Abstract
The results of randomised controlled clinical trials in humans provide robust evidence to guide clinical practice. Such trials related to the treatment of lipoprotein levels in people with diabetes mellitus have contributed to clinical practice guidelines and to the improved clinical outcomes observed in recent years. Randomised controlled trials (RCTs) are often suggested and informed by epidemiology, cross-sectional studies and preclinical studies, and their results can also guide novel basic science research. RCTs are major undertakings in effort, time and cost; hence their careful design, conduct and interpretation are important. Terms such as the phases of clinical research, types of statistical errors and Hawthorne effect are defined. Important study design issues such as subject selection, sample size and randomisation, the choice of study end points and the potential confounding effects of metabolic memory and drug pleiotropic effects are also considered. References to major sources of further information are also provided in this chapter.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
The Adolescent type 1 Diabetes cardio-renal Intervention Trial Research Group. Adolescent type 1 diabetes cardio-renal intervention trial (AdDIT). BMC Pediatr. 2009;9:79.
Gebski V, Beller E, Keech A, Ven Der Weyden M. In: Keech A, Gebski V, Pike R. Interpreting and reporting clinical trials: a guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: Australasian Medical Publishing Company; 2007. Chapter 1.
The Scandinavian Simvastatin Survival Study (4S) group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344(8934):1383–9.
Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH, CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004;364(9435):685–96.
Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR, Forder P, Pillai A, Davis T, Glasziou P, Drury P, Kesaniemi YA, Sullivan D, Hunt D, Colman P, d'Emden M, Whiting M, Ehnholm C, Laakso M. FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet. 2005; 366(9500):1849–61. Erratum in: Lancet. 2006 Oct 21; 368(9545):1415. Lancet. 2006 Oct 21;368(9545):1420. PubMed PMID: 16310551.
ACCORD Study Group, Ginsberg HN, Elam MB, Lovato LC, Crouse 3rd JR, Leiter LA, Linz P, Friedewald WT, Buse JB, Gerstein HC, Probstfield J, Grimm RH, Ismail-Beigi F, Bigger JT, Goff Jr DC, Cushman WC, Simons-Morton DG, Byington RP. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1563–74.
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 20,536 high-risk individuals: randomised placebo-controlled trial. Lancet. 2002;360:7–22.
Keech A, Gebski V. Interpreting and reporting clinical trials: a guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: Australasian Medical Publishing Company; 2007. Chapter 3, pg 12.
Beller E, Gebski V, Keech A. Interpreting and reporting clinical trials: A guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: Australasian Medical Publishing Company; 2007. Chapter 8.
Forder P, Gebski V, Keech A. Interpreting and reporting clinical trials: a guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: Australasian Medical Publishing Company; 2007. Chapter 9.
AIM-HIGH Investigators. The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated low-density lipoprotein cholesterol rationale and study design. The atherothrombosis intervention in metabolic syndrome with low HDL/high triglycerides: impact on global health outcomes (AIM-HIGH). Am Heart J. 2011;161(3):471–7.
Rajamani K, Colman PG, Li LP, Best JD, Voysey M, D’Emden MC, Laakso M, Baker JR, Keech AC, on behalf of the FIELD study investigators. Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial. Lancet. 2009;373(9677):1780–8.
French JRP. Field experiments: changing group productivity. In: Miller JM, editor. Experiments in social process: a symposium on social psychology. New York, NY: McGraw-Hill; 1950. p. 82.
Jenkins AJ, Best JD, Klein RL, Lyons TJ. 'Lipoproteins, glycoxidation and diabetic angiopathy'. Diabetes Metab Res Rev. 2004;20(5):349–68.
Jenkins AJ, Rowley KG, Lyons TJ, Best JD, Hill MA, Klein RL. Lipoproteins and diabetic microvascular complications. Curr Pharm Des. 2004;10(27):3395–418.
Sóter MO, Gomes KB, Fernandes AP, Md C, Pinheiro PS, Bosco AA, Silva DD, Sousa MO. -1131T>C and SW19 polymorphisms in APOA5 gene and lipid levels in type 2 diabetic patients. Mol Biol Rep. 2012;39(7):7541–8.
Deshmukh HA, Colhoun HM, Johnson T, McKeigue PM, Betteridge DJ, Durrington PN, Fuller JH, Livingstone S, Charlton-Menys V, Neil A, Poulter N, Sever P, Shields DC, Stanton AV, Chatterjee A, Hyde C, Calle RA, Demicco DA, Trompet S, Postmus I, Ford I, Jukema JW, Caulfield M, Hitman GA, CARDS, ASCOT, and PROSPER Investigators. Genome-wide association study of genetic determinants of LDL-c response to atorvastatin therapy: importance of Lp(a). J Lipid Res. 2012;53(5):1000–11.
Villeneuve LM, Reddy MA, Natarajan R. Epigenetics: deciphering its role in diabetes and its chronic complications. Clin Exp Pharmacol Physiol. 2011;38(7):451–9.
Saremi A, Nelson RG, Tulloch-Reid M, Hanson RL, Sievers ML, Taylor GW, Shlossman M, Bennett PH, Genco R, Knowler WC. Periodontal disease and mortality in type 2 diabetes. Diabetes Care. 2005;28(1):27–32.
Strong JP, Malcom GT, Newman 3rd WP, Oalmann MC. Early lesions of atherosclerosis in childhood and youth: natural history and risk factors. J Am Coll Nutr. 1992;11:51S–4.
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.
White NH, Sun W, Cleary PA, Danis RP, Davis MD, Hainsworth DP, Hubbard LD, Lachin JM, Nathan DM. Prolonged effect of intensive therapy on the risk of retinopathy complications in patients with type 1 diabetes mellitus: 10 years after the diabetes control and complications trial. Arch Ophthalmol. 2008;126(12):1707–15.
Holman RR, Paul SK, Bethel MA, Neil HA, Matthews DR. Long-term follow-up after tight control of blood pressure in type 2 diabetes. N Engl J Med. 2008;359(15):1565–76.
Jermendy G. Vascular memory: can we broaden the concept of the metabolic memory? Cardiovasc Diabetol. 2012;11(1):44.
Pedersen TR, Wilhelmsen L, Faergeman O, Strandberg TE, Thorgeirsson G, Troedsson L, Kristianson J, Berg K, Cook TJ, Haghfelt T, Kjekshus J, Miettinen T, Olsson AG, Pyörälä K, Wedel H. Follow-up study of patients randomized in the Scandinavian simvastatin survival study (4S) of cholesterol lowering. Am J Cardiol 2000;86:257–62.
Bulbulia R, Bowman L, Wallendszus K, Parish S, Armitage J, Peto R, Collins R for the Heart Protection Study. Effects of 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20536 high-risk individuals: a randomised controlled trial. Lancet 2011;378;2013–2020.
Ford I, Murray H, Packard CJ, Shepherd J, MacFarlane PW, Cobbe SM, for the West of Scotland Coronary Prevention Study Group. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Eng J Med 2007;357;1477–1486.
Sever PS, Chang CL, Gupta AK, Whitehouse A, Poulter NR. ASCOT Investigators. The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the UK. Eur Heart J 2011;32:2525–32.
Sjølie AK, Klein R, Porta M, Orchard T, Fuller J, Parving HH, Bilous R, Aldington S, Chaturvedi N. Retinal microaneurysm count predicts progression andregression of diabetic retinopathy. Post-hoc results from the DIRECT Programme. Diabet Med. 2011;28(3):345–51.
Perkins BA, Ficociello LH, Silva KH, Finkelstein DM, Warram JH, Krolewski AS. Regression of microalbuminuria in type 1 diabetes. N Engl J Med. 2003;348(23):2285–93.
Halimi JM. The emerging concept of chronic kidney disease without clinical proteinuria in diabetic patients. Diabetes Metab. 2012;38(4):291–7. doi: 10.1016/j.diabet.2012.04.001. Epub 2012 May 22. Review. PubMed PMID: 22622176.
Rigalleau V, Beauvieux MC, Gonzalez C, Raffaitin C, Lasseur C, Combe C, Chauveau P, De la Faille R, Rigothier C, Barthe N, Gin H. Estimation of renalfunction in patients with diabetes. Diabetes Metab. 2011;37(5):359–66.
Tsmikas S, Shortal BP, Witztum JL, Palinski W. In vivo uptake of radiolabeled MDA2, an oxidation specific monoclonal antibody, provides an accurate measure of atherosclerotic lesions rich in oxidized LDL and is highly sensitive to their regression. Arterioscler Thromb Vasc Biol. 2000;20:689–97.
Jenkins AJ, Rothen M, Klein RL, Moller K, Eldridge L, Zheng D, Durazo-Arvizu R, McGee D, Lackland D, Thorpe SR, Garvey WT, Lyons TJ, DCCT/EDIC Research Group. Cross-sectional associations of C-reactive protein with vascular risk factors and vascular complications in the DCCT/EDIC cohort. J Diabetes Complications. 2008;22(3):153–63.
Lopes-Virella MF, Carter RE, Gilbert GE, Klein RL, Jaffa M, Jenkins AJ, Lyons TJ, Garvey WT, Virella G, Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications Cohort Study Group. Risk factors related to inflammation and endothelial dysfunction in the DCCT/EDIC cohort and their relationship with nephropathy and macrovascular complications. Diabetes Care. 2008;31(10):2006–12.
Florentin M, Liberopoulos EN, Kei A, Mikhailidis DP, Elisaf MS. Pleiotropic effects of nicotinic acid: beyond high density lipoprotein cholesterol elevation. Curr Vasc Pharmacol. 2011;9(4):385–400.
Mihos CG, Salas MJ, Santana O. The pleiotropic effects of the hydroxy-methyl-glutaryl-CoA reductase inhibitors in cardiovascular disease: a comprehensive review. Cardiol Rev. 2010;18(6):298–304.
Foucher C, Brugère L, Ansquer JC. Fenofibrate, homocysteine and renal function. Curr Vasc Pharmacol. 2010;8(5):589–603.
Keech AC, Mitchell P, Summanen PA, O'Day J, Davis TM, Moffitt MS, Taskinen MR, Simes RJ, Tse D, Williamson E, Merrifield A, Laatikainen LT, d'Emden MC, Crimet DC, O'Connell RL, Colman PG, FIELD study investigators. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet. 2007;370(9600):1687–97.
Davis TM, Ting R, Best JD, Donoghoe MW, Drury PL, Sullivan DR, Jenkins AJ, O'Connell RL, Whiting MJ, Glasziou PP, Simes RJ, Kesäniemi YA, Gebski VJ, Scott RS, Keech AC, on behalf of the FIELD Study investigators. Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the fenofibrate intervention and event lowering in diabetes (FIELD) study. Diabetologia. 2011;54(20):280–90.
Keech AC, Pike R, Granger R, Gebski V. Interpreting the results of a clinical trial (Chapter 20). In: Keech AC, Gebski VJ, Pike R, editors. Interpreting and reporting clinical trials: a guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: AMPCo. 2007;143–148
Note for guidance on good clinical practice (CPMP/ICH/135/95). ICH topic E6. European Agency for the Evaluation of Medicinal Products, 2002.
World Health Organization. International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health Organization; 1992.
International Conference on Harmonization. Medical dictionary for regulatory activities (MedDRA); 2003.
World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. Helsinki: World Medical Association; 2000.
Barter PJ, Caulfield M, Eriksson M, Grundy SM, Kastelein JJ, Komajda M, Lopez-Sendon J, Mosca L, Tardif JC, Waters DD, Shear CL, Revkin JH, Buhr KA, Fisher MR, Tall AR, Brewer B, ILLUMINATE Investigators. Effects of torcetrapib in patients at high risk for coronary events. N Engl J Med. 2007;357(21):2109–22.
ACCORD Study Group, ACCORD Eye Study Group, Chew EY, Ambrosius WT, Davis MD, Danis RP, Gangaputra S, Greven CM, Hubbard L, Esser BA, Lovato JF, Perdue LH, Goff Jr DC, Cushman WC, Ginsberg HN, Elam MB, Genuth S, Gerstein HC, Schubart U, Fine LJ. Effects of medical therapies on retinopathy progression in type 2diabetes. N Engl J Med. 2010;363(3):233–44.
Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R, SHARP Investigators. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (study of heart and renal protection): a randomised placebo-controlled trial. Lancet. 2011;377(9784):2181–92.
www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm204882.htm. FDA alert 28 Feb 2011.
Jones PH, Davidson MH. Reporting rate of rhabdomyolysis with fenofibrate + statin versus gemfibrozil + any statin. Am J Cardiol. 2005;95(1):120–2.
Sandhu S, Al-Sarraf A, Taraboanta C, Frohlich J, Francis GA. Incidence of pancreatitis, secondary causes, and treatment of patients referred to a specialty lipid clinic with severe hypertriglyceridemia: a retrospective cohort study. Lipids Health Dis. 2011;10:157.
Cholesterol Treatment Trialists' (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670–81.
Cholesterol Treatment Trialists’ Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, Peto R, Armitage J, Baigent C. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117–25.
Scott R, O'Brien R, Fulcher G, Pardy C, d'Emden M, Tse D, Taskinen MR, Ehnholm C, Keech A, on behalf of the FIELD Study Investigators. The effects of fenofibrate treatment on cardiovascular disease risk in 9795 people with type 2 diabetes and various components of the metabolic syndrome: the FIELD study. Diabetes Care. 2009;32(3):493–8.
Robert PG, Nihar RD, Payal K, William JR, Ransi S, Fannie H, Thomas L, Satishkumar M, Elaine BH, Shannon TM, Timothy EA, Scott MW, Robert S, Marc SS. For the LAPLACE-TIMI 57 Investigators, Efficacy, safety, and tolerability of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 in combination with a statin in patients with hypercholesterolemia (LAPLACE-TIMI 57): a randomized, placebo-controlled, dose-ranging, phase 2 study. The Lancet 2012;380(9858, 8–14):2007–2017.
Stein EA, Gipe D, Bergeron J, Gaudet D, Weiss R, Dufour R, Wu R, Pordy R. Effect of a monoclonal antibody to PCSK9, REGN727/SAR236553, to reduce low-density lipoprotein cholesterol in patients with heterozygous familial hypercholesterolaemia on stable statin dose with or without ezetimibe therapy: a phase 2 randomised controlled trial. Lancet 2012;380:29–36.
Keech A, Gebski V, Pike R. Interpreting and reporting clinical trials: a guide to the CONSORT statement and the principles of randomised controlled trials. Sydney: Australasian Medical Publishing Company; 2007.
Liu MB, Davis K. A clinical trials manual from the Duek Clinical Research Institute. Lessons from a horse named Jim. 2nd ed. Oxford. UK: Wiley-Blackwell; 2010.
Acknowledgements
The Clinical Trials Centre is partly supported by funding from the Australian National Health and Medical Research Council.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Keech, A., Jenkins, A.J., Gebski, V. (2014). About Randomised Clinical Trials Related to Lipoproteins in Diabetes Mellitus. In: Jenkins, A., Toth, P., Lyons, T. (eds) Lipoproteins in Diabetes Mellitus. Contemporary Diabetes. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4614-7554-5_17
Download citation
DOI: https://doi.org/10.1007/978-1-4614-7554-5_17
Published:
Publisher Name: Humana Press, New York, NY
Print ISBN: 978-1-4614-7553-8
Online ISBN: 978-1-4614-7554-5
eBook Packages: MedicineMedicine (R0)