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Pancreatic beta-cell dysfunction REStorEd by Rosiglitazone and Valsartan Effects: a 52-week randomised controlled factorial study in subjects with impaired fasting glucose and/or impaired glucose tolerance
ISRCTN ISRCTN42786336
DOI 10.1186/ISRCTN42786336
ClinicalTrials.gov identifier
EudraCT number
Public title Pancreatic beta-cell dysfunction REStorEd by Rosiglitazone and Valsartan Effects: a 52-week randomised controlled factorial study in subjects with impaired fasting glucose and/or impaired glucose tolerance
Scientific title
Acronym PRESERVE TRIAL
Serial number at source N/A
Study hypothesis Type two diabetes is cause by progressive beta-cell dysfunction against a background of obesity and insulin resistance in susceptible individuals.

Peroxisome Proliferator-Activated Receptor (PPAR) gamma-mediated mechanisms are involved in the regulation of important processes that may protect the pancreatic beta-cell. Local pancreatic and systemic activation of the Renin-Angiotensin System (RAS), as frequently observed in people with obesity/insulin resistance, may be harmful to the pancreatic beta-cell causing beta-cell dysfunction and beta-cell apoptosis.

Treatment of subjects at high risk to develope type two diabetes, including those with impaired fasting glucose and/or impaired glucose tolerance (with/without a familiy history of diabetes) with a PPAR gamma agonist and/or an angiotensin II receptor blocker may improve beta-cell function.
Lay summary Not provided at time of registration
Ethics approval Ethics approval received from the local medical ethics committee
Study design Randomised controlled trial
Countries of recruitment Netherlands
Disease/condition/study domain Impaired glucose metabolism
Participants - inclusion criteria 1. Male and female subjects (aged 35 to 70 years)
2. Impaired Fasting Glucose (IFG): fasting plasma glucose 6.1 or higher and less than 7.0 mmol/l, or fasting plasma glucose 5.6 or higher and less than 7.0 mmol/l) and a family history of Diabetes Mellitus type two (DM2) (i.e. first and second degree [i.e. grandparents] relatives)
3. Impaired Glucose Tolerance (IGT): two hour plasma glucose during 75 g oral glucose tolerance test 7.8-11.1 mmol/l
Participants - exclusion criteria Drug use:
1. Current use of Angiotensin-Converting Enzyme Inhibitors (ACE-I), Angiotensin Receptor Blockers (ARB) and/or Thiazolidinediones (TZDs) and inability to discontinue these drugs
2. Known hypersensitivity to any of the study drugs
3. Prior use of blood glucose lowering medications except during pregnancy
4. Use of systemic glucocorticoids or niacin

Cardiovascular co-morbidities:
1. Ejection fraction known to be less than 40% or congestive heart failure, or existing clinical Cardio-Vascular (CV) disease:
a. previous Myocardial Infarction [MI] or stroke
b. angina with either more than 50% stenosis in more than or equal to two major coronary arteries, or ST depression of more than or equal to 2 mm, or a positive nuclear test, or previous coronary angioplasty, stent or bypass
c. previous limb bypass or vessel angioplasty or angiographic evidence of more than 50% stenosis, or intermittent claudication with an ankle/arm pressure less than or equal to 0.8
2. Uncontrolled hypertension requiring ACE-I or ARB

Other Criteria:
1. History of diabetes (except gestational DM) or on anti-diabetic medication
2. Renal or Hepatic Disease:
a. renal artery stenosis
b. creatinine clearance less than 40 ml/min or serum creatinine 200 umol/l or higher
c. clinical proteinuria (one or above, positive proteinuria on dipstick or 300 mg and above albuminuria/day, in the absence of urine)
d. measured Alanine Transferase (ALT) 2.5 or more times the upper limit of normal
e. active liver disease including jaundice, chronic hepatitis, previous liver transplant
3. Major illness with life expectancy of less than five years or that may interfere with participation
4. Use of another experimental drug
5. Pregnant or unwilling to use reliable contraception (fertile women will have a pregnancy test prior to randomisation)
6. Major psychiatric disorder
7. Diseases and medications that affect glucose tolerance (e.g. pheochromocytoma, Cushing’s syndrome, acromegaly, steroid-dependent asthma, protease inhibitors, anti-psychotics)
8. Unwillingness to be randomised or sign informed consent)
9. Known uncontrolled substance abuse
10. Inability to understand study information and/or communicate with clinic staff
Anticipated start date 01/10/2006
Anticipated end date 01/01/2010
Status of trial Completed
Patient information material
Target number of participants 144
Interventions Participants will be randomised into one of the following four treatment groups for a 52-week intervention:
1. Rosiglitazone 8 mg daily and valsartan-placebo
2. Valsartan 320 mg daily and rosiglitazone-placebo
3. Rosiglitazone 8 mg daily and valsartan 320 mg daily
4. Rosiglitazone-placebo and valsartan-placebo

Further information as of 10/07/12: The decision was made not to initiate the rosiglitazone arm because of the reported potential cardiovascular risks associated with rosiglitazone.
Primary outcome measure(s) To compare beta-cell function, as reflected by the first phase insulin secretion corrected for insulin sensitivity and/or the arginine-stimulated insulin secretion, both co-primary endpoints as measured during the eu-hyperglycemic clamp procedure, following 52 weeks of rosiglitazone, valsartan or rosiglitazone combined with valsartan in subjects with IFG (with and without a family history of DM2) and/or IGT.
Secondary outcome measure(s) To compare the effects of 52 weeks of rosiglitazone, valsartan or rosiglitazone combined with valsartan in subjects with IFG (with and without a family history of DM2) and/or IGT with respect to:
1. Fasting plasma glucose
2. Second phase insulin secretion in response to hyperglycemia during the hyperglycemic clamp test
3. All the above-mentioned beta-cell function parameters at 12 weeks after discontinuation of therapy to assess durability/disease modifying effects
4. The conversion from Normal Glucose Tolerance (NGT) to IGT or diabetes (as evaluated by an oral glucose tolerance test)
5. HbA1c, fasting blood glucose and lipid/lipoprotein concentrations
6. Insulin sensitivity assessed during the euglycemic clamp test
7. Safety and tolerability, including assessments of hypoglycemic events, blood pressure, and urinary albumin excretion rate
Sources of funding 1. Novartis Pharma B.V. (The Netherlands)
2. GlaxoSmithKline (The Netherlands)
Trial website http://www.trialregister.nl
Publications 1. 2012 results in http://www.ncbi.nlm.nih.gov/pubmed/22768174
2. 2012 further results in http://www.ncbi.nlm.nih.gov/pubmed/21712806
3. 2013 results in http://www.ncbi.nlm.nih.gov/pubmed/23553863
Contact name Dr  M  Diamant
  Address VU University Medical Center
Department of Endocrinology
Diabetes Center
De Boelelaan 1117
P.O. Box 7057
  City/town Amsterdam
  Zip/Postcode 1081 HV
  Country Netherlands
  Tel +31 (0)20 4440534
  Email m.diamant@vumc.nl
Sponsor VU University Medical Center (The Netherlands)
  Address Van der Boechorststraat 7
  City/town Amsterdam
  Zip/Postcode 1081 BT
  Country Netherlands
Date applied 28/09/2006
Last edited 08/07/2013
Date ISRCTN assigned 28/09/2006
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