Patients taking Metformin at individual dose and Liraglutide 0.6 mg once daily for the 1st week, 1.2 mg daily for another 5 weeks, 1.8 mg daily for another 6 weeks.
Drug: Victoza®
Patients taking Metformin at individual dose and Liraglutide 0.6 mg once daily for the 1st week, 1.2 mg daily for another 5 weeks, 1.8 mg daily for another 6 weeks. When arrived at the dosage of 1.8 mg daily and the dose is not tolerated by the patient, the dose of Liraglutide can be decreased.Liraglutide is injected in the subcutaneous tissue once daily
Other Name: Victoza®, Liraglutide

Primary Outcome Measures :
  1. The difference in increase of retinal blood flow after flicker stimulation of retinal endothelial cells [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Retinal capillary blood flow will be assessed using scanner laser doppler flowmetry.

Secondary Outcome Measures :
  1. Central vascular elasticity [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Central arterial elasticity will be measured by Pulse wave velocity.

  2. Skin endothelial function and Skin oxygenation [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Microvascular skin blood flow and postcapillary tissue oxygenation (sO2)will be measured.

  3. Blood glucose control [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Fasting plasma glucose will be measured.

  4. Blood glucose control [ Time Frame: up to 2 weeks before baseline and after 6 and 12 weeks after baseline ]
    HbA1c will be maesured.

  5. Change of biomarkers of sub-clinical inflammation and cardiovascular risk [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Biomarkers PAI-1, hsCRP, VCAM, E-selectin and ADMA will be measured.

  6. Change of biomarker of heart failure [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    NT-pro BNP will be measured.

  7. Insulin/ intact Proinsulin ratio, C-peptide [ Time Frame: timepoint 0 and after 6 and 12 weeks ]
    Insulin Intact Proinsulin and C-peptide will be maesured.

  8. Change of body weight [ Time Frame: up to 2 weeks before baseline and after 6 and 12 weeks after baseline ]
    Body weight will be measured.

  9. Safety evaluation [ Time Frame: up to 2 weeks before baseline and after 12 weeks post baseline ]

    The safety evaluation includes:

    • Metabolic parameters indicating hepatic function (ALAT, ASAT, γ-GT)
    • Blood analysis (Alkaline Phosphatase, Blood cell count)
    • Change in pancreas function (Amylase, Lipase)
    • Change in renal function (Creatinine, Potassium)
    • Change in thyroid function (Calcitonin)
    • Vital signs (Blood Pressure, Radial Pulse, ECG)
    • β-HCG (only female patients of childbearing potential)
    • Adverse Events
    • Adverse Drug Reactions

Information from the National Library of Medicine

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Ages Eligible for Study:   30 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Diabetes Mellitus type 2
  2. HbA1c ≥ 5.5% and ≤ 7.0%
  3. Treatment with Metformin (daily dose 500 - 3000 mg monotherapy, the past 3 months)
  4. Age 30 - 65 years

Exclusion Criteria:

  1. Pre-treatment with PPAR gamma agonists or DPP IV inhibitors or GLP-1 analogues within the last three months
  2. History of type 1 Diabetes Mellitus
  3. No full legal mental and physical ability to give informed consent
  4. Uncontrolled hypertension (systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 90 mmHg)
  5. Anamnestic acute and chronic infections
  6. Inflammatory bowel disease and/or diabetic gastroparesis
  7. Anamnestic history of epilepsy
  8. Anamnestic history of hypersensitivity to the study drugs or to drugs with similar chemical structures
  9. History of severe or multiple allergies
  10. Treatment with any other investigational drug within 3 months before trial entry
  11. Progressive fatal disease
  12. History of drug or alcohol abuse in the past 2 years
  13. Liver disease with ASAT or ALAT above 3 times the upper normal limit
  14. Serum potassium > 5.5 mmol/L
  15. Moderate to Severe Kidney disease with a GFR ≤ 60 ml/min
  16. Pregnancy or breast feeding
  17. Sexually active woman of childbearing potential not practicing a highly effective method of birth control as defined as those which result in a low failure rate (i.e. less than 1% per year) when used consistently and correctly such as implants, injectables, combined oral contraceptives, hormonal IUDs, sexual abstinence or vasectomised partner
  18. Have had more than one unexplained episode of severe hypoglycaemia (defined as requiring assistance of another person due to disabling hypoglycaemia) within 6 months prior to screening visit
  19. History of dehydration, diabetic precoma, diabetic ketoacidosis or diabetic gastroparesis
  20. Acute (within the previous 2 days) or scheduled investigation with iodine containing radiopaque material
  21. Acute myocardial infarction, open heart surgery or cerebral event (stroke/TIA) within the previous 6 months
  22. Anamnestic uncontrolled unstable angina pectoris, pericarditis, myocarditis, endocarditis, haemodynamic relevant aortic stenosis, aortic aneurysma or heart insufficiency NYHA III or IV
  23. Anamnestic recent pulmonary embolism or pulmonary insufficiency
  24. Smoking within the last 6 months (> 1 cigarette/day)
  25. Planned change in antidiabetic, lipid lowering or blood pressure medication

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01208012

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IKFE Institute for Clinical Research and Development
Mainz, Germany, 55116
Sponsors and Collaborators
ikfe-CRO GmbH
Novo Nordisk A/S
IKFE Institute for Clinical Research and Development
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Principal Investigator: Thomas Forst, Prof. Dr. Ikfe GmbH

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Prof. Thomas Forst, MD, ikfe GmbH Identifier: NCT01208012     History of Changes
Other Study ID Numbers: Lira-Vasc-001
First Posted: September 23, 2010    Key Record Dates
Last Update Posted: March 15, 2011
Last Verified: March 2011

Keywords provided by ikfe-CRO GmbH:
Diabetes Mellitus treatment Metformin

Additional relevant MeSH terms:
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Diabetes Mellitus
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Hypoglycemic Agents
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists