Effects of ROSIglitazone on Inflammatory Markers and Adipokines in Diabetic Patients Using an Angiotensin Receptor Blocker (TELmisartan) - The ROSITEL Study
Information source: Canadian Cardiovascular Research Network
ClinicalTrials.gov processed this data on August 20, 2015
Link to the current ClinicalTrials.gov record.
Condition(s) targeted: Type 2 Diabetes Mellitus
Intervention: rosiglitazone (Drug); metformin or sulfonylurea (Drug)
Sponsored by: Canadian Cardiovascular Research Network
Official(s) and/or principal investigator(s):
Milan K Gupta, MD, Principal Investigator, Affiliation: Partners Research
The purpose of the ROSITEL study is to assess the effects of rosiglitazone, as compared to
standard oral therapies for diabetes (metformin/sulfonylurea), on inflammatory markers and
adipokine levels in diabetic patients using an angiotensin receptor blocker (ARB).
We hypothesize that ARB-treated diabetic patients receiving rosiglitazone will experience
greater reductions in vascular inflammation and levels of leptin and resistin, associated
with increased adiponectin levels, compared to a metformin/sulfonylurea regimen, and that
these benefits will result in part, from greater improvements in insulin sensitivity in the
Official title: Effects of ROSIglitazone on Inflammatory Markers and Adipokines in Diabetic Patients Using an Angiotensin Receptor Blocker (TELmisartan) - The ROSITEL Study
Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
Primary outcome: Change in adiponectin level in the rosiglitazone vs. metformin/sulfonylurea arms
Secondary outcome: Secondary end-points include changes in leptin, resistin, hs-CRP, IL-6, MMP-9, ICAM-1, insulin sensitivity (as estimated by the HOMA technique), HbA1c, and lipid levels in the rosiglitazone vs. metformin/sulfonylurea arms
Type 2 diabetes is a chronic and progressive disease that is strongly associated with
all-cause and cardiovascular mortality. The United Kingdom Prospective Diabetes Study
(UKPDS) demonstrated that glycemic control alone only modestly reduces the risk of
macrovascular disease among type 2 diabetic patients . Insulin resistance, which has been
identified as an important underlying or associated factor in the pathogenesis of type 2
diabetes, is the main proposed mechanism responsible for the accelerated atherosclerosis
noted in this population.
Evidence continues to accumulate supporting the role of chronic subclinical vascular
inflammation as a central component in the development of atherosclerosis, insulin
resistance and type 2 diabetes. Markers of subclinical inflammation, in particular
C-reactive protein (CRP) and interleukin-6 (IL-6), have been shown to be independent
predictors of both diabetes and cardiovascular risk. More recently, the visceral adipocyte
has been recognized to produce a number of metabolically and hormonally active substances,
collectively called adipokines. The adipokine adiponectin may have antiatherogenic and
anti-inflammatory properties. High levels of adiponectin seem to be associated with
protection against type 2 diabetes and atherosclerosis via anti-inflammatory pathways.
Unlike adiponectin, leptin and resistin are examples of adipokines that seem to be
associated with the development of both atherosclerosis and insulin resistance.
Rosiglitazone is a thiazolidinedione drug that is approved for the treatment of type 2
diabetes. As a nuclear peroxisome proliferator-activated receptor-γ agonist, rosiglitazone
reduces insulin resistance, thereby sensitizing the liver, muscle, and adipose tissue to the
actions of circulating insulin. Treatment with rosiglitazone has been demonstrated to
favourably modify levels of inflammatory biomarkers and adipokines, to attenuate endothelial
dysfunction, and to reduce coronary events following percutaneous coronary intervention.
Diabetes and hypertension co-exist in approximately 75% of patients and this combination
synergistically augments cardiovascular risk. In fact, blood pressure control seems to be
of greater importance in the prevention of macrovascular disease than is glycemic control.
Therefore, in patients with diabetes, dual targeting of insulin resistance and blood
pressure is essential to reduce overall atherosclerotic risk. Recent evidence suggests that
angiotensin receptor blockers (ARB) in addition to their antihypertensive efficacy may
directly improve insulin sensitivity. These unique attributes of ARB's may prove
particularly beneficial when combined with an insulin sensitizer, such as rosiglitazone, in
the treatment of diabetic patients.
The rationale therefore of the ROSITEL study is to compare the effects of rosiglitazone to
usual therapy on adipokine levels, inflammatory markers, and insulin sensitivity in
ARB-treated diabetic patients with suboptimal glycemic control.
Minimum age: 40 Years.
Maximum age: 80 Years.
- Type 2 diabetes
- Hemoglobin A1c (HbA1c) level greater or equal to 0. 075
- Treatment naïve (no current oral anti-diabetic therapy) or on monotherapy with
either metformin or any sulfonylurea
- Must meet one of the following:
- Already on an angiotensin receptor blocker (ARB for hypertension and/or
- If not on an ARB: SBP>129 mm Hg and/or DBP >79 mm Hg And/Or albumin to
creatinine ratio (ACR) > 2. 0 mg/mmol in men or > 2. 8 mg/mmol in women
- Women who are pregnant, breast feeding, or not using a reliable method of
- Clinical signs of congestive heart failure or measured left ventricular ejection
- Hemodynamically significant valvular heart disease or hypertrophic obstructive
- Insulin-dependent diabetes mellitus
- Use of any PPAR-ỵ agonist (Rosiglitazone or Pioglitazone)
- Renal dysfunction (creatinine > 1. 8 x ULN)
- Hepatic disease (liver function test >1. 5 x ULN [upper limit normal])
- Other significant laboratory abnormalities that the investigator feels may compromise
the patient's safety by participation in the study
- History of systemic inflammatory disease (rheumatoid arthritis, inflammatory bowel
disease, systemic lupus erythematous), myositis/myopathic process, or cancer)
- Use of steroids or chemotherapy drugs within the past year or chronic use of
nonsteroidal anti-inflammatory drugs besides aspirin (use for > 2 weeks within the
- Patients on potassium sparing-diuretics
- Treatment with excluded medications prior to or at the time of randomization
- Known hypersensitivity to Rosiglitazone, or ARB's
- Participation in another clinical study concurrently or within the 30-day phase prior
to screening for entry into the present study
- Unwilling to provide written informed consent for study participant and/or
- Unreliability as a study participant as based on the investigator's prior knowledge
of the patient, such as the inability or willingness to participate in or complete
the study or the presence of concurrent physical or psychological disorders that may
make it impractical for the patient to participate in or complete the study.
Locations and Contacts
Partners Research, Brampton, Ontario L6V 1B4, Canada
Starting date: April 2006
Last updated: November 24, 2010