Ischemic Injury and Ischemic Preconditioning in Diabetes

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: NCT00184821
Recruitment Status : Completed
First Posted : September 16, 2005
Last Update Posted : April 5, 2007
Dutch Diabetes Fund
Information provided by:
Radboud University

September 9, 2005
September 16, 2005
April 5, 2007
June 2004
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Complete list of historical versions of study NCT00184821 on Archive Site
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Ischemic Injury and Ischemic Preconditioning in Diabetes
Acute Local Ischemic Preconditioning in Patients With Type 1 Diabetes in Vivo

In this proof-of-concept study, forearm vulnerability to ischemic exercise is studied in patients with type 1 diabetes mellitus with and without prior ischemic preconditioning (short period of ischemia that protects against subsequent ischemic exercise). Annexin A5 scintigraphy is used to quantify subtle signs of mild and reversible forearm injury that results from ischemic exercise.

The following hypotheses are tested:

  1. Patients with type 1 diabetes are not more vulnerable to ischemic injury as compared with previously studied healthy volunteers.
  2. Ischemic preconidtioning is still present in patients with type 1 diabetes. Depending on the validity of hypothesis 2, the effect of short pharmacological interventions are studied on vulnerability to forearm ischemia/reperfusion injury in the absence or presence of local forearm ischemic preconditioning.

All patients will be studied in supine position after an overnight fast, while plasma glucose levels are monitored. In the first 8 patients intravenous insulin is administered as needed, to reach target glucose levels between 5-7 mmol/l. Patients will be subjected to 10 minutes of forearm ischemia (non-dominant arm), combined with handgripping at 50% of maximal force until exhaustion. Upon reperfusion, Tc-99m-HYNIC-Annexin A5 will be injected intravenously. Targeting of annexin A5 to thenar muscle and forearm flexor muscle will be quantified as the percentage difference in radioactivity between experimental and control side. This procedure will be performed twice (randomized cross-over design), with at least 2 week interval, either with or without 10 minutes ischemia followed by 10 minutes of reperfusion prior to ischemic exercise.

Depending on the results of this study, substudies will be performed to study the effect of diazoxide (K-ATP channel opener, may mimic ischemic preconditioning), glibenclamide (K-ATP channel blocker, may inhibit ischemic preconditioning) or adenosine (infusion into brachial artery of non-dominant arm as a substitute for ischemic preconditioning).

Observational Model: Defined Population
Primary Purpose: Screening
Time Perspective: Cross-Sectional
Time Perspective: Prospective
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  • Diabetes Mellitus, Insulin-Dependent
  • Ischemia-Reperfusion Injury
  • Procedure: Ischemic preconditioning
  • Procedure: Forearm ischemic exercise
  • Procedure: Annexin A5 scintigraphy
  • Drug: Diazoxide
  • Drug: glibenclamide
  • Drug: adenosine
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Engbersen R, Riksen NP, Mol MJ, Bravenboer B, Boerman OC, Meijer P, Oyen WJ, Tack C, Rongen GA, Smits P. Improved resistance to ischemia and reperfusion, but impaired protection by ischemic preconditioning in patients with type 1 diabetes mellitus: a pilot study. Cardiovasc Diabetol. 2012 Oct 10;11:124. doi: 10.1186/1475-2840-11-124.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Same as current
May 2005
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Inclusion Criteria:

  • type 1 diabetes mellitus
  • age 18-50 years

Exclusion Criteria:

  • hypertension (systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg
  • cardiovascular disease (coronary artery insufficiency,CVA/TIA, peripheral artery disease
  • HbA1c > 9%
  • Body Mass Index < 25 kg/m2
  • Unable to stop co-medication (other than insulin) for 1 week
  • Previous exposure to radiation (diagnostic or therapeutic) in the past year
Sexes Eligible for Study: All
18 Years to 50 Years   (Adult)
Contact information is only displayed when the study is recruiting subjects
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Radboud University
Dutch Diabetes Fund
Study Chair: Richard Engbersen, MD Radboud University Nijmegen Medical Centre; department of Pharmacology-Toxicology
Study Chair: Gerard Rongen, MD, PhD Radboud University Nijmegen Medical Centre; Department of Pharmacology-Toxicology
Study Chair: Wim Oyen, MD, PhD Radboud University Nijmegen Medical Centre; Department of Nuclear Medicine
Study Chair: Marc Mol, MD, PhD Canisius Wilhelmina Ziekenhuis Nijmegen; Department of Internal Medicine
Principal Investigator: Paul Smits, MD, PhD Radboud University Nijmegen Medical Centre; Department of Pharmacology-Toxicology
Study Chair: B. Bravenboer, MD, PhD Catharina Hospital Eindhoven, Dept. of Internal Medicine
Radboud University
April 2007