Liver and Metabolic Effects of Insulin Pump Therapy in Diabetics Type 2 with Non-alcoholic Hepatic Steatosis (STEATO-POMPE)

Nantes University Hospital (NUH)

Status

Completed

Conditions

Type 2 Diabetes (T2D)

Treatments

Procedure: Multi-injection treatment ( MDI ).

Procedure: Insulin pump therapy

Study type

Interventional

Funder types

Other

Identifiers

NCT04270656

RC19_0449

Details and patient eligibility

About

The prevalence of fatty liver disease (NAFLD: Non-Alcoholic Fatty Liver Disease or to a more severe degree NASH: Non-Alcoholic SteatoHepatitis) reached 40-70% in subjects with type 2 diabetes (T2D). NAFLD can be easily detected by performing a hepatic ultrasonography. The presence of a NAFLD is positively correlated with the severity of insulin resistance and dysglycemia in this population. The presence of NAFLD worsens the prognosis of T2D with an increased cardiovascular risk. This hepatic impairment would also increase the risk of microvascular complications, especially nephropathy. Conversely, T2D increases the risk of transition from NAFLD to NASH and then to hepatic fibrosis and its related complications (cirrhosis, hepatocellular carcinoma). The risk of progression of liver steatosis to fibrosis is also more important as diabetes and insulin resistance are more severe.

In addition to diabetes and insulin resistance, other risk factors are associated with more severe liver damage such as changes in microbiota. Indeed, it has already been described a smaller amount of bacteroides in the microbiota of subjects with T2D and the most severe hepatic impairment. The treatment of NAFLD/NASH is poorly codified without approved drugs in this indication, while many phase 3 trials with candidate drugs are undergoing. Life-style measures (physical activity and low carbohydrate/calorie diet) can limit the progression from NAFLD to more severe liver fibrosis. Some bariatric surgery studies have also shown good results in this situation. Pharmacological interventions are also reported with proven efficacy of pioglitazone, vitamin E and orlistat.

The OPT2MISE study has recently shown the superiority of insulin pump (or continuous sub-cutaneous insulin infusion: CSII) compared to multiple daily insulin injections (MDI) to improve glycemic control in a population of patients with T2D in failure of well-titrated MDI. In addition, treatment with CSII showed a 45% decrease in insulin resistance (assessed by HOMA-IR) in a population of newly diagnosed T2D.

In light of these data, investigators hypothesize that the introduction of insulin pump treatment in a population of subjects with T2D and NAFLD, by improving insulin sensitivity, could reduce fatty liver content compared to standard MDI treatment.

Enrollment

46 patients

Sex

All

Ages

37 to 70 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Male / female 35/70 years (including ranges) with T2D ≥ 1 year
Benefiting from the indication of use of the free Freestyle glucose meter
Treatment with multi-injection insulin therapy comprising a daily injection of basal insulin (Glargine U100, Glargine U300, Degludec) and at least 2 daily injections of an insulin analogue (lispro, aspart or glulisine) +/- metformin, dipeptidyl peptidase-4 (DPP4) and/or sodium-glucose cotransporter type 2 (SGLT2) at a dose stable for at least 3 months.
For women of childbearing age, oestro-progestative pill, IUD, implant.
11% ≥ HbA1c ≥ 6.5%
Presence of hepatic steatosis according to the ultrasonography
Absence of chronic alcoholic intoxication
Absence of chronic viral hepatitis or other chronic liver diseases (eg hemochromatosis ...)

Exclusion criteria

Type 1 diabetes
Contraindication to pump treatment
Treatment with anti-diabetics or other than metformin, dipeptidyl peptidase-4 (DPP4) and/or sodium-glucose cotransporter type 2 (SGLT2)
Treatment with basal inulin of Levemir
Contraindication to performing MRI
Chronic alcohol abuse (after alcohol consumption> 20g / day in men and> 10g / day in women) according to the medical examination
Chronic viral hepatitis based on HBV and HCV serology results
Hemochromatosis according to the martial assessment
Other toxic or drug hepatitis
Severe hepatic pathology: hepatic cirrhosis, hepatocellular carcinoma
Severe renal insufficiency (MDRD <30 ml / min)
Severe and progressive cardiovascular pathology
Treatment (permanent or intermittent) with glucocorticoids
Treatment known to improve hepatic steatosis (glitazone, vitamin E, orlistat)
history or bariatric surgery project for the duration of the study
Drug treatment likely to cause hepatic steatosis (amiodarone, carbamazepine, tamoxifen, valproate, clozapine, anti-retroviral drugs) unless the dose has been stable for ≥ 3 months
Guardianship, curatorship or safeguard of justice