Our goal of the study is to learn the effects of the diabetes medication named Pioglitazone, in type-2 diabetic obese participants with Heart failure. The main question it aims to answer are: 1. To demonstrate that impaired mitochondrial function leading to reduced ATP generation plays a key pathophysiologic role in the development of heart failure with preserved ejection fraction (HFpEF) in obese type 2 diabetic (T2D) individuals. 2. To demonstrate that pioglitazone, improves diastolic (as well as systolic) function by improving myocardial insulin sensitivity and by reducing both myocardial and epicardial fat content.



Eligible Ages
Between 30 Years and 70 Years
Eligible Genders
Accepts Healthy Volunteers

Inclusion Criteria

  1. Provision of signed and dated informed consent form 2. Stated willingness to comply with all study procedures and availability for the duration of the study 3. Male or female, aged 30-70 years 4. Body Mass Index (BMI) of 27.5-40kg/m² 5. HbA1c of 6.5 to 10% 6. Blood pressure of less than or equal to 145/65mmHg 7. eGFR greater than 45 ml/min/1.73m² 8. Subject must have HFpEF (EF > 50% by ECHO screening) 9. NYHA class II-III heart failure 10. Only T2D patients treated with diet/exercise, metformin, sulfonylurea, metformin/SU, DPP4i or insulin will be studied. 11. For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation and for an additional [4 weeks] after the end of study participation. 12. For males of reproductive potential: use of condoms or other methods to ensure effective contraception with partner.

Exclusion Criteria

  1. Subjects with history of osteoporosis or proliferative diabetic retinopathy 2. Subjects with Heart failure due to restrictive or infiltrative cardiomyopathy, active myocarditis, constrictive pericarditis, severe valvular heart disease, etc. will be excluded 3. Patients with symptomatic coronary artery disease. 4. Subjects with significant change in diuretic management during the month prior to screening (defined by doubling of diuretic dose, or addition of another HF medication). 5. Subjects treated with a GLP-1 RA or thiazolidinedione. 6. Subjects treated with a SGLT2i 7. Pregnancy or lactation 8. Known allergic reactions to components of the study interventions. 9. Any metal plates, parts, screws, shrapnel, pins in body, or cardiac (heart) pacemaker

Study Design

Phase 4
Study Type
Intervention Model
Parallel Assignment
Intervention Model Description
double-blind placebo controlled, randomized clinical trial
Primary Purpose
Triple (Participant, Care Provider, Investigator)
Masking Description
Neither the participant nor the investigator knows what treatment is given

Arm Groups

ArmDescriptionAssigned Intervention
Active Comparator
Pioglitazone Administration Group
Pioglitazone 15mg/day titrated to 30 mg/day at week 2 and to 45 mg/day at week 4
  • Drug: Pioglitazone
    Participants will be taking Pioglitazone tablets 1/day for 24 weeks.
    Other names:
    • Actos
Placebo Comparator
Placebo/Control Group
  • Drug: Placebo
    Placebo for Pioglitazone
    Other names:
    • Placebo tablet

Recruiting Locations

Texas Diabetes Institute/UH
San Antonio, Texas 78229-3900
Ralph DeFronzo, MD

More Details

The University of Texas Health Science Center at San Antonio

Study Contact

Sivaram Neppala, MD

Detailed Description

Either Pioglitazone or Placebo Pioglitazone will be administered during this study in this Type 2 Diabetic population with Heart Failure to examine if there are any beneficial effects on diastolic and systolic function. Myocardial blood flow (MBF) is measured using a PET scan, then participants will be randomized to pioglitazone or a placebo to examine the effects of the study drug on the effects on the systolic and diastolic function of the heart. In addition, myocardial insulin sensitivity change will be measured as well as myocardial fat content. The ratio of ATP: PCr will also be measured.


Study information shown on this site is derived from ClinicalTrials.gov (a public registry operated by the National Institutes of Health). The listing of studies provided is not certain to be all studies for which you might be eligible. Furthermore, study eligibility requirements can be difficult to understand and may change over time, so it is wise to speak with your medical care provider and individual research study teams when making decisions related to participation.