The purpose of this study is to evaluate the safety and efficacy of TAK-559, once daily (QD), taken in combination with metformin in treating subjects with type 2 diabetes mellitus
Insulin is a primary regulator of blood glucose concentrations. A subnormal response to circulating insulin levels at target tissues leads to a decrease in insulin-mediated glucose uptake. Insulin resistance is associated with normal to high insulin levels and is often accompanied by dyslipidemia, a disruption in lipid metabolism resulting in increased triglycerides and low-density lipoprotein levels as well as decreased high-density lipoprotein levels in patients with type 2 diabetes mellitus. In the early stages of insulin resistance, a compensatory mechanism of increased insulin secretion by the pancreas maintains normal to near-normal glucose levels. Once the pancreas fails to maintain the increased insulin output, overt type 2 diabetes mellitus occurs. Insulin also plays an important role in the metabolism of fat and proteins and exerts its influence at the peroxisome proliferator-activated receptor level. Peroxisome proliferator-activated receptor -alpha receptors are expressed predominantly in skeletal muscle, adipose tissue, heart, liver, kidney, gut, macrophages, and vascular tissue, and play a key role in energy storage, glucose homeostasis, and vascular biology. Thus, as insulin activates peroxisome proliferator-activated receptor-alpha receptors, this results in the cellular uptake of glucose. Peroxisome proliferator-activated receptor receptors are ligand-activated transcription elements that regulate gene expression necessary for metabolism. For this reason, peroxisome proliferator-activated receptors play a pivotal role in glucose homeostasis, adipocyte differentiation, and lipid storage. The genes predominantly targeted by transcription activity of activated peroxisome proliferator-activated receptor-alpha receptors are those that mediate fatty acid uptake, fatty acid oxidation, and lipoprotein metabolism. As such, peroxisome proliferator-activated receptor-alpha agonists have their greatest effect on lipid metabolism and vascular biology. TAK-559 is a novel oxyiminoalkanoic acid under investigation for use as an oral agent in the treatment of patients with type 2 diabetes mellitus. TAK-559 has partial peroxisome proliferator-activated receptor-alpha agonist activity, potent peroxisome proliferator-activated receptor-alpha activity, and modest peroxisome proliferator-activated receptor-gamma activity at high concentrations in nonclinical models. This study was designed to evaluate the safety and glycemic control of TAK-559 in patients with type 2 diabetes mellitus taking metformin for whom monotherapy with an oral anti-diabetic had been insufficient.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
15
TAK-559 16 mg, tablets, orally, once daily and metformin stable dose orally, once daily for up to 26 weeks.
TAK-559 32 mg, tablets, orally, once daily and metformin stable dose, orally, once daily for up to 26 weeks.
TAK-559 placebo-matching tablets, orally, once daily and metformin stable dose, orally, once daily for up to 26 weeks.
Change from baseline in glycosylated hemoglobin.
Time frame: Final Visit.
Change from baseline in glycosylated hemoglobin.
Time frame: Weeks 2, 4, 8, 12, 16 and 20
Change from baseline in fasting plasma glucose.
Time frame: Weeks 2, 4, 8, 12, 16, 20 and Final Visit
Change from baseline in serum insulin.
Time frame: Weeks 4, 12, 16, 20 and Final Visit.
Change from baseline in C-peptide.
Time frame: Weeks 4, 12, 16, 20 and Final Visit.
Change from baseline in triglycerides.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in total cholesterol.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in high-density lipoprotein.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in low-density lipoprotein.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in very-low-density lipoprotein.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in apolipoproteins A1 and B 100.
Time frame: Final Visit
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Change from baseline in free fatty acids.
Time frame: Weeks 12, 16, 20 and Final Visit.
Change from baseline in thrombosis marker plasminogen activator inhibitor-1
Time frame: Weeks 4, 12, 16, 20 and Final Visit
Change from baseline in thrombosis marker fibrinogen.
Time frame: Weeks 4, 12, 16, 20 and Final Visit
Change from baseline in inflammation marker Interleukin-6.
Time frame: Weeks 4, 12, 16, 20 and Final Visit
Change from baseline in inflammation marker C-reactive protein.
Time frame: Weeks 4, 12, 16, 20 and Final Visit
Change from baseline in urinary albumin to creatinine ratio.
Time frame: Weeks 12, 16, 20 and Final Visit