EMPOWIR:Enhance the Metabolic Profile of Women With Insulin Resistance
Fjalë kyçe
Abstrakt
Përshkrim
Progressive weight gain that starts in the fourth and fifth decades is commonly reported by women from all ethnic and socio-economic groups. Our previous data suggest that, in large and diverse subpopulations of healthy-appearing women this midlife weight gain may represent the earliest clinical manifestation of insulin resistance - demarcated by increased insulin response curves in the presence of completely normal glucose tolerance tests. We termed the disorder Syndrome W to highlight its defining triad of weight gain, waist gain and white-coat hypertension in women and its role as an alphabetic and chronologic antecedent to the better known Syndrome X. As in other disorders of insulin action in younger women, including Polycystic Ovarian Syndrome (PCOS), early adrenarche, and precocious puberty, Syndrome W is, presumably, a harbinger of The Metabolic Syndrome and Type 2 diabetes at an early and optimal period for intervention.
Preliminary data from our first pilot study suggested that metformin, in combination with a hypocaloric, low-fat, carbohydrate modified dietary program produced significant and sustainable weight loss in women with Syndrome W, with notable reductions in fasting insulin levels. These findings supported hypotheses that insulin elevation might be an antecedent, as well as a consequence, of weight gain, accounting for a progressive and intractable weight spiral as women transition from their forties to their sixties. Additional two to four year follow-up in an intention-to-treat analysis of consecutive women who lost ≥10% of their body weight after one year of the treatment regimen further suggests that this composite intervention prevents weight regain and the onset of overt glucose impairment. The protocol evolved from evaluation and treatment of several hundred patients seen in The Endocrine Faculty Practice over a ten year period and has been highly successful in a broad ethnic range of normo-glycemic, hyperinsulinemic subjects. These include midlife women with weight gain and overweight men with upper body obesity - populations which have not been comparably treated in prior studies which focus predominantly on subjects with discernible glycemic abnormalities. The magnitude and duration of the treatment effect suggest that more rigorous study should be undertaken with a randomized clinical trial.
PPAR agonists including thiazolidinediones (TZD's) are a newer category of insulin sensitizers with increasingly wide and well-studied positive attributes, including redistribution of fat depots, increased adiponectin secretion, and reduction of inflammatory and proinflammatory markers.
The combination of metformin and rosiglitazone (Avandamet®) is FDA-approved for the treatment of hyperglycemia in patients with Type 2 diabetes. Previous clinical research and recent laboratory data suggest that the two categories of insulin sensitizers have independent and additive mechanisms of action that could target and, ultimately, modulate the underlying pathogenesis of insulin resistance.
Comparison studies suggest that TZD's may have a greater insulin sensitizing action and provide greater reduction in hyperinsulinemia than metformin. However, due to increased adipocyte expression (and possible other mechanisms), weight gain is a common and undesirable side effect of TZD treatment. The addition of metformin to rosiglitazone, along with dietary strategies that reduce endogenous insulin production could prove an ideal therapeutic option to attenuate insulin resistance and preserve ß-cell function in high risk individuals. Early initiation of this dual regimen in normoglycemic subjects with documented hyperinsulinemia could have profound implications for Syndrome W women and for an additional 25% of the adult US population estimated to have other manifestations of The Metabolic Syndrome.
The primary study question addressed is whether dual treatment regimens which modulate insulin action can reduce hyperinsulinemia and insulin resistance in high risk, but healthy-appearing normoglycemic, hyperinsulinemic subjects identified because of progressive, intractable, midlife weight gain
Datat
Verifikuar së fundmi: | 02/28/2014 |
Paraqitur së pari: | 02/04/2008 |
Regjistrimi i vlerësuar u dorëzua: | 02/04/2008 |
Postuar së pari: | 02/17/2008 |
Përditësimi i fundit i paraqitur: | 03/26/2014 |
Përditësimi i fundit i postuar: | 03/27/2014 |
Data e paraqitjes së rezultateve të para: | 01/29/2014 |
Data e paraqitjes së parë të rezultateve të QC: | 03/26/2014 |
Data e rezultateve të para të postuara: | 03/27/2014 |
Data e fillimit të studimit aktual: | 12/31/2007 |
Data e vlerësuar e përfundimit primar: | 12/31/2010 |
Data e vlerësimit të përfundimit të studimit: | 12/31/2010 |
Gjendja ose sëmundja
Ndërhyrja / trajtimi
Drug: metformin and rosiglitazone
Faza
Grupet e krahëve
Krah | Ndërhyrja / trajtimi |
---|---|
Placebo Comparator: A: Study diet EMPOWIR dietary intervention food exchange program; 40-45% carbohydrates, 35-40% protein, and 20% fat AND 4 week dosage escalation of placebo metformin, 500 mg/day to a total dose of 2000mg/day; starting dose of placebo rosiglitazone 2mg/day added at weeks 3 and weeks 4 to a total dose of 4 mg/day. | |
Active Comparator: B: Study diet plus Metformin Metformin and Rosiglitazone Placebo
EMPOWIR dietary intervention food exchange program; 40-45% carbohydrates, 35-40% protein, and 20% fat AND 4 week dosage escalation of metformin, 500 mg/day to a total dose of 2000mg/day; starting dose of placebo rosiglitazone 2mg/day added at weeks 3 and weeks 4 to a total dose of 4 mg/day. | |
Active Comparator: C: Study diet plus metformin and avandia Metformin and Rosiglitazone
EMPOWIR dietary intervention food exchange program; 40-45% carbohydrates, 35-40% protein, and 20% fat AND 4 week dosage escalation of metformin, 500 mg/day to a total dose of 2000mg/day; starting dose of rosiglitazone 2mg/day added at weeks 3 and weeks 4 to a total dose of 4 mg/day. |
Kriteret e pranimit
Moshat e pranueshme për studim | 35 Years Për të 35 Years |
Gjinitë e pranueshme për studim | Female |
Pranon Vullnetarë të Shëndetshëm | po |
Kriteret | Inclusion Criteria: 1. Healthy, non-diabetic women with "≥20 pound weight gain since their twenties" 2. Age: 35-55 3. Peri-menopausal or postmenopausal status 4. Body Mass Index (BMI) 25-35 kg/m2 5. Either: 1. a single blood pressure recording ≥135/85 or the use of blood pressure medication OR 2. HDL≤50mg/dl or triglycerides ≥150 mg/dl or the use of lipid modifying medication 6. Area-under-the-curve (AUC-)insulin level>100mcgU/ml along with normal fasting (≤100 mg/dl) & postprandial ((≤200 mg/dl) glucose determinations following a 75-gram standard oral glucose tolerance test. - Exclusion Criteria: 1. known diabetes, fasting blood sugar ≥100 mg/dl or HbA-1-C≥6.0% 2. known hepatic disease or ALT>40 3. known renal disease or creatinine ≥ 1.4 4. known severe pulmonary disease 5. chronic acidosis of any etiology 6. Congestive heart failure (NYS Category 1), treated or untreated 7. Cancer - active within 5 years 8. current alcoholism or other substance abuse 9. co-morbid psychiatric disorder, which in the opinion of the screening physician would require concomitant psychotherapy as part of obesity management 10. currently untreated thyroid abnormality (TSH≤0.2 or ≥4mIU/L) 11. pregnancy or contemplation of pregnancy 12. use of TZD or metformin within the past year 13. allergy to TZD or biguanide 14. use of FDA approved or alternate obesity agent within 6 months of the study 15. history of pseudotumor cerebri 16. other impairment, such as a history of medication noncompliance, which in the judgment of the screening clinician, would preclude active study participation. 17. history of known or suspected heart disease |
Rezultati
Masat Kryesore të Rezultateve
1. Fasting Insulin [6 months]
Masat dytësore të rezultateve
1. Body Weight [6 months]
2. HOMA-IR [6 months]
3. Waist Circumference [6 months]
4. Systolic BP [6 months]
5. Diastolic BP [6 months]
6. HDL [6 months]
7. Triglycerides [6 months]
8. Adiponectin [6 months]